Suction-Type Suffocation Incidents in Infants and Toddlers
Authors: Nakamura Suad Wanna , Pollack-Nelson Carol , Chidekel Aaron S. 
Published: August 2004

Objectives. To describe the danger of upper airway obstruction associated with semirigid hollow objects in infants and toddlers and to define a minimum frequency with which episodes involving these products have occurred and propose a model defining the potentially hazardous characteristics of these objects.
Methods. A retrospective study of incidents reported to the US Consumer Product Safety Commission from January 1983 to March 2000, involving children younger than 5 years, was conducted. The medical literature (Medline) was searched for similar cases. The resulting case series was analyzed.
Results. A total of 17 incidents were identified in which a semirigid, hollow hemispherical/ellipsoidal object was described as having “cupped” the face, simultaneously covering the nose and the mouth. Of the 17 incidents, 13 involved toys; the remaining 4 incidents involved 2 different consumer products. All of these incidents involved children aged 4 to 36 months. Eight incidents resulted in death; 9 were nonfatal because of parental intervention. In all cases investigated, the infant was found with the semirigid object strongly adhering to his or her face. In 16 incidents, significant physical effort reportedly was required to remove the objects from the child’s face. The fatal incidents involved children aged 4 to 24 months, whereas the age range of the children in nonfatal incidents was 7 to 36 months. In all but 1 of the fatal cases, the victim was found dead in a crib or playpen. The cross-sectional diameter of the products involved in suffocation incidents was in the range of 6.4 to 9.7 cm. The depths of the products ranged from 4.2 to 5.1 cm. The approximate volume of containers ranged between 100 and 170 mL. These dimensions are compatible with the range of anthropometric measurements that allow the product to fit snugly over the mouth and the nose of a young child, resulting in complete airway obstruction.
Conclusions. Children between the ages of 4 and 36 months are at risk from suffocation by hollow, semirigid hemispherical/ellipsoidal objects through suction formation and complete airway obstruction. Shallow containers with dimensions ranging from approximately 6.0 to 11.0 cm seem to be especially hazardous. Several recommendations may be proposed to lessen the hazard to young children. These include product design changes that limit the amount of contact with the perimeter and reduce the chance of forming a seal between the container and the face and ventilation holes to prevent a seal from forming. Although design change alone may be very helpful in products that are intended for use by children who are younger than 3 years, products that have similar dimensions and are not intended for infants present additional challenges. Thus, a very important additional prevention strategy is education. Pediatricians and other health care providers should alert parents and caregivers to the dangers of leaving such products in an infant’s crib or playpen or allowing infants to play with these objects while unattended.