Public Release: 

Drawstrings Pose Strangulation Risk

Johns Hopkins University Bloomberg School of Public Health

Drawstrings a threat

Articles of clothing with drawstrings, such as hooded sweatshirts and coats, or jackets with drawstrings about the waist, may lead to serious injury and accidental death. After studying 47 investigations of drawstring entrapments occurring between 1985 and 1994, in which eight children were killed, researchers at the Johns Hopkins School of Public Health Center for Injury Research and Policy outlined two distinct hazard patterns: strangulation caused when drawstrings are snagged by playground equipment and dragging when drawstrings are caught in vehicles. Their results, published in the January 15 issue of the Archives of Pediatrics and Adolescent Medicine, are accompanied by recommendations for reducing the drawstring hazard by eliminating or modifying drawstrings.

"Eliminating drawstrings is an effective way to prevent these accidents. Children would be safer with 'no strings attached'," said lead author, Dorothy Drago, MA, MPH, who conducted the study while a graduate student at the Hopkins School of Public Health.

Alternatives to eliminating drawstrings may be shortening drawstrings, sewing them into channels, making drawstrings "break away," or removing toggles and knots at the ends. These measures, however, need scientific testing before their benefits are established.

Of 47 incidents involving children ages two - 14 years of age, 31 involved drawstrings snagged on playground slides. Entanglement in school bus doors accounted for 12. "A typical playground accident occurred when a young child wearing a jacket with untied drawstrings around the neck was playing on a slide and the drawstring snagged near the top of the slide, between the platform or handrail and the start of the slide. As the child slid down, the snagged drawstring tightened and strangled the child," said principal investigator, Susan Baker, MPH, professor, Health Policy and Management.

Better playground supervision is not the answer, researchers said. "Placing the burden on supervision is not as effective as an intervention to change the product, " added Drago. "Supervision fails."

Leaving a school bus proved equally dangerous when, unnoticed by the driver or wearer, a jacket waist drawstring became entangled in the bus handrail, the doors closed and the driver drove off. Over the last several years, four children have been killed when they were dragged and run over by their school buses.

The U.S. Consumer Product Safety Commission (CPSC) has periodically addressed clothing entrapment and has issued safety recommendations on sliding board construction. The National Highway Transportation and Safety Administration (NHTSA) issued a 1993 voluntary recall to modify school bus door apparatus. The potential for drawstring injury persists because the NHTSA has no authority to enforce the recall or modifications.

Great Britain banned drawstrings on children's clothing in 1976.


This research was supported in part by U.S. Public Health Service Grant # R49

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