Choking, Aspiration, and Suffocation Interventions

Product Modifications


Product modification is, as its name suggests, an alteration of some kind to the product in order to remove the risk of choking. This is usually done after the product’s introduction to the consumer market, when a certain risk has been identified in the product. Often, product modification is linked with legislation (such as the Small Parts Test Fixture,6 which requires a product to be greater than 3.17 cm in diameter and at least 5.71 cm in length) brought about by media coverage of tragic events that could have been avoided had the product’s design been altered in some way, without removing its function.

In 1983 the CPSC compiled a list of common characteristics in the products (mainly squeeze toys, pacifiers, and rattles) involved in 195 choking incidents.7 The findings indicated that four main product characteristics should be considered when evaluating these products for safety: size (usually the diameter), compressibility, flexibility, and configuration.

Product modification can focus on areas other than toys. A recent review of choking incidents involving clothing drawstrings conducted by Drago and colleagues8 suggested several potential intervention strategies, from shortening the drawstrings to removing them altogether. Clothing drawstrings are a hazard on home and public playgrounds. Over one-half (56%) of the 147 deaths reported to CPSC in the 10 year period 1990-2000 resulted from hanging, primarily from ropes, cords, clothing strings or other items tied to or entangled in the equipment, (Tinsworth 2001).

Pull cords on window coverings, particularly those on venetian-type horizontal blinds represent a substantial strangulation hazard. The first epidemiological study of this fata l home injury reported 183 deaths in children age 1 month to 8 years during the period 1981-1995. These deaths represented a mortality rate of 0.14 (95% confidence interval { CI, 0.10-0.18) per 100,000 persons 3 years old or younger. Manfacturers modified the cord design for mini-blinds in 1995 and voluntary standards requiring the elimination of all loops on mini blind cords and placement of non-detachable cord tension devices on continuous-loop cords was published in 1997. Free safety information and m odifications for mini blind cords are available by calling 800-506-4636, (Rauchschwalbe & Mann JAMA 1997).

Unfortunately, no studies exist that have assessed the real-world impact of these potential product modifications on choking and asphyxiation.

The practice of placing infants in adult beds results in a surprising number of suffocation or strangulation deaths among infants under 2 years of age. Nakamura and colleagues' review of CPSC mortality data for 8 years (1990-1997) found 515 deaths during this period. 394 were due to entrapment in the bed structure and 121 were due to overlying by parent. The major cause of strangulation was entrapment of the child's head in various structures of the bed, (Nakamura, 1999). Again, there have been no studies assessing the impact of educational interventions or modification of bed structures.