{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T22:40:00Z","timestamp":1759963200371},"reference-count":16,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2009,1,2]],"date-time":"2009-01-02T00:00:00Z","timestamp":1230854400000},"content-version":"vor","delay-in-days":62,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2008,11]]},"abstract":"Abstract<\/jats:title>Objectives\/Hypothesis:<\/jats:bold> 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\u2010mm inside\u2010diameter 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.<\/jats:p>Study Design:<\/jats:bold> Retrospective case series, 48 tertiary care pediatric hospitals (1989\u20132004) and historical review (1972\u20132007).<\/jats:p>Methods:<\/jats:bold> American Academy of Pediatrics and Consumer Product Safety Commission documents and published reports. Forty\u2010eight children's hospital medical records were reviewed by ICD\u20109 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.<\/jats:p>Results:<\/jats:bold> Twenty\u2010three 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.<\/jats:p>Conclusions:<\/jats:bold> Over one\u2010fifth 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\u2010mm diameter open\u2010bottom 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\u2010parts fatalities to children (including children 3 years of age and older) and the overwhelming majority of nonfatal injuries.<\/jats:p>","DOI":"10.1097\/mlg.0b013e31818173d5","type":"journal-article","created":{"date-parts":[[2008,10,22]],"date-time":"2008-10-22T07:09:03Z","timestamp":1224659343000},"page":"2082-2086","source":"Crossref","is-referenced-by-count":24,"title":["Development of the Small Parts Cylinder: Lessons Learned"],"prefix":"10.1002","volume":"118","author":[{"given":"Scott M.","family":"Milkovich","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Altkorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James S.","family":"Reilly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Stool","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke","family":"Tao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gene","family":"Rider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,1,2]]},"reference":[{"key":"e_1_2_6_2_2","unstructured":"World Population Prospects:The 2006 Revision Department of Economic and Social Affairs Population Division. Available athttp:\/\/www.un.org\/esa\/population\/publications\/wpp2006\/wpp2006.htm."},{"key":"e_1_2_6_3_2","unstructured":"Public Law 91\u2010113 83 Stat. 187\u201090."},{"key":"e_1_2_6_4_2","unstructured":"Correspondence between Dale Miller Bureau of Product Safety and HJames Holroyd Chairman of Accident Prevention Committee of AAP January 25 1971 as cited in VanHouten DT Human Factors Analysis of Ingestion Aspiration and Choking Injuries U.S. Consumer Product Safety Commission Report June 5 1978."},{"key":"e_1_2_6_5_2","unstructured":"VanHoutenDT. Human Factors Analysis of Ingestion Aspiration and Choking Injuries U.S. Consumer Product Safety Commission Report June 5 1978."},{"key":"e_1_2_6_6_2","unstructured":"Proposed Banning of Toys and Other Children's Articles Presenting Choking Aspiration and\/or Ingestion Hazards Due to Small Parts Federal Register January 22 1973;Vol. 38:No. 14."},{"key":"e_1_2_6_7_2","unstructured":"FrezzaA.Study to determine the size of toy\/toy parts which caused suffocation Final Report Contract # CPSC\u2010C\u201076\u20100123 29 September 1977."},{"key":"e_1_2_6_8_2","unstructured":"RutherfordGWJr BealeSP FriedmanJI.Hazard Analysis Injuries Associated with Small Objects U.S. Consumer Product Safety Commission Directorate for Hazard Identification and Analysis\u2010Epidemiology May 1978."},{"key":"e_1_2_6_9_2","unstructured":"U.S. Code of Federal Regulations 16cfr1501."},{"key":"e_1_2_6_10_2","unstructured":"U.S Code of Federal Regulations 16cfr1510 and 16cfr1511."},{"key":"e_1_2_6_11_2","unstructured":"DeppaSW.Human factors analysis: Choking incidents in children U.S. Consumer Products Safety Commission Directorate for Epidemiology Division of Human Factors November 1983."},{"key":"e_1_2_6_12_2","unstructured":"CPSC Press release #90=055 CPSC Decides Choking Issues. Available athttp:\/\/www.cpsc.gov\/cpscpub\/prerel\/prhtml90\/90055.html."},{"key":"e_1_2_6_13_2","unstructured":"Choking Risks to children under four from toys an other objects DTI Report URN 99\/708. Available athttp:\/\/www.berr.gov.uk\/files\/file25392.pdf."},{"key":"e_1_2_6_14_2","unstructured":"Trouble in Toyland NYPIRG's 2002 Toy Safety Report. Available athttp:\/\/www.nypirg.org\/consumer\/toysafety00\/hazards.html."},{"key":"e_1_2_6_15_2","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1001\/jama.1995.03530220029027","article-title":"Characteristics of objects that cause choking in children","volume":"274","author":"Rimell FL","year":"1995","journal-title":"JAMA"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0031-3955(05)70525-3"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2003.08.022"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1097%2FMLG.0b013e31818173d5","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1097\/MLG.0b013e31818173d5","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T20:19:34Z","timestamp":1696882774000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1097\/MLG.0b013e31818173d5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,11]]},"references-count":16,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2008,11]]}},"alternative-id":["10.1097\/MLG.0b013e31818173d5"],"URL":"https:\/\/doi.org\/10.1097\/mlg.0b013e31818173d5","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,11]]}}}