Unintentional deaths from suffocation and strangulation account for about 20% of all nontransport-related infant and child fatalities in the United States. In the late 1950s, some preventive countermeasures were introduced to reduce the number of deaths resulting from refrigerator or freezer entrapment. A few years later, countermeasures were introduced to prevent deaths resulting from suffocation by plastic bags, inhumation, and mechanical strangulation from wedging in infant cribs. For three of these major causes of suffocation and strangulation deaths among infants and children (refrigerator or freezer entrapment, suffocation by plastic bag, and inhumation at construction sites), there appears to have been a statistically-significant decline in incidence; however, there is no evidence of a statistically-significant reduction in deaths from mechanical strangulation in cribs. The impact of current countermeasures is discussed, and some suggestions for new or modified approaches are made.
Figure 3 shows death rates per million children from suffocation in refrigerators and freezers in California from 1960 through 1981. The rates were high in the early 1960s, then declined, then increased in 1966–2196856ya. Since then, the death rate has declined statistically-significantly (p = 0.05).
The ratio of suffocation events per million refrigerators and freezers sold in California is also displayed in Figure 3. Since 37% of entrapments in refrigerators or freezers involved more than 1 child (Table 3), it was appropriate to determine the ratio of events of entrapment in refrigerators or freezers (regardless of the number of children involved) to the number of units sold. As seen in Figure 3, the pattern is about the same as for death rates; that is, there is a peak ratio in the mid-to-late 1960s followed by a steady decline (p = 0.025) through 1981. It should be noted that the approximate lifespan of a refrigerator built in the 1950s was 15 years, according to the Association of Home Appliance Manufacturers. This may account for the lag before the decline in the incidence rate begins.