Characteristics of Objects That Cause Choking in Children

OBJECTIVE: To characterize the types, shapes, and sizes of objects causing choking or asphyxiation in children and to compare these characteristics to current standards. DESIGN: To evaluate morbidity, retrospective 5-year medical record survey; to evaluate mortality, data reanalysis. SETTINGS: Pediatric hospital and consumer product testing laboratory. PATIENTS: All children (n = 449) who underwent endoscopy for foreign body aspiration or ingestion at Children's Hospital of Pittsburgh (Pa) between 1989 and 1993 and children (n = 449) whose deaths due to choking on man-made objects were recorded by the Consumer Product Safety Commission (CPSC) between 1972 and 1992. MAIN OUTCOME MEASURES: Objects removed from children's aerodigestive tracts were characterized by location, procedure for removal, and type. Objects causing death were characterized by type, shape, and consistency. Three-dimensional objects that had caused asphyxiation were analyzed by computer-simulated models. RESULTS: Of the 165 children treated by endoscopy, 69% were 3 years of age or younger. Foreign bodies most often ingested or aspirated were food (in 36 children) and coins (in 60 children). Of 449 children whose deaths after aspirating foreign bodies were reported to the CPSC, 65% were younger than 3 years. Balloons caused 29% of deaths overall. Conforming objects such as balloons caused a significantly (P < .001) higher proportion of deaths in those aged 3 years or older (60%) vs those younger than 3 years (33%). Of the 101 objects causing deaths that we could analyze, 14 met current standards for use by children of any age. CONCLUSIONS: Balloons pose a high risk of asphyxiation to children of any age. Changes in regulations regarding products intended for children's use might have prevented up to 14 (14%) of 101 deaths in this study.