Research In Action

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. 

Results

• 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%) than girls were injured.
• Most injuries occurred at home (88%).

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%.

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%).
• 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%). 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%) and concussion (26%).

The good news is that the vast majority of kids in this data analysis were treated and released from the ED (95%). 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% 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.

Takeaways

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 Pediatrics (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.

Click here for more information on the AAP’s updated guidelines for safe sleep practices for infants.