Hanging injuries and resulting mortality in infants and young children are usually accidental. Deaths and complications such as long-term neurological consequences are rare but potentially serious.
A case of a 31-month old boy who almost killed himself after an accidental hanging from the cord of window blinds is described here. It emphasises the need for adequate safety regulations for manufacturers, as well as for home safety awareness among healthcare providers and parents.
General guidelines are provided that can be discussed during routine visits by the primary healthcare providers, based on British Blind and Shutter Association (BBSA) guidance.
While strangulation and hanging injuries in children are not common presentations in the emergency department, they can have devastating outcomes. They can also be prevented with increased home safety awareness, and there is a case for stricter regulation of the design, manufacture, supply and installation of window blinds. (1)
Case report: clinical course
A 31-month old boy was discovered by his twin brother hanging from a window blind cord. The young boy alerted his father, who found the child with the cord around his neck, pale, unresponsive, blue, tongue protruding and apnoeic. His father managed to cut the cord and performed mouth-to-mouth resuscitation for 30 seconds, following which the child became responsive and cried.
The child was brought to the hospital in an ambulance. Physical examination in the emergency department revealed a conscious child with a patent airway, breathing spontaneously and haemodynamically stable. Neurological examination was normal, with a Glasgow Coma Scale score of 15/15. There was a visible ligature mark around the neck (see Box 1 "Case report: ligature marks following accidental near-hanging by window blind cord"). The trachea was in the midline with no palpable subcutaneous air, and there was no audible stridor. A cervical spine X-ray and CT scan ruled out any fracture or dislocation.
The child was admitted for neurological observation and remained stable overnight. He was discharged home the following day with appropriate advice and a review of home safety arrangements scheduled with the health visitors.
His subsequent progress has been uneventful. His good outcome was due to prompt initial resuscitation initiated by his father--guided over the telephone by the paramedic team--and subsequent care by the multidisciplinary team.
Epidemiology of child hanging injuries Hanging injuries and fatalities are quite rare among infants and young children. In most instances, they are caused by common objects of everyday use. Most of the causes are preventable, so parental education on home safety is necessary. Health visitors, community nurses and practice nurses have a crucial role to play in providing parental education regarding home safety measures.
In the UK, there has been one child death per year from strangulation associated with blind cords, (1) though the probable underreporting of near-misses suggests that it should be given greater priority...