Background The neck is a vulnerable part of the body due to its close proximity with major blood vessels, trachea and lack of bony protection. Neck injuries are more likely than not to be non -accidental. 2.5% of deaths worldwide are by strangulation.

Symptoms in survivors include bruising, hoarse voice, dysphagia, unconsciousness, surgical emphysema and psychological problems in the long term.

There is little literature about non-lethal, non-accidental strangulation injuries in children.

Method Case note review in a 12 month period of 6 children presenting with neck bruising and alleging to being strangled

Summary These children had neck bruising consistent with being held around the neck (Table 1). There were no serious consequences. 2 children sustained injuries when restrained by teachers, one disabled child throttled by step-dad for not going to bed. 3 cases were associated with domestic violence.

Conclusions When there are suspicions of attempted strangulation Child protection procedures should be followed even if there are no visible injuries was the child would continue to be at risk of harm.

Teachers should review their practice of restraint when dealing with violent children.

Adolescent girls, can be subjected to severe domestic abuse from their partners with of serious consequences.

More research on the long-term effects of children experiencing strangulation is required.