Suffocation, foreign body inhalation and strangulation are well-recognised causes of death in the paediatric age group. Data from the United States and United Kingdom show a significant burden of death due to unintentional suffocation, choking or strangulation.
Prevention of these deaths is more likely to be achieved with a ’best practice’ model. Best practice incorporates surveillance of New Zealand issues and uses a three-way approach: safe product design and use, effective legislation, and parent and professional education. Best practice also includes particular attention to those population groups where disparate outcomes are demonstrated.
In New Zealand, unintentional injury is the second leading cause of death in those aged between one month and 24 years (34.5 percent for 2002–08). Previous CYMRC data have indicated that within the unintentional injury category, death from ‘suffocation’ is the third leading cause. The use of the term ’suffocation’ within CYMRC data encompasses a heterogeneous collection of causes that end in death due to asphyxia. This includes unintentional strangulation from cords or ropes around the neck, foreign body inhalation leading to blockage of the airways, oro-nasal obstruction of the external airways (unintentional suffocation), chest compression, and head and neck entrapment (traumatic asphyxia). Previous CYMRC reports have not explored the contributions that various conditions make to the wider classification of death from ‘suffocation’ used by the CYMRC. For this reason, detailed knowledge of the New Zealand cases will be provided in this report, highlighting causal factors, trends and preventable factors.
Furthermore, unintentional suffocation4 is increasingly being recognised as a significant contributing factor to SUDI in those aged less than one year. As more information becomes available from death scene investigations, it is becoming clear that a considerable proportion of deaths that might previously have been labelled as sudden infant death syndrome (SIDS) are attributable to unsafe sleeping situations.5 Death by traumatic asphyxia occurs in these situations as suffocation occurs when an infant becomes wedged between bedding and a firm surface or is overlain by a co-sleeping partner (5, 6). A 10-year review of SUDI in Auckland found that 64 percent of deaths occurred in a bed-sharing situation. Analysis of such detailed scene data may explain, in part, the proportional increase of reported infant death due to unintentional suffocation in bed, leading to diagnostic transfer. Location of infant sleep has also been shown to be an important contributor. A case control study over two decades showed an eight-fold increase in reported deaths in adult beds compared with deaths reported in cribs over the time studied. Concurrently, deaths in cribs decreased over this time period.
Other mechanisms of unintentional death by asphyxia include strangulation from cords or ropes and choking on food or other objects. Children in the 1–5-year age range are more likely to become tangled in hanging cords, such as curtain cords, bibs or pacifier cords and be unable to extract themselves from these situations. Older children are at risk during dangerous or experimental play with ropes, such as climbing trees with ropes and rope swings. Trachea size in children is smaller than adults, with trachea being of similar size to the size of the child’s little finger. Furthermore, children younger than three years of age are more likely to put things in their mouth as part of normal development. Together, these factors increase the risk of young children choking on both food and non-food items. Hard, round foods, such as peanuts and beans, are the most likely causes of death due to choking, although items with elasticity and lubricity, such as hot dogs and balloons, also contribute to childhood choking deaths internationally. While this report focuses on mortality, mortality remains only a small proportion of the overall health burden associated with unintentional suffocation, foreign body inhalation and strangulation. For example, for every child that dies from foreign body inhalation another 10 are seen in hospital. This does not include those children who choke and are successfully treated at home.
In this special report we will provide information on the mechanisms and circumstances of death by suffocation, foreign body inhalation and strangulation in New Zealand children and young people aged less than 25 years, from the New Zealand Mortality Review Database. With this information we hope that effective prevention strategies can be put in place that are developmentally appropriate, culturally acceptable and provide effective information using health promotion principles.