Strangulation and Suffocation
· Airway and breathing-related injuries fatal. Several such incidents involving
occur less frequently than other injury children between one and 10 years of age
causes, but are often fatal1. have been reported around the world. The
European Commission has published a
· Choking is defined as blockage of the Decision requiring magnetic toys to dis-
airway due to round and cylinder shaped play a specific warning about the safety
food products such as candies, nuts, risks and it is anticipated that this issue
grapes and also non-food products such will be covered by an amendment to the
as coins, buttons, small toy parts, under- Toy Safety Directive5.
sized pacifiers, uninflated latex balloons
and inedibles in food products. · Children placed in adult beds are at in-
creased risk for airway obstruction injury.
· Suffocation is defined as death due to In the United States for example since
oxygen deprivation from external causes 1990 at least 296 children aged 2 and
like plastic bags, entrapment in sealed under have died in adult beds as a result
containers (i.e. toy chest) and spaces2. of entrapment in the bed structure7. Dur-
ing this same period at least 57 children,
nearly all aged 3 and under, have died
· Strangulation is defined as death due to
due to entrapment in bunk beds alone.
lack of oxygen from pressure on the
Additionally, 209 children in this age group
trachea from items such as clothing draw-
died in adult beds from suffocation as a
strings, crib bars, window blinds and
result of being covered by another per-
· In England and Wales, 61 children died in
· Strangulation is the leading cause of
a two-year period due to choking, strangu-
deaths on playgrounds and deaths have
lation or suffocation, with the majority
been related to both playground equip-
being boys, under 3 years of age3. A
ment design and as a result of cords and
further 5,000 children aged 15 or under
drawstrings on children's clothing getting
were brought to accident and emergency
caught in the equipment9. Since 2007
units in the United Kingdom because of
there have been onerous restrictions on
choking, with the majority of these injuries
the use of cords and drawstrings on
occurring in the home3.
children’s clothing in the European Union
to address this risk6.
· Studies in Greece, Germany and Israel all
confirm that food products containing
· The total annual cost of airway obstruction
inedibles are inherently unsafe and that
injury among children ages 14 and under
labelling is not an adequate protection. It
in the United States is estimated to be
is estimated that 2,000 injuries occur
nearly $3.7 billion. Children aged 4 and
annually in the European Union due to
under account for more than 78% of these
inedibles in food products alone4.
· It has been identified that four main prod-
uct characteristics should be considered
when evaluating products for safety: size/ The following product requirements, modifi-
diameter, compressibility, flexibility and cations and legislation have proved to be
configuration2. Another factor that has successful in reducing deaths from choking,
emerged as potentially dangerous is suffocation and strangulation:
· Warning labels - labels placed on prod-
· Recently there have been a number of ucts that explain the hazard, not just a
accidents and incidents happening with label stating “for children aged 3 years
children swallowing small toy magnets. and up”, have raised carers’ awareness of
They pose a risk to the health and safety the dangers they pose8.
of children as they are made of small and
often powerful magnetic pieces. If more · Product bans – the United Kingdom
than one piece is swallowed the magnetic banned clothing drawstrings in 1976 and
pieces can be attracted to each other and no known deaths from drawstring-related
cause twisted/knotted intestines, intestinal injuries have been reported since then9.
perforation or blockage which may be Thus regulations and/or standards that
restrict cords or drawstrings on clothing · For the European Commission to ban
and inedibles in food products are effec- latex balloons, inedibles in food products
tive in reducing hazards. and drawstrings in clothing.
· Product modification – product require- · For the European Commission to adopt a
ments for slat spacing for crib designs, mandatory standard for bunk beds to
balconies, and outdoor fencing have been address entrapment hazards. The stan-
effective in reducing strangulation. But dard would restrict opening sizes, require
older crib models that do not meet the guardrails and specify company identifica-
requirements need to be removed from tion and age-specific warning labels to be
homes and not passed to other families, present on all new bunk beds.
especially immigrants and poorer families
purchasing used cribs2. Another issue is · For the European Commission to adopt,
the need to lower the minimum force as a mandatory standard, the EN 1176
required to open a lid or door to a sealed series of standards relating to playground
container in order to allow children to equipments and surfacing.
escape when trapped (i.e., lids on toy
boxes)2. EU Collaboration
· Product safety commission – National · For the European Commission to support
consumer safety organisations in Europe an educational campaign to the public
have improved the safety of consumer regarding safety practices to prevent
products in their country. In the United choking, suffocation and strangulation
States it is estimated that the work done injuries in children.
by the Consumer Product Safety Commis-
sion has contributed to a 30 percent
· For the European Commission to estab-
decline in the rate of deaths and injuries
lish a European Product Safety Commis-
associated with consumer products over
sion whose purpose would be to provide a
the past 30 years11.
clearinghouse of child product safety
information for consumers and a hotline
Recommended Policy Actions for consumers to report unsafe products
and to ensure the collection and review of
data on product related injury incidents to
assess the need for product recalls.
· For the European Commission to improve
the requirements relating to warning labels
placed on products so that labels explain · For the European Commission and Mem-
the hazard in addition to identifying it. ber States to support a Europe-wide
surveillance system for injury data related
to product involvement on a population
· For the European Commission to adopt a level that is accessible online and updated
mandatory standard to lower the minimum monthly.
force that is required to open a lid or door
to any toy or container that a child can
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The European Child Safety Alliance is a Programme of EuroSafe and is hosted by the Consumer Safety Institute in the Netherlands
PO Box 75169 1070 AD Amsterdam The Netherlands Tel. +31 20 511 45 13 Fax +31 20 511 45 10