WebMD Medical News
Brenda Goodman, MA
Laura J. Martin, MD
Feb. 17, 2011 -- Nearly 10,000 children are taken to the emergency room each year -- an average of one every hour -- after falling or becoming wedged or caught in cribs, playpens, and bassinets, a new study shows.
“It’s certainly a very common source of injury,” says study researcher Gary A. Smith, MD, DrPH, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “We also recognize that this is an underestimate,” Smith says, because the study only looked at injuries reported to emergency rooms, not those treated by urgent care centers, doctors in private practice, or those that went without treatment at all. “So we’ve got a real problem.”
Experts say the study, which collected reports of injuries to children from hospital emergency rooms across the U.S. over 19 years, represents the first national look at this problem. The study comes in the midst of a flurry of regulatory activity over cribs and crib products that has culminated in the recalls of millions of items and the first new government-mandated safety standards in cribs issued in nearly two decades.
The study was published online in the journal Pediatrics.
The research was praised by government regulators and industry representatives for helping to increase awareness of dangers to children posed by unsafe sleep environments.
“The Juvenile Products Manufacturers Association applauds any study which raises awareness of crib and sleep environment safety for parents,” Amy Chezem, communications director for the JPMA, which represents many crib manufacturers, says in a statement.
Researchers who were not involved in the study also praised its scope.
“I thought that it was an important study,” says Rachel Y. Moon, MD, a pediatrician and expert on sudden infant death syndrome, or SIDS, at Children’s National Medical Center in Washington, D.C.
“You have to be careful no matter where your baby is. There are a lot of things that can be done to cribs, playpens, and bassinets that can make them safer,” Moon says.
More than 80% of the injuries involved cribs, and two-thirds of reported injuries occurred when children fell from the crib or jumped out.
About 15% of injuries resulted from falling inside the crib or hitting or being cut on the inside of the crib. About 6% resulted from becoming caught or wedged in the crib.
The vast majority of injuries were not life-threatening.
Soft-tissue injuries, including bruises and scrapes, were the most common, representing about a third of all reported injuries. But in about one in five cases, a child was rushed to the emergency room with a concussion. Fractures represented 12% of injuries; lacerations, or cuts, made up 14%.
“The thing about it, being a parent, is that children will roll over for the first time or sit up for the first time or stand for the first time when you’re not expecting it,” Smith says. “All of a sudden, one day, they’re doing it, and I think parents are just simply caught off-guard.”
About 1% of children died, sometimes after becoming caught or wedged in the crib. Most of these deaths involved a diagnosis of suffocation or sudden infant death syndrome. Two-thirds of the deaths occurred in babies younger than 6 months.
Part of the problem, experts say, is that parents think that it’s safe to put soft products like pillows, blankets, and crib bumpers in cribs, when those products can be dangerous in two ways.
Infants may roll over into soft material and suffocate while they are sleeping. Babies who are older and stronger, on the other hand, may use materials like bumpers to pull themselves out.
“What we’ve looked at before have been deaths associated with sleep areas, and one of the big issues is that in trying to prevent injuries, many parents will put pillows and bumper pads in cribs to try to prevent injuries,” Moon says, when in reality, these kinds of materials are often the problem.
“The only thing that should be in the crib is the baby,” Moon says.
The study authors say a big part of the problem has been flaws in crib manufacturing and design that have led in recent years to the recalls of more than 11 million cribs, many of them drop-side models.
“This is all because cribs have just had a terrible track record,” Craig says. “The design hasn’t really changed for over two decades, so right now we’re seeing a big shift in our understanding of how to make them safer.”
In June, new government regulations will take effect that prevent the sale of drop-side cribs, a design that has contributed to 32 deaths, studies show, since 2000.
“JPMA reminds parents of how important it is to carefully follow the manufacturer instructions, recommendations, and restrictions on all sleep-related products to ensure the safest environment possible,” Chezem says.
As the study mentions, "Caregivers need to be aware of their important role in the correct use of cribs and related products, such as checking routinely for compromised structural integrity of the crib and keeping track of their child’s developmental milestones to assess the changing risks of injury."
Experts advise parents should be wary of hand-me-down cribs or equipment purchased at yard sales.
“Parents should check any previously used equipment at the web site Recalls.gov to make sure it hasn’t had safety issues,” Smith says.
When using any crib, new or used, experts advise parents to double-check the bed is assembled correctly and that the hardware is not loose. Mattress size is also important. There shouldn’t be any gaps between the mattress and the frame.
And as your child grows, move the mattress down so the bars stay too high to climb over.
“When your child gets to 35 inches in height, it’s time to transition them to a toddler bed,” Smith says.
SOURCES:Smith, G. Pediatrics, March 2011.Gary A. Smith MD, DrPH, director, Center for Injury Research and Policy, Nationwide Children’s Hospital, Ohio.Rachel Y. Moon, MD, pediatrician, Children’s National Medical Center, Washington, D.C.Federal Register, Consumer Product Safety Commission Notice, Dec. 28, 2010.Amy Chezem, communications director, Juvenile Product Manufacturers Association.
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