Prevention of Accidental Childhood Strangulation a Clinical Study

Abstract

Accidental strangulation is a preventable problem, and there is limited scientific understanding of its mechanism in children. If the amount of external pressure that occludes the airway can be determined, design changes may be made to allow for production of household objects that would break apart at safe pressure levels. A force gauge was applied to the suprahyoid region in 90 children under standardized anesthesia. Three blinded observers performed the study. The anesthesiologist maintained the airway and used a stethoscope to auscultate for breath sounds and monitor the CO2 curves to evaluate obstruction. The recorder noted the numbers from the gauge. A single observer applied the force gauge. Age was the most significant variable in occluding the airway. Obstruction appears to occur at the level of the larynx. Increased knowledge regarding the external pressure required for airway occlusion would allow for the design and manufacture of products with a reduced potential for accidental strangulation.

Strangulation injury from indigenous rocking cradle

“…This generally occurs above the larynx and below the angle of jaw. [12] Neck compression may lead to laryngeal edema. [29] Moreover, airway of infants is anatomically vulnerable to obstruction at the level of oropharynx between the soft palate and the skull.…”

“…Obstruction to carotid artery flow is unlikely in children as approximately 5 kg tension on ligature around the neck is required to cause cessation of carotid flow and even then the patency of vertebral arteries is preserved. [112] However, only 2 kg tension is required to cause bilateral jugular venous obstruction which may cause cerebral edema and unconsciousness or seizures. [1] This may consequently lead to rise in intracranial tension later in the course of illness, herniation and brain death.…”

“…[1] In western countries, it is the third most common cause of accidental childhood deaths, 17% of them being due to ropes and cords. [23] It ranks fourth amongst the causes of unintentional injury in children less than 1 year of age following roadside accidents, drowning and burns.…”

Accidental childhood strangulation by human hair

“…To cite the force necessary to occlude a child's airway [4], we turned to a previously published study that some of us participated in, entitled ''Prevention of Accidental Childhood Strangulation, A Clinical Study [5]''. This study consisted of making in vivo measurements in the suprahyoid region on 90+ anesthesitized children, aged 0-6 years of age.…”

“…Fig. 6 Endoscopic verification of airway occlusion during airway occlusion force measurements in young children [5].…”