Abstract
Accidents constitute one of the greatest risks to children, yet there are few medical reports that discuss the subject of accidental asphyxia. However, a systematic analysis of all documented cases in Germany over the years 2000–2008 has now been conducted, aiming at identifying patterns of accidental asphyxia, deducing findings, defining avoidance measures and recommending ways of increasing product safety and taking possible precautions. The analysis is based on a detailed retrospective analysis of all 91 relevant autopsy reports from 24 different German forensic institutes. A variety of demographic and morphological data was systematically collected and analysed. In 84 of the 91 cases, the sex of the victim was reported, resulting in a total of 57 boys (68 %) and 27 girls (32 %). The age spread ranged between 1 day and 14 years, with an average of 5.9 years. Most accidents occurred in the first year of life (20 %) or between the ages of 1 and 2 years (13 %). In 46 % of cases, the cause of death was strangulation, with the majority occurring in the home environment. In 31 % of all cases, the cause of death was positional asphyxia, the majority resulting from chest compression. In 23 % of cases, the cause of death was aspiration, mainly of foreign bodies. Today, accidental asphyxiation is a rare cause of death in children in Germany. Nevertheless, the majority of cases could have been avoided. Future incidence can be reduced by implementing two major precautions: increasing product safety and educating parents of potentially fatal risks. Specific recommendations relate to children’s beds, toys and food.
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Bundesarbeitsgemeinschaft Mehr Sicherheit für Kinder e.V (2007) Einkaufen für die Kleinsten. Kinderprodukte unter der Lupe. Sicherheitshinweise für Anschaffung und Gebrauch. http://www.kindersicherheit.de. Accessed 15 Dec 2011)
Geserick G, Bundschuh G (1967) Accidental death by accidental hanging and strangling. Dtsch Gesundheitswesen 22:656–659
Denton JS (2002) Fatal accidental hanging from a lanyard key chain in a 10-year-old boy. J Forensic Sci 47:1345–1346
Meel BL (1998) An accidental suffocation by a rubber balloon. Med Sci Law 38:81–82
Hord JD, Anglin D (1993) Accidental strangulation of a toddler involving a wall light switch. Am J Dis Child 147:1038–1039
Kleint W, Gruner G, Hupfer I (1966) Self-strangulation of an infant by a suspended toyband. Dtsch Gesundheitsw 21:1125–1126
Flobecker P, Ottosson J, Johannson L, Hietala MA, Gezelius C, Eriksson A (1993) Accidental deaths from asphyxia. A 10-year retrospective study from Sweden. Am J Forensic Med Pathol 14:74–79
Collins KA (2001) Death by overlaying and wedging: a 15-year retrospective study. Am J Forensic Med Pathol 22:155–159
Gesundheitsberichterstattung des Bundes. Online-Quelle: www.gbe-bund.de. Accessed 3 Feb 2012
Greendyke RM (1965) Accidental strangulation in infancy. Pediatrics 36:275–276
Shepherd RT (1990) Accidental self-strangulation in a young child. Med Sci Law 30:119–123
Verma SK (2007) Pediatric and adolescent strangulation deaths. J Forensic Leg Med 14:61–64
Bergeson PS, Hernried LS, Sonntag PL (1977) Infant strangulation. Pediatrics 59(Suppl 2):1043–1046
Nixon JW, Kemp AM, Levene S, Sibert JR (1995) Suffocation, choking, and strangulation in childhood in England and Wales: epidemiology and prevention. Arch Dis Child 72:6–10
Roberton D, Rookwood K, Rutter N (1981) Collapsible washing lines: a strangulation hazard. Br Med J 282(6277):1664
Stevens RR, Lane GA, Milkovich SM, Stool D, Rider G, Stool SE (1999) Prevention of accidental childhood strangulation: where is the site of obstruction? Int J Pediatr Otorhinolaryngol 49(Suppl 1):S321–S322
Chin N, Berns SD (1995) Near-hanging caused by a toy necklace. Ann Emerg Med 26:522–525
Petruk J, Shields E, Cummings GE, Francescutti LH (1996) Fatal asphyxiations in children involving drawstrings on clothing. CMAJ 155:1417–1419
Denton JS (2002) Fatal accidental hanging from a lanyard key chain in a 10-year-old boy. J foresnic Sci 47:1345–1346
Clark MA, Feczko JD, Hawley DA, Pless JE, Tate LR, Fardal PM (1993) Asphyxial deaths due to hanging in children. J Forensic Sci 38:344–352
Le D, Macnab AJ (2001) Self strangulation by hanging from cloth towel dispensers in Canadian schools. Inj Prev 7:231–233
Schmidt U, Nadjem H, Pollak S (2001) Death caused by accidental hanging in the hand strap loop of a garage door. Arch Kriminol 207:19–25
Pfeffer CR (1997) Childhood suicidal behavior. A developmental perspective. Psychiatr Clin North Am 20:551–562
Gould MS, Shaffer D, Greenberg T (2003) The epidemiology of youth suicide. In: King RA, Apter A (eds) Suicide in children and adolescents. Cambridge University Press, Cambridge, pp 1–40
Dervic K, Friedrich E, Oquendo MA, Voracek M, Friedrich MH, Sonneck G (2006) Suicide in Austrian children and young adolescents aged 14 and younger. Eur Child Adolesc Psychiatry 15:427–434
Lockemann U, Koops E, Püschel K (1992) Strangulationstodesfälle im Kindesalter. Beitr gerichtl Med 50:13–20
Lifschultz BD, Donoghue ER (1996) Deaths due to foreign body aspiration in children: the continuing hazard of toy balloons. J Forensic Sci 41:247–251
Byard RW, Beal S, Bourne AJ (1994) Potentially dangerous sleeping environments and accidental asphyxia in infancy and early childhood. Arch Dis Child 71:497–500
Altmann A, Nolan T (1995) Non-intentional asphyxiation deaths due to upper airway interference in children 0 to 14 years. Inj Prev 1:76–80
Byard RW (1994) Unexpected death due to acute airway obstruction in daycare centers. Pediatrics 94:113–114
American Academy of Pediatrics Committee on Pediatric Emergency Medicine (1993) First aid for the choking child. Pediatrics 92:477–479
Schöpfer JE, Mützel E, Endisch G, Penning R (2009) Tödliche Unfälle durch Ersticken und Ertrinken im Kindesalter. In: Peschel O, Mützel E, Penning R (eds) Das Kind in der forensischen Medizin. Ecomed, Hüthig Jehle Rehm, pp 196–213
Reiser J, Gehl A, Vogel H, Püschel K (2012) Ersticken infolge einer Fremdkörperaspiration: postmortaler Nachweis mittels CT. Arch Kriminol 229:55–61
Byard RW (1996) Hazardous infant and early childhood sleeping environments and death scene examination. J Clin Forensic Med 3:115–122
Scheers NJ, Rutherford GW, Kemps JS (2003) Where should infants sleep? A comparison of risk for suffocation of infants sleeping in cribs, adult beds, and other sleeping locations. Pediatrics 112:883–889
Nakamura S, Wind M, Danello MA (1999) Review of hazards associated with children placed in adult beds. Arch Pediatr Adolesc Med 153:1019–1023
Tardieu A (1855) Mémoire sur la mort par suffocation. Ann Hyg Publique Med Leg 4:371–441
Fracasso T, Vennemann M, Klöcker M, Bajanowski T, Brinkmann B, Pfeiffer H, the GeSID Group (2011) Petechial bleedings in sudden infant death. Int J Legal Med 125:205–210
Wisser M, Rothschild MA, Schmolling JC, Banaschak S (2012) Caput succedaneum and facial petechiae—birth-associated injuries in healthy newborns under forensic aspects. Int J Legal Med 126:385–390
Brinkmann B (2004) Ersticken. In: Brinkmann B, Madea B (eds) Handbuch gerichtliche Medizin, vol 1. Springer, Berlin, pp 699–796
Patzelt D, Philipp K, Correns A (1990) Strangulationsunfälle im Säuglings- und Kleinkindesalter. In: Brinkmann B, Püschel K (eds) Ersticken. Fortschritte in der Beweisführung. Springer, Berlin, pp 186–188
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Collaborating authors from Institutes of Legal Medicine: Althaus L, Wedau-Hospital, Duisburg; Bach P, State of Brandenburg, Potsdam; Banaschak S, University of Cologne; Cordes O, City of Bremen; Dettmeyer SR, University of Giessen; Dressler J, University of Leipzig; Gahr B, Heinrich-Heine-University, Düsseldorf; Grellner W, Georg-August-University, Göttingen; Héroux V, Johannes-Gutenberg-University, Mainz; Mützel E, Ludwig-Maximilians-University, Munich; Tatschner T, University of Würzburg; Zack F, University of Rostock; and Zedler B, Johann-Wolfgang-Goethe-University, Frankfurt am Main.
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Meyer, F.S., Trübner, K., Schöpfer, J. et al. Accidental mechanical asphyxia of children in Germany between 2000 and 2008. Int J Legal Med 126, 765–771 (2012). https://doi.org/10.1007/s00414-012-0737-z
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DOI: https://doi.org/10.1007/s00414-012-0737-z