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June 4, 1997, Vol 277, No. 21 >
ARTICLE | June 4, 1997

Pediatric Window-Cord Strangulations in the United States, 1981-1995 FREE

Renae Rauchschwalbe, MS; N. Clay Mann, PhD
[+] Author Affiliations

Presented as a poster exhibit at the annual meeting of the Society for Academic Emergency Medicine, Denver, Colo, May 1996.

The contribution made to this article by Ms Rauchschwalbe, a senior compliance officer for the US Consumer Product Safety Commission, was performed in her official capacity. However, it is not intended nor should it be inferred that the opinions expressed herein represent the official position of the US Consumer Product Safety Commission.

Reprints: N. Clay Mann, PhD, Department of Emergency Medicine, UHN-52, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97201-3098.


JAMA. 1997;277(21):1696-1698. doi:10.1001/jama.1997.03540450052034
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Article
References

Objective.  —To document the prevalence of pediatric asphyxial death from window-covering cords in the United States and identify associated risk factors.

Design.  —Retrospective analysis of existing death certificate and incident files compiled by the US Consumer Product Safety Commission.

Setting.  —United States, 1981 through 1995.

Patients.  —Children aged 1 month to 8 years suffering unintentional traumatic asphyxiation from a window-covering cord.

Results.  —A total of 183 fatal window-cord strangulations were reported for the years 1981 through 1995, representing a mortality rate of 0.14 (95% confidence interval [CI], 0.10-0.18) per 100 000 persons (≤3 years old) per year in the United States. Ninety-three percent of victims were 3 years of age or younger. Pull cords on venetian-type horizontal window coverings accounted for 86% of documented injuries. Infant victims were more likely to become entangled while put down for a nap and toddlers were more likely to be suspended by the cord after falling or jumping from a height (P=.002). Window coverings remained anchored and did not undrape when substantial weight was suspended in the draw-cord loop.

Conclusions.  —Window-covering cords represent a substantial strangulation hazard compared with other potentially harmful household products that were modified based on voluntary standards to mitigate the risk of injury. Product design modifications and parental education will be necessary to avert this type of fatal home injury.

REFERENCES

1 +
Feldman KW, Simms RJ.  Strangulation in childhood . Pediatrics . 1980;;65:1079-1085.
2 +
Code of Federal Regulations:Commercial Practices, Part 1000 to End, Federal Hazardous Substances Act Regulations. Washington, DC: US Consumer Product Safety Commission; 1980;16 (pt 1511): 518-521.
3 +
ASTM. 1996 Annual Book of ASTM Standards: General Products, Chemical Specialties, and End Use Products . West Conshohocken, Pa: ASTM; 1996;: 509-537. ASTM Designation F963-96.
4 +
Nelson T. Hazard Analysis of Injuries Related to Cribs . Washington, DC: US Consumer Product Safety Commission, Bureau of Epidemiology; 1975;:12-25.
5 +
Hord JD, Anglin D.  Accidental strangulation of a toddler involving a wall light switch . Am J Dis Child . 1993;;147:1038-1039.
6 +
Consumer Product Safety Commission Alert: Crib Toys. Washington, DC: US Consumer Product Safety Commission; July 1986.
7 +
1979 Annual Report, Part 1. Washington, DC: US Consumer Product Safety Commission; 1979:29.
8 +
Waller JA.  Injury as a public health problem . In: Last J, ed. Public Health and Preventive Medicine , 11th ed. New York, NY: Appleton-Century-Crofts; 1981;:1549-1591.
9 +
Kraus JF.  Effectiveness of measures to prevent unintentional deaths of infants and children from suffocation and strangulation . Public Health Rep . 1985;;100:231-240.
10 +
Kemper M, Gibson S.  Accidental hanging with recovery . J Pediatr . 1945;;26:401-405.
11 +
Bergeson PS, Hernried LS, Sonntag PL.  Infant strangulation . Pediatrics . 1977;;59 ( (suppl 6) , pt 2): 1043-1046.
12 +
Moore L' Byard RW.  Pathological findings in hanging and wedging deaths in infants and young children . Am J Forensic Med Pathol . 1993;;14:296-302.
13 +
Byard RW, Beal S, Bourne AJ.  Potentially dangerous sleeping environments and accidental asphyxia in infancy and early childhood . Arch Dis Child . 1994;;71:497-500.
14 +
Nixon JW, Kemp AM, Levene S, Sibert JR.  Suffocation, choking, and strangulation in childhood in England and Wales . Arch Dis Child . 1995;;72:6-10.
15 +
Shepherd RT.  Accidental self-strangulation in a young child . Med Sci Law . 1990;;30:119-123.
16 +
Consumer Product Safety Alert: Window Blind and Drapery Cord Strangulation. Washington, DC: US Consumer Product Safety Commission; August 1993.
17 +
CPSC and Industry Redesign Products to Save Lives. Washington, DC: US Consumer Product Safety Commission; October 1994. Release 95-003.
18 +
Consumer Product Safety Alert: Children Can Strangle in Window Covering Cords. Washington, DC: US Consumer Product Safety Commission; October 1994.
19 +
Prevention Report. Washington, DC: Office of Disease Prevention and Health Promotion; December/January 1994.
20 +
Yee WH.  Accidental strangulation by windowblind cords . Can Med Assoc J . 1990;;142:436.
21 +
Little RS.  Drapery cord injury and strangulation in babies . Am Fam Physician . 1994;;49:335.
22 +
National Electronic Injury Surveillance System (NEISS) Sample Design and Implementation. Washington, DC: US Consumer Product Safety Commission; 1984.
23 +
International Classification of Diseases, Ninth Revision, Clinical Modification. Washington, DC: Public Health Service, US Dept of Health and Human Services; 1980.
24 +
Current Population Reports: US Population Estimates by Age, Sex, Race, and Hispanic Origin: 1980 to 1991. Washington, DC: US Bureau of the Census; 1992. Document P251095.
25 +
Current Population Reports: US Population Estimates by Age, Sex, Race, and Hispanic Origin: 1990 to 1994. Washington, DC: US Bureau of the Census; 1992. Document P25 1130.
26 +
Hook EB, Regal RR.  The value of capturerecapture methods even for apparent exhaustive surveys . Am J Epidemiol . 1992;;135:1060-1067.
27 +
Wittes JT.  On the bias and estimated variance of Chapman's two-sample capture-recapture population estimate . Biometrics . 1972;;28:592-597.
28 +
News From the CPSC: CPSC Announces Recall of Additional Wooden Bunk Beds. Washington, DC: US Consumer Product Safety Commission; December 1995. Release 96-040.
29 +
News From the CPSC: CPSC Announces Recliner Chair Recall. Washington, DC: US Consumer Product Safety Commission; May 1996. Release 96130.
30 +
News From the CPSC: New Infant Strangulation Prompts Second Recall of Child Enclosures. Washington, DC: US Consumer Product Safety Commission; December 1988. Release 88-117.
31 +
News From the CPSC: CPSC Adopts Voluntary Standard for Toy Chests. Washington, DC: US Consumer Product Safety Commission; August 1983. Release 83-047.
32 +
Satran L.  Fatalities caused by electrically operated garage doors . Pediatrics . 1981;;68:422-423.
33 +
News From the CPSC: Parents Urged to Replace Unsafe Garage Door Openers. Washington, DC: US Consumer Product Safety Commission; March 1990. Release 90-051.
34 +
Pearn JH, Brown J, Wong R, Bart R.  Bathtub drownings . Pediatrics . 1979;;64:68-70.
35 +
Sturner WQ, Spruill FG, Lene WJ.  Accidental asphyxial deaths involving infants and young children . J Forensic Sci . 1976;;21:483-486.
36 +
Clark MA, Feczko JD, Hawley DA, Pless JE, Tate LR, Fardal PM.  Asphyxial deaths due to hanging in children . J Forensic Sci . 1993;;38:344-352.
37 +
Hook EB, Regal RR.  Effect of the variation in probability of ascertainment by sources ('variable catchability') upon 'capture-recapture' estimates of prevalence . Am J Epidemiol . 1993;;137:1148-1166.
38 +
Bishop YMM, Fienberg SE, Holland PW. Discrete Multivariate Analysis: Theory and Practice . Cambridge, Mass: MIT Press; 1975;.
39 +
Jason J, Carpenter MM, Tyler CW.  Underrecording of infant homicide in the United States . Am J Public Health . 1983;;73:195-197.
40 +
Lapidus GD, Gregorio DI, Hansen H.  Misclassification of childhood homicide on death certificates . Am J Public Health . 1990;;80:213-214.
41 +
American National Standard for Safety of Corded Window Covering Products, ANSI/WCMA, A100.1-1996. New York, NY: American National Standards Institute; January 1997.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Feldman KW, Simms RJ.  Strangulation in childhood . Pediatrics . 1980;;65:1079-1085.
2 +
Code of Federal Regulations:Commercial Practices, Part 1000 to End, Federal Hazardous Substances Act Regulations. Washington, DC: US Consumer Product Safety Commission; 1980;16 (pt 1511): 518-521.
3 +
ASTM. 1996 Annual Book of ASTM Standards: General Products, Chemical Specialties, and End Use Products . West Conshohocken, Pa: ASTM; 1996;: 509-537. ASTM Designation F963-96.
4 +
Nelson T. Hazard Analysis of Injuries Related to Cribs . Washington, DC: US Consumer Product Safety Commission, Bureau of Epidemiology; 1975;:12-25.
5 +
Hord JD, Anglin D.  Accidental strangulation of a toddler involving a wall light switch . Am J Dis Child . 1993;;147:1038-1039.
6 +
Consumer Product Safety Commission Alert: Crib Toys. Washington, DC: US Consumer Product Safety Commission; July 1986.
7 +
1979 Annual Report, Part 1. Washington, DC: US Consumer Product Safety Commission; 1979:29.
8 +
Waller JA.  Injury as a public health problem . In: Last J, ed. Public Health and Preventive Medicine , 11th ed. New York, NY: Appleton-Century-Crofts; 1981;:1549-1591.
9 +
Kraus JF.  Effectiveness of measures to prevent unintentional deaths of infants and children from suffocation and strangulation . Public Health Rep . 1985;;100:231-240.
10 +
Kemper M, Gibson S.  Accidental hanging with recovery . J Pediatr . 1945;;26:401-405.
11 +
Bergeson PS, Hernried LS, Sonntag PL.  Infant strangulation . Pediatrics . 1977;;59 ( (suppl 6) , pt 2): 1043-1046.
12 +
Moore L' Byard RW.  Pathological findings in hanging and wedging deaths in infants and young children . Am J Forensic Med Pathol . 1993;;14:296-302.
13 +
Byard RW, Beal S, Bourne AJ.  Potentially dangerous sleeping environments and accidental asphyxia in infancy and early childhood . Arch Dis Child . 1994;;71:497-500.
14 +
Nixon JW, Kemp AM, Levene S, Sibert JR.  Suffocation, choking, and strangulation in childhood in England and Wales . Arch Dis Child . 1995;;72:6-10.
15 +
Shepherd RT.  Accidental self-strangulation in a young child . Med Sci Law . 1990;;30:119-123.
16 +
Consumer Product Safety Alert: Window Blind and Drapery Cord Strangulation. Washington, DC: US Consumer Product Safety Commission; August 1993.
17 +
CPSC and Industry Redesign Products to Save Lives. Washington, DC: US Consumer Product Safety Commission; October 1994. Release 95-003.
18 +
Consumer Product Safety Alert: Children Can Strangle in Window Covering Cords. Washington, DC: US Consumer Product Safety Commission; October 1994.
19 +
Prevention Report. Washington, DC: Office of Disease Prevention and Health Promotion; December/January 1994.
20 +
Yee WH.  Accidental strangulation by windowblind cords . Can Med Assoc J . 1990;;142:436.
21 +
Little RS.  Drapery cord injury and strangulation in babies . Am Fam Physician . 1994;;49:335.
22 +
National Electronic Injury Surveillance System (NEISS) Sample Design and Implementation. Washington, DC: US Consumer Product Safety Commission; 1984.
23 +
International Classification of Diseases, Ninth Revision, Clinical Modification. Washington, DC: Public Health Service, US Dept of Health and Human Services; 1980.
24 +
Current Population Reports: US Population Estimates by Age, Sex, Race, and Hispanic Origin: 1980 to 1991. Washington, DC: US Bureau of the Census; 1992. Document P251095.
25 +
Current Population Reports: US Population Estimates by Age, Sex, Race, and Hispanic Origin: 1990 to 1994. Washington, DC: US Bureau of the Census; 1992. Document P25 1130.
26 +
Hook EB, Regal RR.  The value of capturerecapture methods even for apparent exhaustive surveys . Am J Epidemiol . 1992;;135:1060-1067.
27 +
Wittes JT.  On the bias and estimated variance of Chapman's two-sample capture-recapture population estimate . Biometrics . 1972;;28:592-597.
28 +
News From the CPSC: CPSC Announces Recall of Additional Wooden Bunk Beds. Washington, DC: US Consumer Product Safety Commission; December 1995. Release 96-040.
29 +
News From the CPSC: CPSC Announces Recliner Chair Recall. Washington, DC: US Consumer Product Safety Commission; May 1996. Release 96130.
30 +
News From the CPSC: New Infant Strangulation Prompts Second Recall of Child Enclosures. Washington, DC: US Consumer Product Safety Commission; December 1988. Release 88-117.
31 +
News From the CPSC: CPSC Adopts Voluntary Standard for Toy Chests. Washington, DC: US Consumer Product Safety Commission; August 1983. Release 83-047.
32 +
Satran L.  Fatalities caused by electrically operated garage doors . Pediatrics . 1981;;68:422-423.
33 +
News From the CPSC: Parents Urged to Replace Unsafe Garage Door Openers. Washington, DC: US Consumer Product Safety Commission; March 1990. Release 90-051.
34 +
Pearn JH, Brown J, Wong R, Bart R.  Bathtub drownings . Pediatrics . 1979;;64:68-70.
35 +
Sturner WQ, Spruill FG, Lene WJ.  Accidental asphyxial deaths involving infants and young children . J Forensic Sci . 1976;;21:483-486.
36 +
Clark MA, Feczko JD, Hawley DA, Pless JE, Tate LR, Fardal PM.  Asphyxial deaths due to hanging in children . J Forensic Sci . 1993;;38:344-352.
37 +
Hook EB, Regal RR.  Effect of the variation in probability of ascertainment by sources ('variable catchability') upon 'capture-recapture' estimates of prevalence . Am J Epidemiol . 1993;;137:1148-1166.
38 +
Bishop YMM, Fienberg SE, Holland PW. Discrete Multivariate Analysis: Theory and Practice . Cambridge, Mass: MIT Press; 1975;.
39 +
Jason J, Carpenter MM, Tyler CW.  Underrecording of infant homicide in the United States . Am J Public Health . 1983;;73:195-197.
40 +
Lapidus GD, Gregorio DI, Hansen H.  Misclassification of childhood homicide on death certificates . Am J Public Health . 1990;;80:213-214.
41 +
American National Standard for Safety of Corded Window Covering Products, ANSI/WCMA, A100.1-1996. New York, NY: American National Standards Institute; January 1997.

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