Strangulation in children: A threat to child safety

Aim The aim of this study was to review strangulation cases in children to identify risk factors, different mechanisms, and sequalae of strangulation. Method This is a retrospective analysis of strangulation cases admitted to King Abdullah Specialized Children’s Hospital from 2016 to 2023. The electronic medical records of all patients were reviewed, and the data were collected and analyzed. Results Among the 18 patients diagnosed with strangulation, 61% were males and 39% were females. Of these patients, 61% were between 7 and 14 years old, and 39% were toddlers (less than 4 years old). In terms of the mechanism of strangulation, 50% were deemed accidental, while 50% were self-inflicted as a result of playing in a challenge or suffocation game. Of the accidental cases, seven (77.7%) were children under 4 years old, and six (66%) were caused by curtain rope induction. The remaining three cases resulted from incidents involving a car window and an electric cable. However, the majority (55%) of participants who suffered from self-induced strangulation suffocation games were boys, and all were older than 7 years. In three cases (33%) the gaming or event had been previously noted by parents. The outcome of strangulation was severe in 39% of patients, resulting in neurological impairment and hypoxic-ischemic encephalopathy, and patients (44.4%) remained healthy on follow-up with no sequelae. The mortality rate was 27.7%, either as a result of follow-up complications from strangulation or upon arrival at the emergency department. Conclusion The current study contributes to the body of knowledge on accidental and self-inflicted strangulation in children, which can help healthcare professionals identify and address the mechanism of strangulation. Pediatricians must recognize self-inflicted strangulation as an emerging risk for adolescents in the digital age.