title: Fostering design for avoiding small parts in commonly used objects.
abstract: OBJECTIVE
  Injuries due to the accidental ingestion or aspiration of small parts have became a matter of interest in the last 30 years, focusing on the relationship between a proper prevention and the diminished frequency of occurrences. Small parts in commonly used objects represent a large sector of potential danger, taking explicit mouthing behavior of children in the first four years of life. In this paper the intent is to show the current situation of design projects and legislation around the world, meant to avoid the casual accidents due to manufacturing reasons. Proposed process and quality control standards seek to eliminate production errors and control materials to avoid deviation from the design.
  
  
  METHODS
  The present study draws its data from the Susy Safe registry, a European Commission co-funded project started in February 2005, whose aim is to establish an international registry of cases of Foreign Bodies (FB) injuries in children aged 0-14 years. Information collected from the data base concern age and gender of the child, location, shape, volume, consistency and elipticity of the foreign body, any complication occurred, hospitalization, and behavioral aspects linked to the injury, like the supervision of the parents or the activity concomitant to the injury. Cases are prospectively collected using the Susy Safe system from 06/2005; moreover, also information regarding past consecutive cases available in each center adhering to the project have been entered in the Susy Safe Registry.
  
  
  RESULTS
  Data evidenced that the majority of small parts related injuries are related to stationery. The majority of objects (56.7%), were located in the nose, followed by the ears (31.5%). The distribution on incidence of FB injuries by age class shows that the majority of injuries due to small parts in common objects occurred in children older than >3 years. Male and female were affected with the same frequency when concerning the nose, while all other locations showed a higher frequency in males. Data suggested that hospitalization occurred in 32% of those who compiled the form, resulting in complication just in 16% of injured. Although the most frequent location needing hospitalization was the tracheobronchial tree, the most frequent location showing complication was the nose, 80.3% of the complications, having an infection as most frequent outcome. In children younger than 1 year median volume reached 333.62 mm(3), in children between 1 and 2 years, median volume was 81.12 mm(3), in older children (>3 years) it showed 37.68 mm(3). The same considerations can be seen for the ellipticity, where the median ellipticity was 2.79 in children <1 year, while it was 1.94 in children between 1 and 2 years, and 1.17 in the older ones. Consistency is similar for all age classes, stressing that rigid small parts were those more involved in injuries with foreign bodies. Behavioral aspects pointed out that the 80% of children were playing before the accident, and 65.3% were under adults' supervision. Adult presence resulted associated to the absence of complication, with a p-value of 0.04.
  
  
  CONCLUSIONS
  The study stresses the importance of primary prevention, seen as the active care of adults toward children manipulating foreign bodies potentially dangerous. This presence may not avoid the event, but in case of FBs aspiration, ingestion, insertion or inhalation, it could be the main factor leading to fewer complications.
authors.affiliation: Food and Consumer Product Safety Authority, Region Southwest, PO Box 3000, 3330 DC Zwijndrecht, The Netherlands. ton.de-koning@vwa.nl
authors.forename: Ton
authors.initials: T
authors.lastname: de Koning
authors.forename: Francesca
authors.initials: F
authors.lastname: Foltran
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design / Q000592:standards*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005547:Foreign Bodies / Q000453:epidemiology* / Q000517:prevention & control; D005581:Foster Home Care; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D011634:Public Health; D017678:Sex Distribution