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Suffocation & Choking Safety

  • Each year since 1999, an average of 970 children ages 14 and under died from unintentional suffocation.
  • In 2008, 1,294 children ages 14 and under died from unintentional suffocation.           
  • On average since 2001, there have been nearly 16,250 nonfatal suffocation or inhalation-related injuries among children ages 14 and under.
  • Almost 14,500 children ages 14 and under were treated in emergency departments for nonfatal inhalation or suffocation-related episodes in 2009.
  • In 2008, children under 5 years of age accounted for 93 percent of the unintentional suffocation-related deaths among children ages 14 and under.      
  •  In 2009, choking and suffocation accounted for one-third of all toy-related fatalities reported to the U.S. Consumer Product Safety Commission (CPSC).
  • From 2005 to 2007, cribs and playpens were responsible for half of all nursery product-related deaths among children ages 5 and under.      
  • From 2005 to 2007, 107 infant deaths were associated with cribs or mattresses; a majority of these deaths were due to extra bedding leading to suffocation of the infant.      
  • From 1997 through 2004, the number of sudden, unexpected infant deaths (SUID) attributable to accidental suffocation and strangulation has more than tripled; in 2004, 13.5 percent of SUID cases were attributed to accidental suffocation and strangulation.
  • Of the approximately 900 infants whose deaths are attributed to sudden infant death syndrome (SIDS) each year, 60 percent may have died due to suffocation from soft bedding.


Where and How

  • The majority of childhood suffocation, choking and strangulation incidents occur in the home.
  • Among children ages 14 and under treated in emergency departments for nonfatal choking incidents, almost 60 percent were food-related, 31 percent involved nonfood items and 9 percent were unknown. Overall, 13 percent of cases involved swallowing coins and 19 percent involved candy or gum.   
  • The majority of childhood choking injuries are associated with food items, including hot dogs, hard candies, nuts, grapes, carrots, popcorn, marshmallows and peanut butter.    
  • Nonfood choking hazards tend to be round in nature, such as coins, small balls and/or objects that conform to the airway, like balloons.      
  • In 2009, there were over 77,000 children under age 5 treated in emergency departments for injuries related to nursery products.
  • Common items that strangle children include clothing drawstrings, ribbons, necklaces, pacifier strings, and window blind and drapery cords.          
  • Openings that permit the passage of a child’s body but are too small for his or her head can lead to entrapment and strangulation. Hazards include bunk beds, cribs, playground equipment, baby strollers, carriages and high chairs.            
  • The majority of suffocation deaths among infants are due to airway obstruction from items such as clothing or soft sleeping surfaces. Suffocation among children after infancy is more commonly caused by choking on objects, such as food.
  • Among infants, overlays (rolling against or on top of a child while sleeping) were the most common cause of suffocation and strangulation deaths in bed from 2003 to 2004.


Who

  • Children ages 4 and under, especially under age 1, are at greatest risk for all forms of airway obstruction injury. Children ages 4 and under are almost 25 times more likely to experience a suffocation death than children between 5 and 14 years of age.
  • Unintentional suffocation is the leading cause of injury-related death among children under 1 year of age.
  • From 1990 through 2008, two-thirds of crib, playpen and bassinet-related deaths among children under age 2 occurred among infants younger than 6 months of age.
  • Mortality rates due to accidental suffocation and strangulation in bed among infants has more than quadrupled from 1984 to 2004.
  • Children 3 months of age or under are at the highest risk of suffocation and strangulation in bed.
  • Males and children from low-income families are at increased risk of suffocation, choking and strangulation.                      
  • Black and American Indian/Alaskan Native children are at the highest risk of unintentional suffocationrelated death. Black children are twice as likely as white children to die from suffocation.
  • Children placed in adult beds are at increased risk for airway obstruction injury. The risk of suffocation for infants is 40 times higher in adult beds than cribs.


Costs

  • Among children ages 14 and under, the total cost of airway obstruction injury is over $1.5 billion in the U.S. annually.
  • Children under 5 account for more than 60 percent of the total airway obstruction injury costs among children.       


Laws and Regulations

  • The Child Safety Protection Act requires choking hazard warning labels on packaging for small balls, balloons, marbles and certain toys and games containing small parts. The Act also bans any toy intended for use by children under 3 years of age that may pose a choking, aspiration or ingestion hazard.        
  • The Consumer Product Safety Improvement Act of 2008 required the CPSC to issue a rule outlining labeling requirements for toy and game advertising in catalogues and other printed materials. The rule applies to catalogues and other printed materials that provide a direct means of purchase or order for toys and games intended for children ages 3 to 6. Under the new rule, any toy or game that currently requires a choking warning for small parts, balloons, small balls, or marbles on the product packaging must be advertised with the same warning in any catalogue or other printed item.        
  • The CPSC has issued voluntary guidelines for the drawstrings of children’s upper outerwear garments, such as jackets and sweatshirts. The guidelines help to prevent strangulation from the neck drawstrings and entanglement of the waist drawstrings.
  • In 1992, the CPSC voted to ban infant cushions, in order to prevent infant suffocation while sleeping on the cushions. Banned cushions have all the following features: 1) a flexible fabric covering; 2) loosely filled with a granular material such as plastic foam beads or pellets; 3) easily flattened; 4) capable of conforming to the body or face of an infant; and 5) intended or promoted for use by children under age 1.
  • As of June 2011, the CPSC requires that all cribs manufactured and sold in the U.S. meet new standards. The new standards include improved slats, mattress supports and hardware and prohibit the traditional drop-side rail cribs.
  • The American Academy of Pediatrics does not recommend the use of bumper pads and similar products because of their potential to cause suffocation, entrapment and strangulation of young infants.
Led by Northeast Georgia Medical Center and funded by The Medical Center Foundation's Healthy Journey Campaign
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