Fatal suffocation by rubber balloons in children: mechanism and prevention

This paper presents five autopsy cases of children who died as a result of an accidental choking on latex (rubber) balloons. All of the investigated cases suffocated by an intact (non-broken), pear-shaped and medium-sized balloon of less than 9 cm in length and 4 cm in width. The mouthpieces of all the involved balloons were upward and above the vocal cords, while the nosepieces were downward in the larynx and the trachea. The application of continuous suction forces to uninflated or partially air-filled balloon is considered the most crucial factor in causing asphyxiation by rubber balloon. An uninflated balloon is usually placed outside the mouth cavity where the child sucks the balloon into the mouth, either during a repeated trial of inverting the balloon inside-out or during the application of a direct suction to their bulb. A partially air-filled balloon is usually placed inside the mouth cavity then it is pushed further inside by movements like sucking or chewing. Other important factors are a sudden slippage of the mouthpiece from the fingers or teeth of the child, as well as the panic of the suffocation. The process of suffocation is also facilitated by the counterforce, which results from a sudden pressure of the mouth cavity over the bulb of the balloon, and the consistency of the balloons as pliable objects. Once the balloon enters the airway, it is less likely to be expelled. Supervision of children by adults and proper education programs are needed to decrease this problem.