Childhood non-fatal strangulation by human hair during co-sleeping: A pediatric case report and review of the literature.

Background: Hair-thread tourniquet syndrome (HTTS) is an uncommon condition in which a strand of hair or fine thread constricts tissue, causing vascular compromise. Cervical involvement is exceedingly rare but can mimic intentional strangulation, leading to significant diagnostic and forensic challenges. Case presentation: A previously healthy 17-month-old boy developed apnea and transient loss of consciousness during co-sleeping with his mother due to accidental cervical HTTS. A tightly constricting strand of maternal hair was found encircling the child's neck, resulting in cyanosis and unresponsiveness. The hair was removed using scissors, and the child regained consciousness within five minutes. Forensic examination revealed a thin, circumferential erythematous mark and petechiae above the mark, with no airway compromise or neurological deficits. Whole-body imaging showed no fractures or additional injuries. The mother's long hair (40 cm) was confirmed as the source of the constricting strand. Multidisciplinary evaluation - including forensic assessment, scene investigation, police inquiry, and social service review - supported an accidental etiology. Discussion: Findings reported in the literature on pediatric HTTS have been summarized. Clinical findings consistently include a narrow ligature mark and facial petechia, reflecting vascular obstruction. Because these signs overlap with intentional strangulation, careful evaluation is essential to avoid both over- and under-diagnosis of child abuse. The pathophysiology involves rapid venous outflow obstruction and potential arterial compromise, with risk of cerebral hypoxia. Conclusion: Cervical HTTS is a rare but potentially life-threatening condition. Prompt recognition and removal of the constricting hair facilitate full recovery. Increased awareness among clinicians, forensic specialists, and caregivers is crucial to ensure appropriate investigation, accurate diagnosis, and prevention.