Daniel Stool

PREVENTION AND MANAGEMENT OF AERODIGESTIVE FOREIGN BODY INJURIES IN CHILDHOOD

Pediatricians have a critical role in the evaluation of children who experience a choking episode and foreign body injury. Familiarity with important symptoms and signs improves diagnostic skills and complements radiographic evaluation. Further reduction in injury prevention is assisted by parental education and avoidance of objects and foods that produce the greatest risk. Design modifications of toys and other products for childrens use is the next important step in this safety process.

Fatal and non-fatal food injuries among children (aged 0–14 years)

OBJECTIVE To identify and characterize food items with high risk of airway obstruction in children younger than 15 years. METHODS This retrospective study collected injury data from 1989 to 1998 for 26 pediatric hospitals in the United States and Canada. Aspiration, choking, ingestion, and insertion injuries due to food items were analyzed. The data included 1429 infants and children. Results were compared with fatality data published by the American Association of Pediatrics in 1984. RESULTS The 10 food objects with the highest frequency for both injuries and fatalities were identified. Peanuts caused the highest frequency of injury, and hot dogs were most often associated with fatal outcomes. The severity of respiratory distress prior to hospital evaluation varied for different foods. Age younger than 3 years was the highest-risk factor. Key characteristics such as bite size, shape, and texture were analyzed and found to demonstrate relationships with severity of clinical outcomes. CONCLUSIONS Children younger than 3 years remain at greatest risk of food injury and death. We found that hard, round foods with high elasticity or lubricity properties, or both, pose a significant level of risk. Consideration of the key characteristics of the most hazardous foods may greatly decrease airway obstruction injuries. Food safety education can help pediatricians and parents select, process, and supervise appropriate foods for children younger than 3 years to make them safer for this highest-risk population.

Development of the Small Parts Cylinder: Lessons Learned†

Objectives/Hypothesis: The Consumer Product Safety Commission mandates federal child choking prevention standards in the United States. Consumer Product Safety Commission utilizes the small parts cylinder (SPC), a 31.75‐mm inside‐diameter cylinder with a slanted bottom and depth ranging from 25.4 to 57.1 mm. The SPC was developed with very limited clinical data, and the effectiveness of the SPC remains controversial. Small parts ingestions remain among the most common causes of injury and fatality to preschool children. This study reviews the history, medical basis, and effectiveness of the SPC and provides recommendations for prevention of choking and airway fatalities.

Human factors project: development of computer models of anatomy as an aid to risk management

Behavioral studies and reports in the pediatric medical literature suggest that children, particularly those younger than 4 years, frequently place foreign objects such as toys and small parts of consumer products in their mouths, nasal cavities and ear canals. These actions not infrequently lead to injury or death. Accurate models of the anatomical areas most often severely injured by foreign body impaction (oral cavity, orbit, ear canal and nasal passages) would greatly facilitate assessment of the risks of impaction. Because models of these anatomic regions in children of the ages when they are most at risk are not widely available, Intertek Testing Services, Risk Analysis and Management (ITS RAM), in association with faculty at the University of Pittsburgh and the Pittsburgh Supercomputing Center at Carnegie Mellon University, developed computerized models of these anatomical areas of interest in children at the critical stages of child development. Computer models were also developed of proposed or existing products and of objects represented in the ITS RAM Small Parts Aspiration and Ingestion Database (comprised of data from 17 childrens hospitals) and fatality data from the Consumer Product Safety Commission. The computer models of products and computer anatomical models can be used to assess the possible hazards inherent in the product designs and to communicate the risks associated with product designs to manufacturers and marketing groups.

Quantitative risk analysis

Problem. Each year, unsafe consumer products are involved in millions of injuries and thousands of fatalities around the world. There is a need to quantitatively assess the risks to consumers posed by all types of consumer products. Objective. Quantitative Risk Analysis (QRA) is a scientific methodology that was developed to quantitatively demonstrate the potential risk associated with any given consumer product. QRA is based on the Risk Equation which is Risk = Hazard X Exposure. Methods. Key factors affecting Risk were studied. Factors impacting Hazard include Design Defects, Manufacturing Defects, and Foreseeable Use. Factors impacting Exposure include Product Quantity in distribution, Product Durability, Caregiver Vigilance, and Product Accessibility. Monte Carlo Simulation methods were utilized to generate estimates of product-related risk. Results. The Kinder Egg is used as an example and the QRA results for this product in the North American market are presented. Conclusion. QRA results can do the following: 1.) Determine if a design meets desired or necessary safety expectations 2.) Allow one to understand which components of a given design can be modified to ensure the greatest improvements in the safety of a given product 3.) Guide the development of product safety specifications and requirements and 4.) Determine if a recall is warranted. QRA can benefit risk managers and others by allowing them to identify the critical factors influencing the risks posed by consumer products in the global marketplace.

Prevention of Accidental Childhood Strangulation a Clinical Study

Accidental Strangulation is a preventable problem, and there is limited scientific understanding of its mechanism in children. If the amount of external pressure that occludes the airway can be determined, design changes may be made to allow for production of household objects that would break apart at safe pressure levels. A force gauge was applied to the suprahyoid region in 90 children under standardized anesthesia. Three blinded observers performed the study. The anesthesiologist maintained the airway and used a stethoscope to auscultate for breath sounds and monitor the CO2 curves to evaluate obstruction. The recorder noted the numbers from the gauge. A single observer applied the force gauge. Age was the most significant variable in occluding the airway. Obstruction appears to occur at the level of the larynx. Increased knowledge regarding the external pressure required for airway occlusion would allow for the design and manufacture of products with a reduced potential for accidental strangulation.

Prevention of accidental childhood strangulation: where is the site of obstruction?

BACKGROUND Accidental strangulation is a preventable problem with limited scientific understanding in children. Childrens clothing and household furniture have the potential to cause strangulation. Localizing the site of obstruction would provide understanding and insight to preventing this unfortunate event. METHODS While undergoing the application of pressure to the submental and suprahyoid region in eight patients flexible endoscopy was performed to evaluate the location of obstruction. RESULTS Submental pressure occluded the nasopharynx and oropharynx. Suprahyoid pressure occluded the larynx. CONCLUSIONS In suspension strangulation, airway obstruction appears to occur at the level of the larynx involving the epiglottis and the arytenoids. Increased knowledge regarding site of airway occlusion may help to decrease the hazard of accidental strangulation.

Development of a criterion to prevent tympanic membrane perforation caused by children's products

Consumer products or product components that fit into the external auditory canals may cause tympanic membrane perforation injuries to children (Fig. 1, A&B). The size, shape and consistency characteristics of the products or components of products responsible for these injuries may be described as long and slender with a consistency stiff enough to penetrate the tympanic membrane traumatically. Sharp terminal shapes are particularly hazardous. Assessing the hazard level of these products allows us to understand and communicate the risk of injury. This can in turn lead to the creation and use of product design criteria that reduce the risk of tympanic membrane rupture injuries to children.

Other Significant Hazards: Food-Related Choking

Food is the most common cause of choking-related injuries and fatalities in humans. A foods physical characteristics affect the probability, nature, and severity of food choking incidents. Cylindrical or spherical foods can effectively plug the airway and are often associated with fatalities. Pliability or elasticity increases risk by enabling the foods to conform and maintain contact with the airway wall. Foods such as seeds and nuts are more commonly associated with injury than fatality. They are small, sometimes slippery, and potentially conducive to loss of oral control, particularly when large numbers are placed in the mouth at once. However, they often are too small or flat to completely block the airway. Children represent the largest at-risk group for food choking, with incidents peaking between ages 1 and 2 years. Lack of experience and immature dentition contribute to childrens susceptibility to food-related choking.

Unintentional fires caused by products that focus sunlight

Unintentional Fires Caused by Products that Focus Sunlight Objectives The ability of myriad and sundry transparent and reflective objects to set fires by focusing sunlight has likely known since before the dawn of recorded history and was cited nearly 2500 years ago by Aristophanes. Yet modern generations greet this phenomenon with awe and bewilderment. Over the past decade product recalls, news stories and lawsuits have focused concern on domestic and wildfires set by such seemingly diverse objects as balls, garden ornaments, water bottles, dog bowls and lucky charms. No published safety standards or guidelines so much as mention this rara avis. We address it from historical and engineering perspectives and provide guidance on its assessment. Materials and Methods Recalled and historical products are reviewed. Fire prevention standards and literature involving radiant ignition are examined, as are terrestrial solar irradiance data. Relevant information from imaging and non-imaging optics is cited. Heat transfer variations between large and small irradiated areas are explained. Results of experiments with consumer products are presented. Results Methods of recognising, assessing and minimising hazards of accidental fires from sunlight focused by transparent and reflected objects are discussed. Discussion Understanding the radiometric characteristics of sunlight and focusing properties of transparent and reflective consumer products enables product designers to avoid unintentional fires.