Children's deaths from choking on small objects dropped by 75 percent from 1968 to 2017, according to a report published in JAMA. Various choking hazard regulations enacted during the past 50 years may have played a role in the large decline in choking deaths, although the study design cannot establish a direct causal link. However, despite warning label legislation and other regulations, 184 children in the U.S. died from choking in 2017.
"While we see substantial progress in reducing choking deaths in children over the years, we need to do more to keep young children safe," says study co-author Jennifer Lavin, MD, pediatric ENT specialist at Ann & Robert H. Lurie Children's Hospital of Chicago and Assistant Professor of Otolaryngology - Head and Neck Surgery at Northwestern University Feinberg School of Medicine. "We urge parents to be extra careful in keeping small objects away from children under 3 years old, especially when there are older siblings playing with toys that have small parts, which pose a choking hazard to younger kids."
In 1969, the Child Safety and Protection and Toy Safety Act set the groundwork for prohibiting products designed for children under 3 years old to contain parts that are smaller than the airway of a child that age (or parts fitting in what is known as a small parts test cylinder). This prohibition was enacted in 1979. In 1994, came the requirements for explicit choking hazard warning labels on toys and regulations were tightened for small parts cylinder tests.
"In the 1990s, there was a sharper decline in choking deaths in children younger than 3 years, exceeding 8 percent annually, compared to over 2 percent annual decrease in the years before and after," says Dr. Lavin. "The warning label legislation certainly appears to have made a difference. More national efforts are needed to make an even greater impact toward eliminating deaths from choking in young children."
Dr. Lavin and colleagues highlight the need to reconsider the design of the small parts cylinder, given that 23 percent of object-related choking deaths in children result from objects that passed the current small parts cylinder test.