Cribs, playpens, and bassinets are associated with more than 9,500 injuries in young children each year, according to a retrospective analysis of a national injury database.
The analysis found that from 1990 through 2008, an estimated 181,654 children younger than 2 were treated at U.S. emergency departments for injuries -- mostly falls -- related to these products, according to Gary Smith, MD, DrPH, of the Research Institute at Nationwide Children's Hospital in Columbus, Ohio, and colleagues.
That works out to a injury rate of 12.1 per 10,000 children younger than 2 each year, Smith and co-authors reported online ahead of the March issue of Pediatrics.
The rate of injury decreased significantly over time (P<0.017), although they noted that the total number of injuries did not change -- averaging 26 per day.
"Given the consistently high number of observed injuries, greater efforts are needed to ensure safety in the design and manufacture of these products, ensure their proper usage in the home, and increase awareness of their potential dangers to young children," the researchers wrote.
The issue of crib safety has garnered significant attention in recent years, as more than 9 million cribs have been recalled by the U.S. Consumer Product Safety Commission (CPSC) since September 2007.
After issuing a warning last May about the death risk associated with drop-side cribs -- which allow parents to raise or lower the sides -- the CPSC voted to ban them altogether in December 2010. The restriction starts this June.
On Wednesday, the CPSC -- in cooperation with Burlington Basket Company -- recalled 500,000 bassinets because of a risk of collapse caused by cross-bracing rails that are not fully locked into position.
Despite the focus on crib safety, little research has explored all injuries -- both fatal and nonfatal -- related to cribs, playpens, and bassinets.
To fill the gap, Smith and colleagues analyzed data from the CPSC's National Electronic Injury Surveillance System on children younger than 2 who were treated in emergency departments for these injuries over a 19-year period.
Among the findings:
- Most of the injuries involved cribs (83.2%), followed by playpens (12.6%) and bassinets (4.2%).
- Falls accounted for two-thirds of injuries overall, although that proportion increased with age, likely because of increased mobility and climbing skills.
- The most common diagnosis was a soft-tissue injury (34.1%), followed by a concussion or closed-head injury (21.1%).
- The two most frequently injured body parts were the head or neck (40.3%) and face (27.5%).
- The vast majority of children were treated and released (93.9%); 4% were admitted, transferred, or held for observation; 1.2% died; and 0.9% left against medical advice.
- Most of the deaths occurred in infants younger than 6 months and involved a diagnosis of cardiopulmonary arrest or sudden infant death syndrome (SIDS).
- Hospitalization, transfer, or being held for observation was more common in children younger than 6 months and in those with fractures.
Several efforts have been started in an attempt to increase the safety of cribs, playpens, bassinets.
In addition to banning drop-side cribs, the CPSC has collaborated with the American Academy of Pediatrics (AAP) and Keeping Babies Safe to launch a national campaign on crib safety. The campaign highlights ways that parents can provide a safe sleeping environment for their children, such as placing an infant on its back to sleep as a precaution against SIDS.
The AAP has also recommended a mandate for manufacturers to follow the American Society for Testing and Materials International's voluntary standards designed to reduce hazards related to cribs, playpens, and bassinets.
"Collectively, these actions should help to prevent many of the nonfatal and fatal injuries seen in our investigation," Smith and his colleagues wrote.
In addition to placing an infant on its back for sleep, the CPSC advises parents to use "a crib that adheres to current standards; not to use old, broken, or modified cribs; not to add extra mattresses, pillows, and cushions; and to watch out for strangulation and entrapment hazards, such as gaps between loose components, broken slats, and other parts," the researchers wrote.
The authors acknowledged that the study was limited in that it only included injuries and deaths observed in emergency departments and was restricted to the information provided in medical records.
One of the study authors was supported by a stipend from the Samuel J. Roessler Memorial Medical Scholarship.
The authors reported that they had no conflicts of interest.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner