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Accidental childhood strangulation by human hair
International Journal of Pediatric Otorhinolaryngology (2005) 69, 1621—1628
www.elsevier.com/locate/ijporl
Accidental childhood strangulation by human hair Scott M. Milkovich *, John Owens, Daniel Stool, Xiao Chen, Melissa Beran RAM Consulting, VP, Research; Engineering, 2107 Swift Drive, Suite 200, Oak Brook, IL 60523, USA Received 23 March 2005; accepted 29 April 2005
KEYWORDS Strangulation; Ligature mark; Human hair
Summary A low-income mother is accused of child abuse after co-sleeping with, and then waking to find her 13-month-old daughter entangled and apparently strangling in the mother’s hair. The baby was initially unconscious and cyanotic; revived by the time the parents reached the ER, clinical examination revealed a ligature mark on the neck and petechiae on the face. In a pro bono effort, her attorney teamed with RAM Consulting as an expert witness. RAM performed a six-part investigation including: (1) an anthropometric analysis, (2) determination of the strength of human hair, (3) characterization of the ligature mark, (4) an investigation into airway occlusion forces, (5) an investigation into the conditions required to initiate petechiae, and (6) a review of the literature. Our conclusion was that it is possible for a strangulation incident to occur when a young child is co-sleeping with a parent with long hair, and that this scenario may result in injury or death. Upon review of this report and RAM’s deposition on this matter, the prosecuting attorney’s expert witness withdrew her testimony and the judge dismissed the case. # 2005 Elsevier Ireland Ltd. All rights reserved.
1. Introduction In the early hours of August 5, 2002, a mother awoke to find her 13-month-old daughter entangled and strangling in her (the mother’s) hair. The baby girl had been co-sleeping in her parent’s bed. The baby was entangled on top of her head, and initially the mother and father were unable to untangle and remove the child. When the child was removed, * Corresponding author. Tel.: +1 630 623 2564; fax: +1 630 623 6074. E-mail address: [email protected] (S.M. Milkovich).
she was found to be unconscious and cyanotic with a ligature mark around her neck. She soon revived, and the parents immediately took the child to the local emergency room. The ER physician noted petechiae on the child’s face and documented that a ligature mark extended threequarters of the way around her neck, see Fig. 1. In all other aspects the child appeared to be fine. However, the physician deemed the story to be impossible and fearing child abuse, contacted local officials. The mother was arrested and all six of her children were removed from the house. She was facing up to 30 years in prison.
0165-5876/$ — see front matter # 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2005.04.029
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2.2. Strength of human hair Is the mother’s hair strong enough to support the weight of the child and/or retain enough force on the neck to occlude the airway?
2.3. Ligature mark characterization Are the features of the observed ligature mark consistent with those that would be expected from human hair?
2.4. Airway occlusion force What is the force (or range of forces) required to occlude the airway in young children?
2.5. Conditions required to initiate petechiae What conditions are required to initiate the formation of petechiae under the alleged circumstances?
2.6. Literature review Fig. 1 Ligature mark, as documented in the ER, on the 13-month-old baby girl’s neck.
Is there any evidence to suggest that this is possible or may have happened before?
Unfortunately, the parents were low-income Hispanic migrant workers (the father is unable to speak or understand English) and unable to afford legal representation to defend themselves in court. However, a local attorney took on the case pro bono and contacted RAM Consulting to act as an expert witness [1]. We also agreed to help defend this family on a pro bono basis.
2. Materials and methods Several key analyses were undertaken to prove or disprove the validity of this incident, namely: (1) (2) (3) (4) (5) (6)
anthropometric analysis; strength of human hair; ligature mark characterization; airway occlusion force; conditions required to initiate petechiae; literature review.
A basic question must be answered by each of these analyses.
2.1. Anthropometric analysis Is the mother’s hair long enough to encircle and entangle around the child’s neck?
Fig. 2 Length of mother’s hair, as documented in the ER, on August 5, 2002.
Childhood strangulation by hair
1623
Table 1 Anthropometric data, neck circumference of young children [2] Age (months)
Fifth percentile (cm)
Mean (cm)
95th percentile (cm)
0—3 3—6 6—9 9—12 12—15 15—18
18.0 21.0 20.5 21.3 21.8 21.6
21.1 23.2 23.3 23.4 23.6 23.6
23.9 25.8 25.6 25.6 26.2 25.2
3. Results 3.1. Anthropometric analysis The length of the mother’s hair was documented the night of the incident at the ER, and was found to range from 30.5 cm (12 in.) at the base of the skull, up to 50.8 cm (20 in.) at the crown of the head, see Fig. 2. Anthropometric data analysis [2] shows that children aged 13 months are likely to have a neck circumference ranging from 21.8 to 26.2 cm, with an average of 23.6 cm, see Table 1. The combination of these facts demonstrates that the mother’s hair could have wrapped around the child’s neck, with enough length to entangle.
3.2. Strength of human hair In order to determine if human hair is able to withstand the weight of a young child, and/or retain enough force to occlude the airway, two parameters must be established: (1) the load-bearing capability
Fig. 3
of human hair and (2) the average weight of a young child. To facilitate this investigation, a sample of the mother’s hair was obtained from the mother and provided to us. Since this was a single sample and would be needed for our airway occlusion force investigation, samples of commercially available hair, with similar characteristics were purchased and evaluated. Fig. 3 is a photograph of the tensile tests performed on these hair samples and Table 2 is a tabulation of the test results. Note that the ‘‘diameter’’ tested (small bundle of hair) was deterTable 2 Results of tensile testing of small bundles of human hair Sample number
Ultimate load (kg/lbs)
1 2 3 4 5 Average
15.2/33.4 9.5/20.8 9.3/20.5 10.1/22.2 6.3/13.8 10.1/22.1
Example of the tensile testing procedure used to determine the strength of a small bundle of human hair.
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Table 3 Anthropometric data, body weight of young children [2] Age (months)
Fifth percentile (kg)
Mean (kg)
95th percentile (kg)
0—2 3—5 6—8 9—11 12—15 16—19
3.2 4.9 6.4 7.0 8.4 n/a
5.1 6.9 8.1 9.2 10.1 10.6
6.9 8.2 9.4 10.9 12.6 n/a
mined by estimating the ligature mark diameter from the photograph presented in Fig. 1. It was found that a bundle of human hair of this diameter could be expected to support between 6.3 (13.8 lbs) and 15.2 kg (33.4 lbs), at an average of 10.1 kg (22.1 lbs) of weight without breaking. Next, an anthropometric analysis [2] was performed on the total body weight of young children, which is presented in Table 3. It can be seen that a 13-month-old child is likely to weigh between 8.4 and 12.6 kg, with an average of 10.1 kg. This range is within the range of possible loads that could be supported by a small bundle of human hair, and furthermore, since the child was lying in bed with her parents, it is unlikely that the full body weight of the child would have been needed to be supported in order for this incident to occur.
3.3. Ligature mark characterization The features of a ligature mark can provide a great deal of information about the object that caused the injury. For example, semi-rigid uniform diameter
Fig. 4
cords would be expected to produce a ‘‘sharp’’ well-defined ligature mark, while a more flexible material with a variable diameter (such as human hair) would be expected to produce a more diffuse, less-defined ligature mark. In addition, a stranded material (such as a small bundle of human hair) may leave an indication of this type of structure. Upon examination of the photographs of the ligature mark on the child, a diffuse ligature mark is observed and at one location appears to ‘‘bifurcate’’ and then ‘‘rejoin’’. The mark also appears to more defined towards the edges and less defined in the center, resulting in the appearance of two diffusely defined faint parallel lines, see Fig. 4a below. In an attempt to recreate the ligature mark and its associated features, we took a sample of human hair (commercially purchased) and wrapped it around the neck of an anthropometric manikin. RAM had previously fabricated this manikin to be representative of a young child, including the dimensions of the neck and the elastic behavior of the ‘‘tissue-simulating’’ silicone from which the neck was constructed. Between the hair sample and the manikin’s neck,
(a) Close-up of ligature mark on the child and (b) simulated force distribution created via a pressure-sensitive film.
Childhood strangulation by hair
Fig. 5
Double-blind study to measure airway occlusion force in young children [5].
we placed a sample of ‘‘pressure sensitive film [3]’’, which reacts to varying levels of force by producing varying shades of red color, see Fig. 4b. Since the film is relatively rigid, compared to the hair sample and the manikin’s neck, it produces artificial ‘‘wrinkles’’ that show up as red ‘‘Xs’’ on the image, but looking past these the observer can easily see two diffuse parallel lines of force. This would tend to suggest that it is possible to create this type of ligature mark with human hair.
3.4. Airway occlusion force To cite the force necessary to occlude a child’s airway [4], we turned to a previously published
Fig. 6
1625
study that some of us participated in, entitled ‘‘Prevention of Accidental Childhood Strangulation, A Clinical Study [5]’’. This study consisted of making in vivo measurements in the suprahyoid region on 90+ anesthesitized children, aged 0—6 years of age. A small force gauge was used to momentarily close the airway, confirmed by the anesthesiologist, while the force required to do so was recorded in a double-blind study, see Figs. 5 and 6. The results of these airway occlusion force measurements were statistically analyzed and are presented in Fig. 7. As can be seen from the data, as little as 0.2— 2.0 lbs of direct force is sufficient to close the air-
Endoscopic verification of airway occlusion during airway occlusion force measurements in young children [5].
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S.M. Milkovich et al.
Fig. 7
Airway occlusion forces in young children [5].
way of a 1-year-old child, and as little as 0.5—3.5 lbs of direct force for 2- and 3-year-old children. Therefore, under the right conditions and applied force direction, it is possible to occlude the airway of a 13month-old child with very little force, which is possible to be retained by a small bundle of human hair.
3.5. Conditions required to initiate petechiae One of the factors of major discussion in this case was the presence of petechiae and conjecture into the amount of force required to create this condition, and whether or not this could be accomplished through entanglement in human hair. In a similar occlusion study, this time looking at vascular occlusion forces in the neck, some of us also established that very little external force is required to occlude the exterior jugular vein [6]. While this study in itself does not determine the conditions required for the formation of petechiae in the face, it does loan information as to the low levels of external force required to interfere with blood return from the head, see Fig. 8. In addition, we are familiar with at
Fig. 8
least one incident in a near-strangulation situation, which resulted in petechiae formation on the face (Fig. 9) where the victim was known to be in a vascular occlusion mode for only a few minutes.
3.6. Literature review Next, we searched the literature to determine whether or not incidents of this type, or similar, had been reported before. Indeed we found such a reference entitled ‘‘Accidental Strangulation by Mother’s Hair [7]’’. The key aspects of this case are as follows: 27-month-old male sleeping with mother, who had unbraided waist length hair; awakened by her husband to find the child entangled in hair and cyanotic; once hair was removed from around the neck the child revived; a 1 cm (0.39 in.) wide ligature mark on the child’s neck and numerous petechiae were found on the child’s face during medical examination, both consistent with strangulation; case was ruled an accident.
Vascular occlusion forces for the neck in young children [6].
Childhood strangulation by hair
Fig. 9
Fig. 10
1627
Near-strangulation victim showing petechiae to the face after a few minutes of vascular occlusion in the neck.
RAMes strangulation hazard assessment manikin with the victim’s mother’s hair entangled around the neck.
4. Discussion
5. Conclusion
Finally, we applied an actual sample of the mother’s hair, as was described previously, to our anthropometric manikin, which also contains force sensors in the neck [8], see Fig. 10. The mother’s hair not only easily entangled around the neck of the manikin, but it also resulted in a force on the neck greater than that required to occlude the airway.
It is possible for a strangulation incident to occur when a young child is co-sleeping with a parent with long hair. It is also possible for this scenario to result in an injury or death. Upon review of this report and RAM’s deposition in this matter, the prosecuting attorney’s expert witness withdrew her testimony and the judge dismissed the case. The family has since been reunited.
1628
S.M. Milkovich et al.
References [5] [1] G. Rider, S. Milkovich, D. Stool, X. Chen, Prevention of accidental strangulation, Presented to: Seventh World Conference on Injury Prevention and Safety Promotion, June 6— 9, 2004. [2] CHILDDATA, The Handbook of Child Measurements and Capabilities, DTI, Department of Trade and Industry, UK, DTI/Pub 1732/2k/2.96 AR, URN 95/681, ISBN number:0-9522 571-1-4, June 1995. [3] PRESSUREX1 FILM, Pressure Sensitive Film, distributed by SPI Sensor Products Inc., 188 Route 10, E. Hanover, NJ 07936, manufactured by Fuji Film. [4] R. Stevens, J. Lane, S. Milkovich, D. Stool, G. Rider, S. Stool, Prevention of accidental childhood strangulation: Where is
[6]
[7]
[8]
the Site of the Obstruction? Int. J. Pediatr. Otolaryngol. 49 (Suppl. 1) (1999) S321—S322. R. Stevens, J. Lane, S. Milkovich, D. Stool, G. Rider, S. Stool, Prevention of Accidental childhood strangulation. A clinical study, Ann. Otol. Rhinol. Laryngol. 109 (9) (2000) 797—802. D. Stool, S. Milkovich, R. Stevens, Physical modeling of ligature strangulation, Presented to: Society for Ear, Nose & Throat Advances in Children (SENTAC), December 1999. D. Kindley, R. M. Todd, accidental strangulation by mother’s hair, University Department of Child Health, Alder Hey Children’s Hospital, Liverpool, UK, The Lancet 1 (8063) (1978, 11 March) 565. W. Fox, T. Shaffer, D. Stool, S. Milkovich, G. Rider, X. Chen, R. Ryan, S. Stool, A computerized, robotic model for evaluation of infant strangulation, Pediatr. Res. 53 (4) (2003) 341A.
www.elsevier.com/locate/ijporl
Accidental childhood strangulation by human hair Scott M. Milkovich *, John Owens, Daniel Stool, Xiao Chen, Melissa Beran RAM Consulting, VP, Research; Engineering, 2107 Swift Drive, Suite 200, Oak Brook, IL 60523, USA Received 23 March 2005; accepted 29 April 2005
KEYWORDS Strangulation; Ligature mark; Human hair
Summary A low-income mother is accused of child abuse after co-sleeping with, and then waking to find her 13-month-old daughter entangled and apparently strangling in the mother’s hair. The baby was initially unconscious and cyanotic; revived by the time the parents reached the ER, clinical examination revealed a ligature mark on the neck and petechiae on the face. In a pro bono effort, her attorney teamed with RAM Consulting as an expert witness. RAM performed a six-part investigation including: (1) an anthropometric analysis, (2) determination of the strength of human hair, (3) characterization of the ligature mark, (4) an investigation into airway occlusion forces, (5) an investigation into the conditions required to initiate petechiae, and (6) a review of the literature. Our conclusion was that it is possible for a strangulation incident to occur when a young child is co-sleeping with a parent with long hair, and that this scenario may result in injury or death. Upon review of this report and RAM’s deposition on this matter, the prosecuting attorney’s expert witness withdrew her testimony and the judge dismissed the case. # 2005 Elsevier Ireland Ltd. All rights reserved.
1. Introduction In the early hours of August 5, 2002, a mother awoke to find her 13-month-old daughter entangled and strangling in her (the mother’s) hair. The baby girl had been co-sleeping in her parent’s bed. The baby was entangled on top of her head, and initially the mother and father were unable to untangle and remove the child. When the child was removed, * Corresponding author. Tel.: +1 630 623 2564; fax: +1 630 623 6074. E-mail address: [email protected] (S.M. Milkovich).
she was found to be unconscious and cyanotic with a ligature mark around her neck. She soon revived, and the parents immediately took the child to the local emergency room. The ER physician noted petechiae on the child’s face and documented that a ligature mark extended threequarters of the way around her neck, see Fig. 1. In all other aspects the child appeared to be fine. However, the physician deemed the story to be impossible and fearing child abuse, contacted local officials. The mother was arrested and all six of her children were removed from the house. She was facing up to 30 years in prison.
0165-5876/$ — see front matter # 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2005.04.029
1622
S.M. Milkovich et al.
2.2. Strength of human hair Is the mother’s hair strong enough to support the weight of the child and/or retain enough force on the neck to occlude the airway?
2.3. Ligature mark characterization Are the features of the observed ligature mark consistent with those that would be expected from human hair?
2.4. Airway occlusion force What is the force (or range of forces) required to occlude the airway in young children?
2.5. Conditions required to initiate petechiae What conditions are required to initiate the formation of petechiae under the alleged circumstances?
2.6. Literature review Fig. 1 Ligature mark, as documented in the ER, on the 13-month-old baby girl’s neck.
Is there any evidence to suggest that this is possible or may have happened before?
Unfortunately, the parents were low-income Hispanic migrant workers (the father is unable to speak or understand English) and unable to afford legal representation to defend themselves in court. However, a local attorney took on the case pro bono and contacted RAM Consulting to act as an expert witness [1]. We also agreed to help defend this family on a pro bono basis.
2. Materials and methods Several key analyses were undertaken to prove or disprove the validity of this incident, namely: (1) (2) (3) (4) (5) (6)
anthropometric analysis; strength of human hair; ligature mark characterization; airway occlusion force; conditions required to initiate petechiae; literature review.
A basic question must be answered by each of these analyses.
2.1. Anthropometric analysis Is the mother’s hair long enough to encircle and entangle around the child’s neck?
Fig. 2 Length of mother’s hair, as documented in the ER, on August 5, 2002.
Childhood strangulation by hair
1623
Table 1 Anthropometric data, neck circumference of young children [2] Age (months)
Fifth percentile (cm)
Mean (cm)
95th percentile (cm)
0—3 3—6 6—9 9—12 12—15 15—18
18.0 21.0 20.5 21.3 21.8 21.6
21.1 23.2 23.3 23.4 23.6 23.6
23.9 25.8 25.6 25.6 26.2 25.2
3. Results 3.1. Anthropometric analysis The length of the mother’s hair was documented the night of the incident at the ER, and was found to range from 30.5 cm (12 in.) at the base of the skull, up to 50.8 cm (20 in.) at the crown of the head, see Fig. 2. Anthropometric data analysis [2] shows that children aged 13 months are likely to have a neck circumference ranging from 21.8 to 26.2 cm, with an average of 23.6 cm, see Table 1. The combination of these facts demonstrates that the mother’s hair could have wrapped around the child’s neck, with enough length to entangle.
3.2. Strength of human hair In order to determine if human hair is able to withstand the weight of a young child, and/or retain enough force to occlude the airway, two parameters must be established: (1) the load-bearing capability
Fig. 3
of human hair and (2) the average weight of a young child. To facilitate this investigation, a sample of the mother’s hair was obtained from the mother and provided to us. Since this was a single sample and would be needed for our airway occlusion force investigation, samples of commercially available hair, with similar characteristics were purchased and evaluated. Fig. 3 is a photograph of the tensile tests performed on these hair samples and Table 2 is a tabulation of the test results. Note that the ‘‘diameter’’ tested (small bundle of hair) was deterTable 2 Results of tensile testing of small bundles of human hair Sample number
Ultimate load (kg/lbs)
1 2 3 4 5 Average
15.2/33.4 9.5/20.8 9.3/20.5 10.1/22.2 6.3/13.8 10.1/22.1
Example of the tensile testing procedure used to determine the strength of a small bundle of human hair.
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Table 3 Anthropometric data, body weight of young children [2] Age (months)
Fifth percentile (kg)
Mean (kg)
95th percentile (kg)
0—2 3—5 6—8 9—11 12—15 16—19
3.2 4.9 6.4 7.0 8.4 n/a
5.1 6.9 8.1 9.2 10.1 10.6
6.9 8.2 9.4 10.9 12.6 n/a
mined by estimating the ligature mark diameter from the photograph presented in Fig. 1. It was found that a bundle of human hair of this diameter could be expected to support between 6.3 (13.8 lbs) and 15.2 kg (33.4 lbs), at an average of 10.1 kg (22.1 lbs) of weight without breaking. Next, an anthropometric analysis [2] was performed on the total body weight of young children, which is presented in Table 3. It can be seen that a 13-month-old child is likely to weigh between 8.4 and 12.6 kg, with an average of 10.1 kg. This range is within the range of possible loads that could be supported by a small bundle of human hair, and furthermore, since the child was lying in bed with her parents, it is unlikely that the full body weight of the child would have been needed to be supported in order for this incident to occur.
3.3. Ligature mark characterization The features of a ligature mark can provide a great deal of information about the object that caused the injury. For example, semi-rigid uniform diameter
Fig. 4
cords would be expected to produce a ‘‘sharp’’ well-defined ligature mark, while a more flexible material with a variable diameter (such as human hair) would be expected to produce a more diffuse, less-defined ligature mark. In addition, a stranded material (such as a small bundle of human hair) may leave an indication of this type of structure. Upon examination of the photographs of the ligature mark on the child, a diffuse ligature mark is observed and at one location appears to ‘‘bifurcate’’ and then ‘‘rejoin’’. The mark also appears to more defined towards the edges and less defined in the center, resulting in the appearance of two diffusely defined faint parallel lines, see Fig. 4a below. In an attempt to recreate the ligature mark and its associated features, we took a sample of human hair (commercially purchased) and wrapped it around the neck of an anthropometric manikin. RAM had previously fabricated this manikin to be representative of a young child, including the dimensions of the neck and the elastic behavior of the ‘‘tissue-simulating’’ silicone from which the neck was constructed. Between the hair sample and the manikin’s neck,
(a) Close-up of ligature mark on the child and (b) simulated force distribution created via a pressure-sensitive film.
Childhood strangulation by hair
Fig. 5
Double-blind study to measure airway occlusion force in young children [5].
we placed a sample of ‘‘pressure sensitive film [3]’’, which reacts to varying levels of force by producing varying shades of red color, see Fig. 4b. Since the film is relatively rigid, compared to the hair sample and the manikin’s neck, it produces artificial ‘‘wrinkles’’ that show up as red ‘‘Xs’’ on the image, but looking past these the observer can easily see two diffuse parallel lines of force. This would tend to suggest that it is possible to create this type of ligature mark with human hair.
3.4. Airway occlusion force To cite the force necessary to occlude a child’s airway [4], we turned to a previously published
Fig. 6
1625
study that some of us participated in, entitled ‘‘Prevention of Accidental Childhood Strangulation, A Clinical Study [5]’’. This study consisted of making in vivo measurements in the suprahyoid region on 90+ anesthesitized children, aged 0—6 years of age. A small force gauge was used to momentarily close the airway, confirmed by the anesthesiologist, while the force required to do so was recorded in a double-blind study, see Figs. 5 and 6. The results of these airway occlusion force measurements were statistically analyzed and are presented in Fig. 7. As can be seen from the data, as little as 0.2— 2.0 lbs of direct force is sufficient to close the air-
Endoscopic verification of airway occlusion during airway occlusion force measurements in young children [5].
1626
S.M. Milkovich et al.
Fig. 7
Airway occlusion forces in young children [5].
way of a 1-year-old child, and as little as 0.5—3.5 lbs of direct force for 2- and 3-year-old children. Therefore, under the right conditions and applied force direction, it is possible to occlude the airway of a 13month-old child with very little force, which is possible to be retained by a small bundle of human hair.
3.5. Conditions required to initiate petechiae One of the factors of major discussion in this case was the presence of petechiae and conjecture into the amount of force required to create this condition, and whether or not this could be accomplished through entanglement in human hair. In a similar occlusion study, this time looking at vascular occlusion forces in the neck, some of us also established that very little external force is required to occlude the exterior jugular vein [6]. While this study in itself does not determine the conditions required for the formation of petechiae in the face, it does loan information as to the low levels of external force required to interfere with blood return from the head, see Fig. 8. In addition, we are familiar with at
Fig. 8
least one incident in a near-strangulation situation, which resulted in petechiae formation on the face (Fig. 9) where the victim was known to be in a vascular occlusion mode for only a few minutes.
3.6. Literature review Next, we searched the literature to determine whether or not incidents of this type, or similar, had been reported before. Indeed we found such a reference entitled ‘‘Accidental Strangulation by Mother’s Hair [7]’’. The key aspects of this case are as follows: 27-month-old male sleeping with mother, who had unbraided waist length hair; awakened by her husband to find the child entangled in hair and cyanotic; once hair was removed from around the neck the child revived; a 1 cm (0.39 in.) wide ligature mark on the child’s neck and numerous petechiae were found on the child’s face during medical examination, both consistent with strangulation; case was ruled an accident.
Vascular occlusion forces for the neck in young children [6].
Childhood strangulation by hair
Fig. 9
Fig. 10
1627
Near-strangulation victim showing petechiae to the face after a few minutes of vascular occlusion in the neck.
RAMes strangulation hazard assessment manikin with the victim’s mother’s hair entangled around the neck.
4. Discussion
5. Conclusion
Finally, we applied an actual sample of the mother’s hair, as was described previously, to our anthropometric manikin, which also contains force sensors in the neck [8], see Fig. 10. The mother’s hair not only easily entangled around the neck of the manikin, but it also resulted in a force on the neck greater than that required to occlude the airway.
It is possible for a strangulation incident to occur when a young child is co-sleeping with a parent with long hair. It is also possible for this scenario to result in an injury or death. Upon review of this report and RAM’s deposition in this matter, the prosecuting attorney’s expert witness withdrew her testimony and the judge dismissed the case. The family has since been reunited.
1628
S.M. Milkovich et al.
References [5] [1] G. Rider, S. Milkovich, D. Stool, X. Chen, Prevention of accidental strangulation, Presented to: Seventh World Conference on Injury Prevention and Safety Promotion, June 6— 9, 2004. [2] CHILDDATA, The Handbook of Child Measurements and Capabilities, DTI, Department of Trade and Industry, UK, DTI/Pub 1732/2k/2.96 AR, URN 95/681, ISBN number:0-9522 571-1-4, June 1995. [3] PRESSUREX1 FILM, Pressure Sensitive Film, distributed by SPI Sensor Products Inc., 188 Route 10, E. Hanover, NJ 07936, manufactured by Fuji Film. [4] R. Stevens, J. Lane, S. Milkovich, D. Stool, G. Rider, S. Stool, Prevention of accidental childhood strangulation: Where is
[6]
[7]
[8]
the Site of the Obstruction? Int. J. Pediatr. Otolaryngol. 49 (Suppl. 1) (1999) S321—S322. R. Stevens, J. Lane, S. Milkovich, D. Stool, G. Rider, S. Stool, Prevention of Accidental childhood strangulation. A clinical study, Ann. Otol. Rhinol. Laryngol. 109 (9) (2000) 797—802. D. Stool, S. Milkovich, R. Stevens, Physical modeling of ligature strangulation, Presented to: Society for Ear, Nose & Throat Advances in Children (SENTAC), December 1999. D. Kindley, R. M. Todd, accidental strangulation by mother’s hair, University Department of Child Health, Alder Hey Children’s Hospital, Liverpool, UK, The Lancet 1 (8063) (1978, 11 March) 565. W. Fox, T. Shaffer, D. Stool, S. Milkovich, G. Rider, X. Chen, R. Ryan, S. Stool, A computerized, robotic model for evaluation of infant strangulation, Pediatr. Res. 53 (4) (2003) 341A.