pillows, soft toys, and bumpers.
Using the National Electronic Injury Surveillance System (which monitors injuries treated in US emergency departments (ED) related to consumer products and sports/recreational activities), the authors analyzed data between 1991-2011 regarding injuries among children <3 years associated with nursery products. Information about injuries included:
- Mechanism of injury (fell spontaneously or due to actions of the patient, fell due to actions of another person, collision with or while using the product, etc.)
- Injury diagnosis (ingestion, aspiration, burn, laceration, etc.)
- Disposition from the ED (treated and released, hospitalized, etc.)
- Subjects were grouped into the following age groups: 0-5 months, 6-11 months, 12-17 months, 18-23 months, and 24-35 months.
- An estimated 1,391,844 children <3 years were treated in EDs for nursery product-related injuries during the 21-year study period.
- The highest proportion of injuries occurred in infants 6-11 months of age and more than half occurred in the first year of life.
- More boys (55 percent) than girls were injured.
- Most injuries occurred at home (88 percent).
The study found that injuries overall initially decreased in the first ~10 years of the study period, due to a decrease in injuries related to baby walkers/jumpers/exercisers. However, injury rates then increased significantly after 2003. Though no single product was found to be the contributing factor to this increase in injuries, concussion injuries from 2005-2011 increased over 100 percent.
When examining specific product categories and mechanisms of injury, the study found that:
- A “self-precipitated fall” was the most common mechanism of injury overall (80 percent).
- Most injuries were associated with baby carriers, cribs/mattresses, strollers and baby walkers/jumpers/exercisers.
- Baby carriers, compared to other nursery products, were five times more likely to be related to a caregiver fall.
- Strollers and cribs/mattresses were associated with greater risk of entrapment.
The most common body region injured was the head/neck (47 percent). However, kids <1 year old were more likely to have an injury to the head/neck, while the proportion of upper and lower extremities increased as age increased. The most common diagnoses were soft tissue injury (38 percent) and concussion (26 percent).
The good news is that the vast majority of kids in this data analysis were treated and released from the ED (95 percent). The majority of children admitted were <1 year of age, with baby carriers as the nursery product most commonly associated with admission. The most common mechanisms of injury associated with admission were breathing-related and nonfatal submersion (drowning).
Of note, 0.2 percent of injuries resulted in death, and primarily occurred in patients <1 year of age and among those with a breathing-related mechanism of injury. Most were associated with cribs/mattresses and are likely due to sudden unexpected infant death.
It is heartening to see a decline in injuries associated with baby walkers, but the increase in concussion injuries is a cause of concern. The study notes that there has been a decline in product recalls since the Consumer Product Safety Improvement Act of 2008, which mandated safety standards for all durable infant/toddler products. However, the results of this study, which ended in 2011, were unlikely to reflect the full impact of this legislation.
Baby carriers, followed by cribs/mattresses and strollers/carriers, accounted for the highest proportion of injuries and admissions. Recommendations by the authors and the American Academy of Pediarics (AAP) include:
- Caregivers using a carrier should minimize the use of stairs and carrying other objects while on the stairs.
- Carriers should be matched appropriately to infants based on size and weight.
- Carrier seats should not be placed on slippery or soft surfaces (which could lead to suffocation in the event of a tip-over).
- Mattresses should be snugly fitted into the crib.
- Crib bumper pads are not recommended.
- Avoid hanging objects onto stroller handles.
- Children should always be strapped in while in a stroller.
For more information on the AAP’s updated guidelines for safe sleep practices for infants, click here.