Characteristics of objects that cause choking in children
F. L. Rimell, A. Thome Jr, S. Stool, J. S. Reilly, G. Rider, D. Stool and C. L. Wilson
Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh (PA), USA.
OBJECTIVE--To characterize the types, shapes, and sizes of objects causing
choking or asphyxiation in children and to compare these characteristics to
current standards. DESIGN--To evaluate morbidity, retrospective 5-year
medical record survey; to evaluate mortality, data reanalysis.
SETTINGS--Pediatric hospital and consumer product testing laboratory.
PATIENTS--All children (n = 449) who underwent endoscopy for foreign body
aspiration or ingestion at Children's Hospital of Pittsburgh (Pa) between
1989 and 1993 and children (n = 449) whose deaths due to choking on
man-made objects were recorded by the Consumer Product Safety Commission
(CPSC) between 1972 and 1992. MAIN OUTCOME MEASURES--Objects removed from
children's aerodigestive tracts were characterized by location, procedure
for removal, and type. Objects causing death were characterized by type,
shape, and consistency. Three-dimensional objects that had caused
asphyxiation were analyzed by computer-simulated models. RESULTS--Of the
165 children treated by endoscopy, 69% were 3 years of age or younger.
Foreign bodies most often ingested or aspirated were food (in 36 children)
and coins (in 60 children). Of 449 children whose deaths after aspirating
foreign bodies were reported to the CPSC, 65% were younger than 3 years.
Balloons caused 29% of deaths overall. Conforming objects such as balloons
caused a significantly (P < .001) higher proportion of deaths in those
aged 3 years or older (60%) vs those younger than 3 years (33%). Of the 101
objects causing deaths that we could analyze, 14 met current standards for
use by children of any age. CONCLUSIONS--Balloons pose a high risk of
asphyxiation to children of any age. Changes in regulations regarding
products intended for children's use might have prevented up to 14 (14%) of
101 deaths in this study.
