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									type=other in-section=views id=masm773217 in-journal=bmj elocation-id=c3458 doi=10.1136/bmj.c3458

Personal View
Accidental strangulation with a Venetian blind cord—a near miss
Mahesh Masand
paediatrician, Dr Gray’s Hospital, Elgin, Moray
  A 22 month old girl was brought to our emergency department after accidental
strangulation with the looped cord of a Venetian blind. The mother had walked into the girl’s
bedroom and found her hanging from the cord. The parents quickly dialled 999 and gave
mouth to mouth breathing until the ambulance crew arrived.
   On arrival in the emergency department the girl had an inspiratory stridor and oxygen
saturation going down to 80%, and she was agitated. She had a petechial rash on her face and
beaded marks (from the beaded cord of the blind) round her neck anteriorly. She was
immediately intubated and stabilised before transfer to our regional paediatric intensive care
unit, where she was ventilated for three days. Discharged home on day 7, she has had no
neurological complications or any other abnormalities. Magnetic resonance imaging of her
head and spine showed no abnormalities.
   The child had been standing on the window sill trying to look out when she probably lost
her footing. She was lucky that her mother had walked into the room in time, maybe within
seconds of strangulation.
   It had never crossed my mind that a looped Venetian blind cord could prove to be such a
risk until I came across this case. The medical literature reports no similar cases from the
United Kingdom, but the lay press and television news have reported some deaths by
accidental strangulation with a Venetian blind cord. One report described how a 2 year old
girl in Scotland died after she climbed up to wave out of her brother’s bedroom window and
slipped, hanging herself by the head in the cord loop.(1) In May 2004 a 23 month old toddler
was strangled in the cord of a window blind in Lichfield; the coroner recorded a verdict of
accidental death due to asphyxiation.(2) Other deaths by strangulation with a blind cord
include that of a 2 year old in 2002 in a remote farmhouse in Moray(3) ; a 2 year old twin in
Fife in 2004(3) ; and deaths in Lanarkshire and Wales in 2007. Earlier this year two children
died by strangulation with window blind cords in Staffordshire.(4) In April 2009 the Irish
Times reported the similar death of a toddler,(5) as did the Herald Sun in September 2009.(6)
In Australia at least 11 children have been accidentally strangled by blind or curtain cords
since 2000.(7)

   With the growing popularity of Venetian blinds the window cord has become a major
contributor to accidental strangulation of infants and toddlers. An adviser from the Royal
Society for the Prevention of Accidents has been quoted as saying, “One or two children die
each year in the UK in this way.”(2) (However, newspaper accounts indicate that at least five
deaths have occurred over the past 12 months.) In a personal communication the Child
Accident Prevention Trust told me that deaths by strangulation from window blinds are
underreported, as official statistics do not readily allow such deaths to be identified.
   Rauchschwalbe and colleagues summarised the US experience of window cord
strangulations of children in a retrospective analysis of death certificates and incident files
compiled by the US Consumer Product Safety Commission from 1981 to 1995.(8) The study
showed a total of 181 deaths from window cord strangulation, a mortality rate of 0.14 per
100<thin>000 persons (93% were aged 3 years or younger). Pull cords on Venetian type
coverings accounted for 86% of documented injuries.
   In a similar study on deaths from asphyxia in England and Wales, Nixon and colleagues
collected data from the Office of Population Censuses and Surveys for the years 1990 and
1991.(9) They identified 136 children, of whom 65% were aged <3 years. Of these deaths,
47 were due to constriction around the neck, and 15 cases were grouped in the category of
deaths due to accidental hanging secondary to ligatures in cots (dummy cords, curtain cords)
and loose cords such as phone cables and blind cords.
   On 12 March 2008 an MP raised the subject in the UK House of Commons after the death
of a 2 year old toddler in his constituency.(10) He asked for the support of other members in
getting tougher government regulations to modify the design of looped cords and to ban the
current design, as has happened in the United States and Australia.(7) In Scotland a sheriff
called for a ban on looped cords in his written judgment after a fatal accident inquiry into the
death of a 2 year old toddler in Menstrie, Clackmannanshire.(1)
   We can’t prevent all such incidents but can at least reduce the chance of their happening.
The industry should redesign the products and take voluntary action urgently. The
government can also use its power under consumer protection legislation to force the industry
to redesign its products. Nowadays warning labels about dangers of strangulation are attached
to blinds, but is that enough? Many homes have old products, and replacing these will take
years. Therefore the need for public awareness is paramount. Parents can, however, look into
various other safety measures, such as shortening or removing loops, installing tie-down
devices that keep loops taut against walls, keeping cords out of reach of children, using a cord
tensioning device or cord pulley on walls, and eliminating climbing hazards by moving

furniture, including cots, beds, and high chairs, away from windows with looped curtain or
blind cords.
   A safer way to raise blinds than looped cords must be found. Survival after hanging
injuries in childhood is uncommon because of the absence of adults. The focus should
therefore be on trying to prevent the hanging from occurring in the first place.
   Survival after hanging injuries in childhood is uncommon because of the absence of
   adults. The focus should therefore be on trying to prevent the hanging from occurring
   in the first place
   1 Child died waving to grandmother. BBC.
   2 Safety call after child strangled. BBC.
   3 Toddler dies in bedroom accident. BBC.
   4 Two children die in unrelated freak accidents after being strangled by window blind
      cords. Daily Mail. www.dailymail.co.uk/news/article-1251148/Two-children-die-
   5 Consumer agency warns over window-blind cords. Irish Times 2009 Apr 28.
   6 Langmiaid A. Two-year-old child accidentally strangled by window blind cord in
      Geelong. Herald Sun. www.heraldsun.com.au/news/two-year-old-child-accidentally-
   7 Office of Consumer and Business Affairs, Government of South Australia. Consumers
      urged to check curtain and blind cords in the home (media release).
   8 Ruchschwalbe R, Mann NC. Pediatric window-cord strangulations in the United States,
      1981-1995. JAMA 1997;277:1696-8.
   9 Nixon JW, Kemp AM, Levene S, Sibert JR. Suffocation and strangulation in childhood
      in England and Wales: epidemiology and prevention. Arch Dis Childhood 1995;72:6-
   10 Banks G. Window blinds. House of Commons official report (Hansard). 12 Mar 2008:
      col 98WH. www.parliament.the-stationery-
   Parental consent obtained.

Cite this as: BMJ 2010;340:c3458


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