Crib Bumpers and Crib Clutter Remain a Hazard to Infants
Scheers NJ, Woodard DW, Thach BT. Crib bumpers continue to cause infant deaths: a need for a new preventive approach. J Pediatr. 2016;169:93-97.
The dangers of crib bumpers are not breaking news given the accumulation of evidence against their use. In 2007, Thach et al published a case series reviewing 27 deaths attributable to crib bumpers, and in January 2008 and again in 2011, the American Academy of Pediatrics recommended against their use. The National Institutes of Health and the Canadian Paediatric Society also recommend that crib bumpers not be used. However, what has been less explored is how “crib clutter” contributes to injuries and deaths. Are the extra materials found in cribs, such as blankets and toys, playing a role in these deaths and nonfatal injuries?
With this in mind, Scheers et al searched 4 Consumer Product Safety Commission (CPSC) databases were searched from 1985-2012 for bumper-related deaths and from 1990-2012 for incidents and injuries. The databases include sources such as consumer complaints, media articles, medical examiners, and coroner reports. Statistical analyses included mean age, χ2 test for trends, and analysis of variance test with a paired-comparisons information-criterion post hoc test for mean age difference among injury mechanisms.
Interestingly, there were 3 times more bumper deaths reported in the last 7 years than in the previous 3 time periods. It was not clear from the data available if the greater number of deaths was due to more reporting, a diagnostic shift, or perhaps a true increase. In the time periods studied, bumpers caused 48 suffocations, 67% by a bumper alone (with out clutter), and 33% by wedging between a bumper and another object. The mean age of death was 4.6 months, with >90% of deaths occurring in infants less than 7 months of age.
Three children were noticeably older—2 of these children had medically complex histories, and 1 healthy child had a recent viral illness. In the infant deaths where “crib clutter” played a role, approximately 33% of the total deaths could have been prevented if either the bumper or other wedging surface had not been present.
When the number of deaths reported by the CPSC was compared with data from the National Center for the Review and Prevention of Child Deaths from 2008-2011, it was noted that there were several more deaths reported than those reported by the CPSC. This meant that the total increased to 77 deaths.
An examination of injury mechanisms revealed significant differences by age and 3 distinct clusters. The first cluster involved the youngest infants (approximately 5 months), who were involved in near suffocations. The middle cluster was infants involved in choking/ingestion or strangulation/entrapment incidents, and they were somewhat older (approximately 7.7 months). Choking incidents occurred with children ingesting either part of the bumper or bumper tie. The oldest cluster was infants involved in limb entrapments or falls. Concerns with design, construction, and quality control were seen in all groups.
The data in this article clearly show that the crib bumpers are a hazard to the health of children, and the authors recommend that the CPSC ban traditional crib bumpers altogether to reinforce safe sleep practices. Whether or not that formal ban occurs, the pediatric health care community has a responsibility to properly educate families about the concerns raised within this study.
Jessica Tomaszewski, MD, is an assistant clinical professor of pediatrics at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, and a hospitalist pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.
Charles A. Pohl, MD—Series Editor, is a professor of pediatrics, senior associate dean of student affairs and career counseling, and associate provost for student affairs at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania.