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Understanding Non-fatal Strangulation and How It Affects Children

Understanding Non-fatal Strangulation and How It Affects Children

Notice

The information on this page provides general guidance about non-fatal strangulation in children. It is not a medical diagnosis. If you see injuries that worry you, contact local law enforcement or 855-444-3911. Persons responsible for the child's safety should ensure they receive a medical evaluation by a qualified medical professional who is trained to assess these types of injuries.

Understanding Non-fatal Strangulation in Children

Strangulation is extremely dangerous, and children are especially at risk. Their neck muscles are weaker, their airways are smaller, and they may not be able to explain what happened. Even when there are no visible marks, strangulation can cause serious internal injuries and lead to the death of a child.

Why This Matters

Many children who experience or witness domestic violence also experience other forms of harm. Strangulation is one of the most dangerous types of abuse, and recognizing the signs early can help protect a child’s life.

Signs to Watch For

Children may not know how to describe what happened, so adults should look for changes such as:

  • A hoarse or raspy voice
  • Trouble swallowing or breathing
  • Complaints of neck pain
  • Seeing spots or blurry vision
  • Changes in facial color or appearance

These symptoms may appear even when there are no bruises.

Helpful Tools and Training

Professionals across the country have created resources to help adults understand strangulation and respond quickly. These include:

  • Research studies
  • Medical protocols
  • Law enforcement tools
  • Webinars and training videos

Taking time to review these materials can help adults recognize danger and take action to keep children safe.

Resource Documents

Strangulation Webinars

  • Pediatric Strangulation – Alliance for HOPE

  • Attempted Strangulation in Child Maltreatment (October 18, 2019)

  • Pediatric Strangulation: Updates and Statewide Efforts (July 2023)

Key takeaways from the 2023 webinar

  • Child Advocacy Centers are seeing an increase in violence. Children were witnessing strangulation and being asked if they were ever strangled. 
  • There is polyvictimization for children witnessing domestic violence and experiencing child abuse. More than 1/3 of children experiencing DV are expose to other maltreatments
  • Police in Milwaukee are trained to offer medicals and if a victim denies evaluation they are required to sign a form. The victim(s) are given information about the risks. (This is specific for adults)
  • Research for non-fatal strangulation is primarily in the adult population. 
  • There is not a universal protocol for pediatric which highlights the gaps.
  • Kids airways more vulnerable (due to weaker neck muscles and smaller airways)
  • Amount of force used (adults) - 11 pounds of pressure on corroded artery or 4 pounds of pressure on jugular vein.
    • For reference an adult male handshake is 80-100 pounds of pressure;
    • It takes 20 pounds of pressure to open soda can.
    • It takes 33 pounds of pressure to fracture trachea (not common in children).
  • Questions are not being asked in the right way. Individuals completing interviews with victims should focus on questions
    • changes in face,
    • notice change of voice (hoarse),
    • pain swallowing,
    • pain breathing,
    • visual changes (seeing spots, blurry vision).
  • Patients don't always think to report these things so it's important to ask these questions. Important in medical evaluation and during forensic interview. 
  • External injury rare on strangulation cases. Why don't we see injuries?
    • They may have had time to fade and there is lack of understanding with lethality.
    • Compression injury and not a high velocity.
    • Soft tissue area and less likely to cause a bruise.