A young boy from Limerick suffered fatal brain damage after choking on a cocktail sausage at his home three years ago, an inquest has heard.
Four-year-old Robert Power-O'Meara of Churchfield, O'Malley Park, Limerick, died at Children's Health Ireland in Temple Street, on 20 August 2022.
The boy - who was known as Robbie - had been brought to the hospital for specialist care after originally receiving treatment at University Hospital Limerick, where he had been taken by ambulance.
His mother, Melissa Power, told a sitting of Dublin District Coroner's Court that the incident occurred at their home on 16 August 2022, when she was in the kitchen with Robbie while her older son, Bradley, was upstairs playing on a computer in his bedroom.
Ms Power said Robbie came over to her pointing at his throat while she was standing at the cooker after she had given him sausages and chips.
She knew he had been eating a sausage so she tried putting her finger down his throat to make him get sick to get the food up.
Ms Power, who was accompanied by her partner and Robbie's father, Stephen O'Meara, gave evidence that her son had been on a waiting list to get his tonsils removed at the time.
She explained he had recently completed a two-week course of antibiotics but the swelling had not gone down.
The inquest heard that Robbie had previous issues with choking on various foods.
"By placing my fingers down his throat, we would remove the food," Ms Power observed. "On this occasion, the sausage was not coming up."
She described picking up Robbie and running to her next-door neighbour, John Quinn, who also put his fingers down the child's throat to try to clear the blockage.
Ms Power said she noticed blood coming from her son's throat at that stage so she ran back home to phone an ambulance, while another neighbour, Derek Quaide, also offered assistance.
She told the hearing that the ambulance arrived a few minutes later to bring Robbie to the emergency department in UHL before he was later transferred to CHI at Temple Street.
In reply to questions from coroner Cróna Gallagher, Ms Power said her son was in good form on the day and was not suffering from any infection.
She confirmed that he had been eating a cocktail sausage. "He loved them," she added.
Ms Power said nothing had come out of his mouth in the house.
Asked about previous choking incidents, Ms Power said they had been resolved by either pushing the food down or pulling it up with their fingers without the need to call an ambulance.
She said he had never experienced any difficulty with eating sausages before that incident.
However, Ms Power said that since he was aged two, her son would constantly shove food whole into his mouth and she recalled how they would have to hide things like wine gums from him.
The inquest heard medical records showed that Robbie had been referred earlier that year to see an ear, nose and throat specialist at UHL over concerns about his tonsils and possible sleep apnoea.
The coroner noted a second urgent referral had been made following a visit to his GP, Gerard O'Brien, on 12 July 2022.
However, Ms Power said he had never got to see a specialist and they had torn up an appointment letter they received two weeks after he had died.
The inquest heard that Robbie had no pulse on his arrival at UHL at 7.57pm, but circulation was restored after 45 minutes before a decision was made to transfer him to hospital in Dublin.
Consultant paediatric pathologist John O'Neill said a post-mortem examination showed that although Robbie had enlarged tonsils, there was no evidence that they were obstructing his airway.
Dr O'Neill attributed the cause of death to hypoxic-ischemic encephalopathy (a lack of oxygen and blood to the brain) and herniation of the brain which compressed the brain stem.
He said a contributory factor was encephalitis (inflammation) of the brain stem.
While such inflammation could affect the swallowing function, Dr O’Neill said it could not be proven with certainty in the case of Robbie.
In reply to questions from the coroner, the pathologist said Robbie's swollen tonsils could have had an impact, but again it was not something that could be proven with certainty.
Dr Gallagher expressed surprise that a piece of sausage had been found in Robbie's throat during the autopsy.
However, Dr O'Neill said it was unlikely that it would have been there the whole time and was possible that it had come up from his stomach.
The coroner also noted that sausages appeared to be a type of food that children had difficulty in eating as she was aware of their role in a number of other choking cases.
However, Dr O'Neill said there was the potential for "anyone at any age" to choke with any solid, dense food.
He said there would be no concerns normally about a four-year-old child eating a sausage given their stage of development, while there would be with smaller, younger children.
Returning a verdict of accidental death, Dr Gallagher offered her sympathy to Robbie's parents on what she described as "a very unfortunate accident with such tragic consequences".
The inquest heard that Robbie's kidneys had been donated to save the lives of other children.
