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No strings attached: preventing deaths from children’s clothing
  1. Department of Paediatrics & Child Health
  2. Cork University Hospital, University College Cork, Republic of Ireland

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    Editor,—Drawstrings on children’s clothing are a hidden hazard that can lead to death and injury when they catch on cribs, playground equipment, vehicles, and escalators.1-3Although rare, 17 deaths and 42 non-fatal accidents involving the entanglement of drawstrings on children’s outerwear were reported from 1985–95 in the United States. At least 12 of these incidents involved the entanglement of drawstrings in the doors of school buses.4 The recent unrelated deaths of two young boys in Ireland, following entanglement of part of their outercoats in the door of a school bus5 and rotating powershaft of a tractor,6 prompted us to evaluate the safety of children’s outerwear.

    We evaluated the safety of different designs of children’s winter outerwear carrying drawstrings in nine department stores and boutiques in Cork City, Ireland. In addition, we examined the outerwear worn by children (younger than 12 years) in two local primary schools. Outerwear was defined as “safe” according to the following guidelines for children’s outerwear established by the United States consumer product safety commission4:

    • outerwear should not carry hood or neck drawstrings

    • it should not have waist strings that extended beyond 7.4 cm

    • the waist strings should be sewn down at the midpoint

    • there should not be toggles or knots on the ends of strings.

    Of the 77 different designs of outerwear examined from nine department stores and boutiques, only 23.4% (9 of 40 girls’ garments and 9 of 37 boys’ garments) fulfilled the safety recommendations. Almost half of the garments (28 of 59) had hood or neck strings, while 44 of 59 had excessively long waist drawstrings. Two thirds of the garments (38 of 59) were not sewn down at their midpoint and most had toggles or knots on the end (42 of 59).

    Of the 183 school children’s outerwear examined, only 38.8% (33 of 84 girls’ garments, 38 of 99 boys’ garments) met the safety recommendations. Almost half had hood strings, while the remainder had excessively long waist drawstrings, which were not sewn down at their midpoint and/or had toggles or knots at the end. There was no obvious difference in the safety profile of outerwear garments between the sexes or across different age groups.

    The Irish Industrial Research and Standards Order 1976 states that “it is unlawful to manufacture, assemble or sell a child’s outergarment if the hood is designed to be secured by means of a cord drawn through the material”. This study confirms that this law is not being enforced and that consumers are making unsafe choices in selecting outergarments. As the clothing stores we studied are common to most areas in the UK, we have no reason to believe that the design of children’s clothing in the UK is safer than in Ireland, despite the recommendations of the British Standards Institution.7

    The effectiveness of properly enforced legislative and regulatory interventions in the children’s clothing industry has been well illustrated by the reduction in childhood burns from loose and flammable nightclothes.8 However, the fact that less than a quarter of children’s outerwear styles in shops were considered safe in terms of drawstrings indicates a lack of enforcement of recognised safety standards. Although some clothing hazards are difficult to correct without altering the function or aesthetic appeal, this is not the case for outerwear. Metal snaps, buttons, velcro or elastic can replace drawstrings, the main source of danger in outerwear.

    Deaths due to children’s clothing are uncommon but preventable. It is essential that child care professionals, the government, and clothing industry work together to ensure that established safety standards for the design, sale, and importation of children’s outerwear are properly enforced.