Accidental mechanical asphyxia of children in Germany between 2000 and 2008


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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  1. 1.

    Bundesarbeitsgemeinschaft Mehr Sicherheit für Kinder e.V (2007) Einkaufen für die Kleinsten. Kinderprodukte unter der Lupe. Sicherheitshinweise für Anschaffung und Gebrauch. Accessed 15 Dec 2011)

  2. 2.

    Geserick G, Bundschuh G (1967) Accidental death by accidental hanging and strangling. Dtsch Gesundheitswesen 22:656–659

    CAS  Google Scholar 

  3. 3.

    Denton JS (2002) Fatal accidental hanging from a lanyard key chain in a 10-year-old boy. J Forensic Sci 47:1345–1346

    PubMed  Google Scholar 

  4. 4.

    Meel BL (1998) An accidental suffocation by a rubber balloon. Med Sci Law 38:81–82

    PubMed  CAS  Google Scholar 

  5. 5.

    Hord JD, Anglin D (1993) Accidental strangulation of a toddler involving a wall light switch. Am J Dis Child 147:1038–1039

    PubMed  CAS  Google Scholar 

  6. 6.

    Kleint W, Gruner G, Hupfer I (1966) Self-strangulation of an infant by a suspended toyband. Dtsch Gesundheitsw 21:1125–1126

    PubMed  CAS  Google Scholar 

  7. 7.

    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

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Collins KA (2001) Death by overlaying and wedging: a 15-year retrospective study. Am J Forensic Med Pathol 22:155–159

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Gesundheitsberichterstattung des Bundes. Online-Quelle: Accessed 3 Feb 2012

  10. 10.

    Greendyke RM (1965) Accidental strangulation in infancy. Pediatrics 36:275–276

    PubMed  CAS  Google Scholar 

  11. 11.

    Shepherd RT (1990) Accidental self-strangulation in a young child. Med Sci Law 30:119–123

    PubMed  CAS  Google Scholar 

  12. 12.

    Verma SK (2007) Pediatric and adolescent strangulation deaths. J Forensic Leg Med 14:61–64

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Bergeson PS, Hernried LS, Sonntag PL (1977) Infant strangulation. Pediatrics 59(Suppl 2):1043–1046

    PubMed  Google Scholar 

  14. 14.

    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

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Roberton D, Rookwood K, Rutter N (1981) Collapsible washing lines: a strangulation hazard. Br Med J 282(6277):1664

    Article  CAS  Google Scholar 

  16. 16.

    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

    PubMed  Article  Google Scholar 

  17. 17.

    Chin N, Berns SD (1995) Near-hanging caused by a toy necklace. Ann Emerg Med 26:522–525

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Petruk J, Shields E, Cummings GE, Francescutti LH (1996) Fatal asphyxiations in children involving drawstrings on clothing. CMAJ 155:1417–1419

    PubMed  CAS  Google Scholar 

  19. 19.

    Denton JS (2002) Fatal accidental hanging from a lanyard key chain in a 10-year-old boy. J foresnic Sci 47:1345–1346

    Google Scholar 

  20. 20.

    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

    PubMed  CAS  Google Scholar 

  21. 21.

    Le D, Macnab AJ (2001) Self strangulation by hanging from cloth towel dispensers in Canadian schools. Inj Prev 7:231–233

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    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

    PubMed  CAS  Google Scholar 

  23. 23.

    Pfeffer CR (1997) Childhood suicidal behavior. A developmental perspective. Psychiatr Clin North Am 20:551–562

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    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

    Google Scholar 

  25. 25.

    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

    PubMed  Article  Google Scholar 

  26. 26.

    Lockemann U, Koops E, Püschel K (1992) Strangulationstodesfälle im Kindesalter. Beitr gerichtl Med 50:13–20

    PubMed  CAS  Google Scholar 

  27. 27.

    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

    PubMed  CAS  Google Scholar 

  28. 28.

    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

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    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

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Byard RW (1994) Unexpected death due to acute airway obstruction in daycare centers. Pediatrics 94:113–114

    PubMed  CAS  Google Scholar 

  31. 31.

    American Academy of Pediatrics Committee on Pediatric Emergency Medicine (1993) First aid for the choking child. Pediatrics 92:477–479

    Google Scholar 

  32. 32.

    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

    Google Scholar 

  33. 33.

    Reiser J, Gehl A, Vogel H, Püschel K (2012) Ersticken infolge einer Fremdkörperaspiration: postmortaler Nachweis mittels CT. Arch Kriminol 229:55–61

    PubMed  Google Scholar 

  34. 34.

    Byard RW (1996) Hazardous infant and early childhood sleeping environments and death scene examination. J Clin Forensic Med 3:115–122

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    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

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Nakamura S, Wind M, Danello MA (1999) Review of hazards associated with children placed in adult beds. Arch Pediatr Adolesc Med 153:1019–1023

    PubMed  CAS  Google Scholar 

  37. 37.

    Tardieu A (1855) Mémoire sur la mort par suffocation. Ann Hyg Publique Med Leg 4:371–441

    Google Scholar 

  38. 38.

    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

    PubMed  Article  Google Scholar 

  39. 39.

    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

    PubMed  Article  Google Scholar 

  40. 40.

    Brinkmann B (2004) Ersticken. In: Brinkmann B, Madea B (eds) Handbuch gerichtliche Medizin, vol 1. Springer, Berlin, pp 699–796

    Google Scholar 

  41. 41.

    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

    Google Scholar 

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Corresponding author

Correspondence to T. Bajanowski.

Additional information

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).

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  • Asphyxia
  • Accidents
  • Suffocation
  • Strangulation
  • Chest compression
  • Aspiration
  • Precautions