TOKYO -- As people have more opportunities to eat rice cakes during the year-end and New Year season in Japan, there are greater concerns for potential accidents in which people choke on rice cakes while eating. Why do such accidents happen and how can we prevent them? And what responses are needed when people choke on rice cakes?

Have soup or a drink before eating rice cakes

According to the Tokyo Fire Department, there were a total of 368 people who were taken to hospitals after choking on rice cakes or other food items over the five-year period between 2019 and 2023. Of them, 333 people, or more than 90%, were those aged 65 or older. By month, the number of people rushed to hospitals due to such reasons ranged between 10 and 29 between February and November, but the figure spiked to 43 in December and 142 in January, during the year-end and New Year season.

An analysis of 2018-2019 data by Japan's Consumer Affairs Agency found that a total of 661 people aged 65 or older died from choking on rice cakes and for other reasons. Of them, 127 cases, or some 20%, occurred during the first three days of January.

People's ability to swallow gradually weakens as they get older. The Tokyo Fire Department advises some points to be careful of when eating rice cakes: slice them into small pieces to make them easier to eat; avoid quickly swallowing them but instead chew them slowly before swallowing; avoid eating rice cakes with no one around as much as possible; have some soup or a drink before eating rice cakes to moisturize your throat (it is dangerous to pour them down with drinks before chewing them well).

Rice cakes' outstanding adhesive property

So why do rice cakes easily get stuck in one's throat? The degree of easiness to swallow food items is assessed by three factors -- hardness, cohesive property and adhesive property -- used as permission standards for "food for people with dysphagia," a type of "food for special dietary uses," set by the Consumer Affairs Agency.

According to research by Nutri Co., a Yokkaichi, Mie Prefecture-based distributor of products to support people with dysphagia, the adhesive property of rice cakes is 3,982 joules per cubic meter, as opposed to 1,116 for Japanese sweet rolled omelette called "datemaki" and 869 for silken soft tofu. The figure for rice cakes is also nearly 100 times as high as that for jelly for people with dysphagia at 42.

According to Nutri spokesperson Ayano Fujimoto, nursing homes tend to avoid serving rice cakes to residents to prevent choking accidents. "Still, residents prefer to eat rice cakes, so we introduce alternative recipes using porridge jelly powder," she said.

Porridge jelly powder is a blend of rice flour and a thickening powder that supports mastication, and when dissolved in boiling water, it produces a jellylike porridge. When cooled and hardened, it can be used as a substitute for rice cakes.

According to Makoto Iwahashi of the sales department of Miyagen Inc., a Wakayama-based distributor of porridge jelly powder, the product "does not have stickiness peculiar to rice cakes, but people can enjoy the flavor of rice cakes as the powder is made of rice. People are pleased with the product as an alternative to rice cakes."

Don't overlook signs of choking

So what should people do if someone nearby chokes on rice cakes?

If a person eating rice cakes suddenly shows a sign of choking by grabbing their throat with their thumb and index finger, or if they turn pale while being unable to speak, it is likely that they are choking on the food.

If they react to your calls and can cough, make them cough as much as possible. If they are unable to cough and are choking, call out for help to those around and ask them to call an ambulance, bring an automated external defibrillator (AED), and quickly remove the object from the person's airway.

If there is no one else around to seek support, people should start removing the foreign object right away before calling an ambulance. To remove the object from the patient's airway, there are two types of responses -- a back blow and an abdominal thrust.

The back blow method is to slap the part between the patient's shoulder blades with the base of the palm several times when the patient is standing or sitting. For an abdominal thrust, a person stands behind the patient and makes a fist with their hands around the patient's navel, thrusting the abdomen by pressuring the part between the pit of the stomach and the navel. As the pressure on the abdomen can hurt internal organs, it is not suitable for pregnant women or infants.

The Tokyo Fire Department's official website (in Japanese) shows videos on first aid for people choking on rice cakes or other food items.

(Japanese original by Hisako Sugita, Digital News Group)