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.

Study Design: Retrospective case series, 48 tertiary care pediatric hospitals (1989-2004) and historical review (1972-2007).

Methods: American Academy of Pediatrics and Consumer Product Safety Commission documents and published reports. Forty-eight children's hospital medical records were reviewed by ICD-9 and current procedural terminology codes for injury or fatality data from foreign bodies (FBs) involved in airway obstruction or esophageal injury. All FBs dimensions were measured and statistically analyzed.

Results: Twenty-three percent of fatalities resulting from small parts over the study period involve objects that pass SPC evaluation and over 90% of FBs between 27.9 and 30.5 mm involved in nonfatal incidents pass SPC evaluation. Many objects involved in fatal and nonfatal injury pass because of the slanted bottom.

Conclusions: Over one-fifth of injuries and fatalities to children could be prevented if a standard more stringent than the SPC were in use. Alternative gauges and broader age guidelines are recommended. We propose a 38.1-mm diameter open-bottom gauge for nonspherical FBs and a similar 44.5 mm gauge for spherical FBs. We suggest that this new standard would have prevented all small-parts fatalities to children (including children 3 years of age and older) and the overwhelming majority of nonfatal injuries.