Abstract
OBJECTIVES: To examine the frequency and nature of non-fatal asphyxiation and foreign body ingestion injuries among children in the state of Victoria, Australia, and to identify possible areas for prevention. METHODS: For children under 15 years, all Victorian public hospital admissions, July 1987 to June 1995, due to asphyxiation or 'foreign body entering through other orifice' (which includes ingestions), were reviewed. Emergency department presentations due to asphyxiation and foreign body ingestion provided information on circumstances of, and the type of foreign bodies involved in the injuries. RESULTS: The childhood average annual admission rate for asphyxiation was 15.1 per 100,000. Food related asphyxiation peaked in infants under 1 year, and declined to low levels by 3 years. The main foods involved were nuts, carrot, apple, and candy. The rate of non-food related asphyxiation was relatively constant to 3 years of age and then declined by 6 years. Mechanical suffocation was less common. The annual admission rate for 'foreign body entering through other orifice' was 31.7 per 100,000. These injuries peaked in 2-3 year olds then gradually declined. About 80% of these foreign body admissions were ingestions, with coins being the major object ingested. Admission rates for these causes remained constant over the eight years. Asphyxiation resulted in a higher proportion admitted and longer hospital stays. CONCLUSIONS: Prevention of suffocation and strangulation needs to focus on a safe sleeping environment and avoidance of ropes and cords, while foreign body asphyxiation and ingestion needs a focus on education of parents and child carers regarding age, appropriate food, risk of play with coins, and other small items. Legislation for toy small parts could be extended to those used by children up to the age of 5 years, and to other products marketed for children. Design changes and warning labels also have a place in prevention.
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Selected References
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- Altmann A., Nolan T. Non-intentional asphyxiation deaths due to upper airway interference in children 0 to 14 years. Inj Prev. 1995 Jun;1(2):76–80. doi: 10.1136/ip.1.2.76. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Baker S. P., Fisher R. S. Childhood asphyxiation by choking or suffocation. JAMA. 1980 Sep 19;244(12):1343–1346. [PubMed] [Google Scholar]
- Baker S. P., Halperin K. Designing the death out of balloons. JAMA. 1995 Dec 13;274(22):1805–1805. [PubMed] [Google Scholar]
- Binder L., Anderson W. A. Pediatric gastrointestinal foreign body ingestions. Ann Emerg Med. 1984 Feb;13(2):112–117. doi: 10.1016/s0196-0644(84)80573-9. [DOI] [PubMed] [Google Scholar]
- Black R. E., Johnson D. G., Matlak M. E. Bronchoscopic removal of aspirated foreign bodies in children. J Pediatr Surg. 1994 May;29(5):682–684. doi: 10.1016/0022-3468(94)90740-4. [DOI] [PubMed] [Google Scholar]
- Brown T. C. Bronchoscopy for removal of foreign bodies in children. Anaesth Intensive Care. 1973 Nov;1(6):521–525. doi: 10.1177/0310057X7300100611. [DOI] [PubMed] [Google Scholar]
- Conners G. P., Chamberlain J. M., Weiner P. R. Pediatric coin ingestion: a home-based survey. Am J Emerg Med. 1995 Nov;13(6):638–640. doi: 10.1016/0735-6757(95)90047-0. [DOI] [PubMed] [Google Scholar]
- Crysdale W. S., Sendi K. S., Yoo J. Esophageal foreign bodies in children. 15-year review of 484 cases. Ann Otol Rhinol Laryngol. 1991 Apr;100(4 Pt 1):320–324. doi: 10.1177/000348949110000410. [DOI] [PubMed] [Google Scholar]
- Denyer S. Accidents. Foreign bodies: where do children put them? Health Visit. 1990 May;63(5):163–164. [PubMed] [Google Scholar]
- Harris C. S., Baker S. P., Smith G. A., Harris R. M. Childhood asphyxiation by food. A national analysis and overview. JAMA. 1984 May 4;251(17):2231–2235. [PubMed] [Google Scholar]
- Kenna M. A., Bluestone C. D. Foreign bodies in the air and food passages. Pediatr Rev. 1988 Jul;10(1):25–31. doi: 10.1542/pir.10-1-25. [DOI] [PubMed] [Google Scholar]
- Laks Y., Barzilay Z. Foreign body aspiration in childhood. Pediatr Emerg Care. 1988 Jun;4(2):102–106. doi: 10.1097/00006565-198806000-00004. [DOI] [PubMed] [Google Scholar]
- Langlois J. A., Wallen B. A., Teret S. P., Bailey L. A., Hershey J. H., Peeler M. O. The impact of specific toy warning labels. JAMA. 1991 Jun 5;265(21):2848–2850. [PubMed] [Google Scholar]
- Linegar A. G., von Oppell U. O., Hegemann S., de Groot M., Odell J. A. Tracheobronchial foreign bodies. Experience at Red Cross Children's Hospital, 1985-1990. S Afr Med J. 1992 Sep;82(3):164–167. [PubMed] [Google Scholar]
- Litovitz T., Schmitz B. F. Ingestion of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics. 1992 Apr;89(4 Pt 2):747–757. [PubMed] [Google Scholar]
- Mittleman R. E. Fatal choking in infants and children. Am J Forensic Med Pathol. 1984 Sep;5(3):201–210. doi: 10.1097/00000433-198409000-00003. [DOI] [PubMed] [Google Scholar]
- Mu L., He P., Sun D. Inhalation of foreign bodies in Chinese children: a review of 400 cases. Laryngoscope. 1991 Jun;101(6 Pt 1):657–660. doi: 10.1288/00005537-199106000-00014. [DOI] [PubMed] [Google Scholar]
- Reilly J. S. Prevention of aspiration in infants and young children: federal regulations. Ann Otol Rhinol Laryngol. 1990 Apr;99(4 Pt 1):273–276. doi: 10.1177/000348949009900404. [DOI] [PubMed] [Google Scholar]
- Reilly J. S., Walter M. A., Beste D., Derkay C., Muntz H., Myer C. M., Friedman E., Seibert R., Todd N. W., Milbrath M. Size/shape analysis of aerodigestive foreign bodies in children: a multi-institutional study. Am J Otolaryngol. 1995 May-Jun;16(3):190–193. doi: 10.1016/0196-0709(95)90101-9. [DOI] [PubMed] [Google Scholar]
- Reilly J. S., Walter M. A. Consumer product aspiration and ingestion in children: analysis of emergency room reports to the National Electronic Injury Surveillance System. Ann Otol Rhinol Laryngol. 1992 Sep;101(9):739–741. doi: 10.1177/000348949210100904. [DOI] [PubMed] [Google Scholar]
- Rimell F. L., Thome A., Jr, Stool S., Reilly J. S., Rider G., Stool D., Wilson C. L. Characteristics of objects that cause choking in children. JAMA. 1995 Dec 13;274(22):1763–1766. [PubMed] [Google Scholar]
- Ryan C. A., Yacoub W., Paton T., Avard D. Childhood deaths from toy balloons. Am J Dis Child. 1990 Nov;144(11):1221–1224. doi: 10.1001/archpedi.1990.02150350053023. [DOI] [PubMed] [Google Scholar]
- Sadan N., Raz A., Wolach B. Impact of community educational programmes on foreign body aspiration in Israel. Eur J Pediatr. 1995 Oct;154(10):859–862. doi: 10.1007/BF01959798. [DOI] [PubMed] [Google Scholar]
- Schloss M. D., Terraza O. Introduction of a Canadian dollar coin has created a new health hazard for children. J Otolaryngol. 1993 Dec;22(6):428–430. [PubMed] [Google Scholar]
- Sheikh A. Button battery ingestions in children. Pediatr Emerg Care. 1993 Aug;9(4):224–229. doi: 10.1097/00006565-199308000-00013. [DOI] [PubMed] [Google Scholar]
- Wolach B., Raz A., Weinberg J., Mikulski Y., Ben Ari J., Sadan N. Aspirated foreign bodies in the respiratory tract of children: eleven years experience with 127 patients. Int J Pediatr Otorhinolaryngol. 1994 Jul;30(1):1–10. doi: 10.1016/0165-5876(94)90045-0. [DOI] [PubMed] [Google Scholar]