The design restrictions, instituted in 1997, limited the use of drawstrings typically found on jackets and sweatshirts and may have saved 50 children's lives, the new study finds.

"We'd routinely see these cases (of accidental strangulation) a couple times a year," said Dr. Stephen Teach, associate chief of the division of emergency medicine and trauma services at Children's National Medical Center in Washington, D.C.

"They were always so tragic because they were so preventable and families felt so bad about them," added Teach, who was not involved in the new research.

From 1985 through 1995, the government-backed U.S. Consumer Product Safety Commission (CPSC) tallied 17 drawstring-related deaths and 42 non-fatal injuries in children 14 years old and younger.

Some of the most horrific reports were of children being strangled when their drawstrings got caught on play equipment, or being dragged after getting caught on school bus handrails.

According to Gregory Rodgers of the CPSC in Bethesda, Maryland, voluntary guidelines adopted by the CPSC in 1995 were the model for the clothing industry's 1997 self-imposed restrictions.

The guidelines endorsed using buttons, Velcro and other materials instead of drawstrings near a child's neck, and said drawstrings near a child's waist should not hang longer than three inches.

The restrictions cover clothing meant for infants and children up to age 14.

Last year, CPSC took the guidelines a step further and issued a federal rule regarding drawstrings on children's clothing (see Reuters story of July 1, 2011).

DID THE RESTRICTIONS WORK?

To see whether the original guidelines had any effect, Rodgers and a colleague used information collected by CPSC staff on drawstring-related deaths in children. The numbers are based on news reports, medical records and other databases.

Overall, the researchers found 29 children's deaths were blamed on drawstrings between 1985 and 2009.

Of those deaths, 21 were blamed on drawstrings near a child's neck and all but one were in children younger than eight years old, the researchers report in the Archives of Pediatrics & Adolescent Medicine.

The other eight deaths were blamed on drawstrings near a child's waist and occurred in kids between the ages of seven and 14 years old. All but one of these cases, "occurred after drawstrings were entangled in school bus doors or handrails," the researchers write. "All (seven) children were dragged and, in most cases, crushed under the buses' wheels."

The vast majority of the documented deaths happened prior to 1997 - the year the clothing industry adopted the restrictions.

Between 1997 and the end of the study in 2009, there were six recorded deaths blamed on drawstrings.

The researchers say that works out to a 91 percent decrease in deaths after the restrictions were put in place, and based on that figure, they project that about 50 children's lives have been saved during the 12-year study period.

SCHOOL BUSES AND PLAYGROUNDS

Rodgers and his coauthor don't give all of the credit to the drawstring restrictions, however.

In 1995, the National Highway Traffic Safety Administration also adopted policies meant to reduce potential injuries from drawstrings getting caught on buses.

Those policies, according to the CPSC researchers, included recalls "to address hazards" on buses already in use, new bus designs and driver training. Those steps in conjunction with the drawstring requirements have been "particularly effective," they write.

Since those policies were adopted, there have been no reported deaths blamed on drawstrings being caught on buses, they note.

The researchers also say it's possible that improvements in playground safety may have played a role, but those improvements do not explain the rapid decrease in deaths.

Teach said he's definitely seen a drop in drawstring deaths and severe injury cases over the past ten years.

Overall, Teach told Reuters Health that the drawstring requirements are an example of a good, common-sense approach to a problem.

"The best way to manage injuries in children is to prevent them," he said.

SOURCE: bit.ly/KW8XjH Archives of Pediatrics & Adolescent Medicine, July 2012.

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