OBJECTIVE: This study was undertaken to identify avoidable, contributing factors associated with non-intentional asphyxiation deaths due to upper airway interference in children 0 to 14 years. DESIGN: Historical population based incidence study. METHODS: All postneonatal and childhood deaths by asphyxiation from 1985 to 1994, using appropriate ICD-9-CM codes, were compiled from the Victorian government legislated paediatric mortality surveillance system. Recent cases were identified from the State Coroner's Office. Case definition included children under 15 years who died from upper airway interference such as facial occlusion, head and neck entrapment, rope or cord strangulation, or foreign body. RESULTS: Of the identified 42 deaths, eight (19%) were caused by a foreign body in the airway, five (12%) were due to facial occlusion, 16 (38%) were due to ropes and similar material (seven were homemade rope swings), and 13 (31%) were caused by entrapment (seven were in cots or beds). The average annual rate for asphyxiation deaths by all causes for children 0 to 14 years was 4.7 million. Infants under 1 year had a rate of 20.1/million, while the rate for 10 to 14 year olds dropped to 2.0/million. CONCLUSION: Rope swings and rope material are inherently dangerous and frequently prove fatal, especially for older children. For infants, environmental factors are important; in particular food and bedding. Prevention strategies need to be developed that include obligatory standards for the design and manufacture of products for children, appropriate labelling and warnings, and education for children, their carers, and health care professionals.
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