Article

Crib Bumpers Continue to Cause Infant Deaths: A Need for a New Preventive Approach

Authors:
  • BDS Data Analytics, LLC
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Abstract

Objectives: To assess whether clutter (comforters, blankets, pillows, toys) caused bumper deaths and provide an analysis of bumper-related incidents/injuries and their causal mechanisms. Study design: Bumper-related deaths (January 1, 1985, to October 31, 2012) and incidents/injuries (January 1, 1990, to October 31, 2012) were identified from the US Consumer Product Safety Commission (CPSC) databases and classified by mechanism. Statistical analyses include mean age, 95% CIs, χ(2) test for trend, and ANOVA with a paired-comparisons information-criterion post hoc test for age differences among injury mechanisms. Results: There were 3 times more bumper deaths reported in the last 7 years than the 3 previous time periods (χ(2)(3) = 13.5, P ≤ .01). This could be attributable to increased reporting by the states, diagnostic shift, or both, or possibly a true increase in deaths. Bumpers caused 48 suffocations, 67% by a bumper alone, not clutter, and 33% by wedgings between a bumper and another object. The number of CPSC-reported deaths was compared with those from the National Center for the Review and Prevention of Child Deaths, 2008-2011; the latter reported substantially more deaths than CPSC, increasing the total to 77 deaths. Injury mechanisms showed significant differences by age (F4,120 = 3.2, P < .001) and were caused by design, construction, and quality control problems. Eleven injuries were apparent life-threatening events. Conclusion: The effectiveness of public health recommendations, industry voluntary standard requirements, and the benefits of crib bumper use were not supported by the data. Study limitations include an undercount of CPSC-reported deaths, lack of denominator information, and voluntary incident reports.

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... Although implicated in suffocation deaths and injuries (Scheers et al. 2016;Thach et al. 2007) and discouraged by the AAP (Moon et al. 2016), crib bumpers remain popular with parents. While there is substantial data on the hazards inherent in the use of bumpers, to our knowledge there are no data on potential hazards of alternative barriers such as mesh liners or the use of no barriers in cribs. ...
... We focused on four crib injuries: face-covered by a crib barrier; climb-outs and falls from cribs; slat-entrapment; and hitting-heads against the crib sides (Scheers et al. 2016). A secondary objective was to compare reasons for mothers' choice of crib bumpers/mesh liners/vertical bumpers/no barrier (Ajao et al. 2011;Moon 2007;Pease et al. 2017) and the prevalence of their choices. ...
... The most serious injury risk was face-covered because of the potential for suffocation. CB mothers reported breathing difficulties, wedging, and infants/toddlers with face pressed against the bumper, similar to circumstances that have also caused deaths (Scheers et al. 2016;Thach et al. 2007). However, 41% of mothers using crib bumpers rated "no suffocation risk" and 59% rated "they are safe" highly as reasons for their choice, indicating a lack of awareness that crib bumpers are potentially dangerous. ...
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Objective Compare mothers’ reports of injuries for infants and toddlers sleeping with crib-bumpers/mesh-liners/no-barriers and reasons for these sleep environment choices. Methods A cross-sectional survey of mothers subscribing to a parenting magazine and using crib bumpers (n = 224), mesh liners (n = 262), and no barriers (n = 842). Analyses of four possible injuries (face-covered, climb-out/fall, slat-entrapment, hit-head) including multivariate logistic regression adjusted for missing data/demographics and Chi squared analyses of reasons for mothers’ choices. Results Maternal reports of finding infants/toddlers with face covered had 3.5 times higher adjusted odds (aOR) for crib bumper versus mesh liner use. Breathing difficulties and wedgings were reported for infants/toddlers using crib bumpers but not mesh liners. Climb-outs/falls showed no significant difference in aORs for crib bumpers versus no-barriers and mesh liners versus no barriers. Reports of slat-entrapment were less likely for mothers using crib bumpers and mesh liners than using no barrier (aOR = .28 and .32). Reports of hit-heads were less likely for crib bumpers vs no barrier (aOR = .38) with no significant difference between mesh liners versus no barrier use. Mothers using crib bumpers and mesh liners felt their choice prevented slat-entrapment (89%, 91%); 93.5% of crib bumper users felt their choice prevented hit-heads. Significantly more mesh liner than crib bumper users chose them because “There is no suffocation risk” (64.1% vs. 40.6%), while 83.6% of no-barrier users chose them because “I was concerned about suffocation risk.” Conclusions for Practice Mothers appeared to be more concerned about preventing minor risks than suffocation. Understanding reasons for mothers’ use of barriers/no-barriers is important in tailoring counseling for mothers with infants/toddlers.
... results Differences in CO 2 6), ALT (m=10.5%, P25=9.8, ...
... The environmental conditions that lead to sudden infant death syndrome (SIDS)/sudden unexpected infant death (SUID) during sleep vary, including prone sleeping, mattress firmness, crib-sharing, soft objects and loose bedding in the sleep area, smoke exposure and alcohol and illicit drug use of the mother. 1 Crib bumpers (CBs) have been implicated in 48 deaths between 1985 and 2012, including 23 deaths between 2006 and 2012. 2 Twenty-five of the 48 cases were found to have the 'bumper alone' as the cause of death, including 13 deaths from infants wedged between a bumper and crib mattress and 12 deaths with the infant's face against a bumper without wedging, with all cited as impeding respiration. This impaired respiration associated with CBs is the focus of this report. ...
... In addition, it has been suggested that mesh liners (ML) may mitigate some of the problems found with traditional CBs, as such MLs have been cited as 'breathable and thin'. 2 Thus, the purpose of this study was to quantify impaired respiration in currently marketed liners, bumpers and alternative (ALT) products and elucidate the relationship between impaired respiration and permeability of the sample. ...
Article
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Objectives Quantify impaired respiration in currently marketed crib bumpers (CBs), mesh liners (MLs) and alternative products (ALTs) used to attenuate the interaction between the baby and the crib sides and elucidate the relationship between impaired respiration and permeability. Methods We experimentally quantified carbon dioxide rebreathing (CO 2 RB) via an infant manikin and air permeability via previously published test protocols, in commercially available CBs, MLs and ALTs. Results Differences in CO 2 RB in ML (median [m]=8.2%, 25th percentile [P25]=6.8, 75th percentile [P75]=8.6), ALT (m=10.5%, P25=9.8, P75=10.7) and CB (m=11.6%, P25=10.2, P75=14.3) were significant (p<0.0001). For comparison, manikin tests with a pacifier yielded CO 2 RB of 5.6%–5.9%, blanket draped over the face/torso yielded CO 2 RB of 7.7%–8.6% and stuffed animal in various positions yielded CO 2 RB from 6.1% to 16.1%. Differences in permeability between ML (m=529.5 cubic feet per minute [CFM], P25=460, P75=747.5), ALT (m=29.0 CFM, P25=27.7, P75=37.7) and CB (m=46.6 CFM, P25=30.1, P75=58.7) groups were significant (p<0.0001). CO 2 RB was poorly correlated with air permeability (max R ² =0.36). In a subset of tests, CB CO 2 RB increased by 50%–80% with increasing penetration force, whereas the ML CO 2 RB was nominally unchanged. Conclusions Government agencies and standards organisations are presently considering regulation of bedding including CBs. As paediatricians are consulted in the development of such regulations, our findings that permeability by itself was a poor predictor of CO 2 RB should be considered.
... Cribs manufactured to newer standards have a narrower distance between slats to prevent head entrapment. Because bumper pads have been implicated as a factor contributing to deaths from suffocation, entrapment, and strangulation 65,66 and because they are not necessary to prevent head entrapment with new safety standards for crib slats, they are not recommended for infants. 65,66 6. ...
... Because bumper pads have been implicated as a factor contributing to deaths from suffocation, entrapment, and strangulation 65,66 and because they are not necessary to prevent head entrapment with new safety standards for crib slats, they are not recommended for infants. 65,66 6. Consider offering a pacifier at nap time and bedtime. ...
Article
Full-text available
Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS; International Classification of Diseases, 10th Revision [ICD-10], R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After an initial decrease in the 1990s, the overall death rate attributable to sleep-related infant deaths has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, the use of a firm sleep surface, room-sharing without bed-sharing, and the avoidance of soft bedding and overheating. Additional recommendations for SIDS reduction include the avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence is presented for skin-to-skin care for newborn infants, use of bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report (www.pediatrics.org/cgi/doi/10.1542/peds.2016-2940).
... Tobacco smoking within the household, previous habits in the older children or mother's age, were not significantly associated with supine positioning. Even though SIDS contribution to SUID mortality declines, infant mortality rate attributed to ASSB has been increasing [9,10] since bedding, irrespective of sleep position, increases SIDS risk fivefold 1. Proposed mechanisms include suffocation due to overlay when excess or loose bedding are used in infants' sleep area, in addition to possible entrapment or strangulation from objects placed within the crib, particularly bumper pads [10][11][12]. Furthermore, parents' perception that babies feel uncomfortable on a firm, hard surface along with their concern to prevent injuries, promote the use of blankets or pillows as barriers between the sleep surface and the crib railings [1,10]. ...
... Crib bumpers have no meaningful health benefit and have been associated with the asphyxiation and suffocation deaths of more than 40 infants in the US. 1 The American Academy of Pediatrics 2 and Centers for Disease Control and Prevention 3 advise against their use, and the states of Maryland, Ohio, and New York have prohibited their sale. ...
... 40 However, multiple fatalities attributable to bumper padrelated suffocation or strangulation have been reported. 41,42 Since 2011, the American Academy of Pediatrics has recommended against bumper pad use due to the risk of injury. 43,44 The city of Chicago 45 and the state of Maryland 46 have taken these recommendations further, banning the sale of bumper pads. ...
Article
Objective: The goal of this study was to determine the epidemiology of injuries associated with nursery products among young children treated in US emergency departments. Methods: Data from the National Electronic Injury Surveillance System were retrospectively analyzed for patients aged <3 years who sustained an injury associated with a nursery product from 1991 through 2011. Results: An estimated 1 391 844 (95% confidence interval, 1 169 489-1 614 199) nursery product-related injuries among children aged <3 years were treated in US emergency departments during the 21-year study period, averaging 56.29 injuries per 10 000 children. The annual injury rate decreased significantly by 33.9% from 1991 to 2003, followed by a significant increase of 23.7% from 2003 to 2011. The decrease was driven by a significant decline in baby walker/jumper/exerciser-related injuries; the increase was driven by a significant increase in concussions and closed head injuries. Nursery product-related injuries were most commonly associated with baby carriers (19.5%), cribs/mattresses (18.6%), strollers/carriages (16.5%), or baby walkers/jumpers/exercisers (16.2%). The most common mechanism of injury was a self-precipitated fall (80.0%), and the most frequently injured body region was the head or neck (47.1%). Conclusions: Although successful injury prevention efforts with baby walkers led to a decline in nursery product-related injuries from 1991 to 2003, the number and rate of these injuries have been increasing since 2003. Greater efforts are warranted to prevent injuries associated with other nursery products, especially baby carriers, cribs, and strollers. Prevention of falls and concussions/closed head injuries associated with nursery products also deserves special attention.
... 8 Data also show that soft bedding and bumpers continue to be found in the cribs of infants who died in sleep-related deaths. 9 However, publications describing parental practice have been limited by their methods. They have typically been based on either parental self-report or death scene investigations. ...
Article
Full-text available
Background and objective: Reports describing factors associated with sleep-related infant death rely on caregiver report or postmortem findings. We sought to determine the frequency of environmental risk factors by using nocturnal sleep videos of infants. Methods: Healthy, term newborns were recruited for a parent study examining the role of parenting in the development of nighttime infant sleep patterns. For 1 night at ages 1, 3, and 6 months, video recordings were conducted within family homes. Videos were coded for sudden infant death syndrome risk factors in post hoc secondary analyses after the parent study was completed. Results: Among 160 one-month-olds, initially 21% were placed to sleep on nonrecommended sleep surfaces and 14% were placed nonsupine; 91% had loose/nonapproved items on their sleep surface, including bedding, bumper pads, pillows, stuffed animals, and sleep positioners. Among 151 three-month-olds, 10% were initially placed on a nonrecommended sleep surface, 18% were placed nonsupine, and 87% had potentially hazardous items on their sleep surface. By 6 months, 12% of the 147 infants initially slept on a nonrecommended surface, 33% were placed to bed nonsupine, and 93% had loose/nonrecommended items on their surface. At 1, 3, and 6 months, 28%, 18%, and 12% changed sleep locations overnight, respectively, with an increased likelihood of bed-sharing and nonsupine position at the second location at each time point. Conclusions: Most parents, even when aware of being recorded, placed their infants in sleep environments with established risk factors. If infants were moved overnight, the second sleep environment generally had more hazards.
Article
Each year in the United States, ∼3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Classification of Diseases, 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths has remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. Additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is also included. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report.
Article
Every year in the United States, approimately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.
Article
The literature overview about the issues of sudden infant death syndrome (SIDS) is presented in the article. The emphasis is on the evolution of the diagnosis definitions, incorrect use of the “synonym” term “sudden child death syndrome” in our country. Epidemiological characteristics of SIDS in countries with different levels of per capita income are presented. Modern view on the theories of the syndrome onset is analyzed. Risk factors are analyzed from the position of influence and change, i.e. possible modification to affect the syndrome incident that is crucial for every pediatrician. SIDS protective factors as the basis of primary prevention are discussed. The algorithm (ROSTOK rule) for organizing safe sleep space for children to reduce the risks of infant death associated with sleep is presented. This algorithm is proposed to be used in educational programs for pregnant women and parents of infants.
Chapter
The demand for baby cribs and bassinets made from rattan is increasing, but consumer attention still tends to focus on the aesthetic design rather than on the safety of the product. Meanwhile, the designs of rattan bassinet and crib slats may pose potential risks of entrapment for baby’s safety. This research was conducted to analyze the products’ ergonomics by observing the babies’ behavior when doing their activities in them. The crib and bassinet have variations in the gap sizes between the components on the crib sides. In terms of physical safety, the handmade rattan crib slats components, with 10 mm diameter rattan that is curved in form, have a risk of producing inconsistent rattan gaps that exceed 2 3/8 in. (60 mm). This results in the potential for injury to the limbs of infants aged 5–12 months. The baby’s limbs can be trapped in the rattan slat decoration.
Chapter
The sudden unexpected infant death (SUID) usually occurs in a healthy infant and children, and the cause of death remains unclear. Sudden infant and children death syndrome (SICDS) cannot be completely prevented, but it is thought that risk can be decreased by sleeping safely. SICDS is associated with a variety of risk factors, including maternal, infant, and environmental factors. The sudden infant death rates were significantly declined from the late 1980s to early 1990s, after prevention campaigns were introduced across many countries. These campaigns appear to affect some part of our population and resulted in behavioral change; this is not totally successful. The principles and evidence for public health approaches to prevention are based on different strategies. The interventions must focus on a limited number of simple feasible interventions and deliver through programs. The programs should be resourced appropriately, based on the long term and taken on long-term leadership which could make the target communities engagement and authorization. These programs must have been performed in robust monitoring and evaluation.
Chapter
The safest place for an infant to sleep is in a new crib, bassinet, portable crib, or play yard. A new play yard or portable crib is preferable to a used crib. Used or older cribs may not meet current safety standards and/or may have loose screws or missing hardware, which also make them unsafe. Use of outdated or damaged cribs, bassinets, and play yards can lead to entrapment, suffocation, or strangulation. Sleep areas other than a new crib, bassinet, portable crib, or play yard are not recommended; these include car seats (unless in transit), swings, sofas, chairs, and pillows. The crib mattress should be firm and not indent when the infant is sleeping on it. The only other item in the sleep environment should be a fitted sheet, which should fit snugly on the mattress and wrap around to the bottom of the mattress on all four sides. All other objects, including pillows, stuffed toys, quilts, comforters, and mattress toppers, should be removed. The safety of swaddling and swaddle sacks is not clear, and swaddling should be discontinued when the infant begins to show signs of trying to roll over (usually around 2–4 months). Baby monitors do not reduce the risk of SIDS. Parents should use caution in purchasing any infant sleep products which purport to reduce SIDS or to make an otherwise unsafe sleep practice (e.g., non-supine positioning) safe; at this time, there is no research to support any of those products’ claims of superior safety over using a crib, bassinet, portable crib, or play yard.
Chapter
Soft sleep surfaces and loose bedding have long been known to be risk factors for sudden infant death syndrome (SIDS) and sudden unexpected infant deaths (SUID) and are a particularly high-risk factor in deaths coded as accidental suffocation and strangulation (ASSB). While the use rate of supine sleeping has decreased with the safe to sleep campaign, soft bedding remains prevalent. The American Academy of Pediatrics (AAP) recommends that infants sleep on a firm, flat surface with no loose bedding, pillows or bumpers; however, there are frequently barriers to adherence for each of these recommendations. In this chapter, we review the basis for each of these recommendations as well as potential barriers to adherence and strategies for helping families comply with placing infants in a safe sleep environment.
Chapter
Investigation of Sudden Infant Death Syndrome - edited by Marta C. Cohen June 2019
Chapter
Investigation of Sudden Infant Death Syndrome - edited by Marta C. Cohen June 2019
Chapter
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Purpose To measure changes in registered nurse (RN) knowledge/beliefs and practices, parents' recall of infant safe sleep (ISS) teaching, and inpatient infant sleep environments and safety after implementing an ISS initiative. Design and Methods This longitudinal quasi-experimental study took place in three hospitals in the United States. An existing infant safe sleep tool was revised and updated to align with current recommendations on sleep environments. A bundled intervention included educating nurses, changing unit processes and implementing crib cards and room signs. Paired questionnaires surveyed 62 nurses before and 2 months after the intervention. Audits of 462 cribs/sleep environments with parent conversations assessed infant sleep conditions and parents' recall of RN teaching before and after the intervention. Results After Bonferroni correction, eight of 19 items for RN knowledge/beliefs and self-reported practice showed statistically significant improvements with moderate effect sizes. All 11 items for parents' recall of RN teaching showed statistically significant improvements, with odds ratios ranging from 7 to 76. Five of six real-time sleep safety conditions (from crib/sleep environment audits) had statistically significant improvements. Odds ratios ranged from eight to 83. Conclusion An updated educational tool improved nurses' and parents' knowledge and practices related to current and updated safety factors for infant sleep conditions. Inpatient adherence to infant sleep safety recommendations improved. Practice Implications A two-hour investment of nurses' time yielded statistically significant improvements. Factors critical to the success of the ISS project roll-out are reported. Improvements in parents' recall of teaching and actual sleep environments suggest potential for long-term changes in infant safety at home.
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We evaluated images in popular stock photography websites for adherence with American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices. Three top stock photo websites were used to collect photographs generated from key phrases. All images depicting an infant sleep environment were analyzed for consistency with AAP guidelines. Descriptive statistics, chi-square and z test of proportions, were conducted. A total of 1233 of 1947 stock photographs showed sleeping infants on a flat surface. In all, 627 (50.8%) photographs showed the infant in the supine position and 79 (5%) of all infant sleep environments were adherent with AAP recommendations. Bedding inconsistent with safe sleep recommendations was identified in 1133 images (71.3%), with blankets noted in 49.5%. Images depicting sleeping infants on stock photography sites do not routinely adhere to AAP recommendations. Media messages inconsistent with health care messages create confusion and misinformation about infant sleep safety and may lead inadvertently to unsafe practices.
Article
Objective: To investigate the circumstances of death and types and roles of objects present in the sleep environment at the time of death for infants who died from suffocation or strangulation during sleep. Methods: This study analyzed 1,736 reported incidents of accidental suffocation and strangulation in bed (ASSB) of infants younger than one year of age. These fatalities occurred from 2000 through 2012 and were reported to the United States Consumer Product Safety Commission. Results: The mean age of ASSB death was 3.76 months (SD: 2.51). Infants younger than five months accounted for 67.3% (1,168/1,736) of all reported fatalities and 58.3% (1,009/1,731) were male. Deceased infants were often found in a crib or bassinet (30.6%; 383/1,253) or in the prone orientation (84.9%; 595/701). The most common objects associated with infant ASSB were pillows (24.5%; 425/1,736), mattresses (21.0%; 364/1,736), blankets (13.1%; 228/1,736), and walls (11.5%; 199/1,736). Wedged (43.3%; 616/1,424) or positioned on top of an object (25.9%; 369/1,424) were the most common positions associated with death. Infants were often found wedged between a mattress and wall (30.2%; 181/599) or oriented face-down or prone on top of a pillow (52.2%; 187/358). Sleep surface sharing was associated with 6.5% (112/1,736) of ASSB deaths. Conclusions: Pillows and blankets are objects in sleep environments frequently associated with unintentional suffocation and strangulation of infants. Increased efforts should be made to remove these and other objects from sleep environments of infants.
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Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.
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Methodologists have criticized the use of significance tests in the behavioral sciences but have failed to provide alternative data analysis strategies that appeal to applied researchers. For purposes of comparing alternate models for data, information-theoretic measures such as Akaike AIC have advantages in comparison with significance tests. Model-selection procedures based on a min(AIC) strategy, for example, are holistic rather than dependent upon a series of sometimes contradictory binary (accept/reject) decisions.
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Rebreathing of expired air may be a lethal hazard for prone sleeping infants. This paper describes a mechanical model to simulate infant breathing, and examines the effects of bedding on exhaled air retention. Under simulated rebreathing conditions, the model allows the monitoring of raised carbon dioxide (CO2) inside an artificial lung–trachea system. Resulting levels of CO2 (although probably exaggerated in the mechanical model compared with an infant, due to the model’s fixed breathing rate and volume) suggest that common bedding materials vary widely in inherent rebreathing potential. In face down tests, maximum airway CO2 ranged from less than 5% on sheets and waterproof mattresses to over 25% on sheepskins, bean bag cushions, and some pillows and comforters. Concentrations of CO2 decreased with increasing head angle of the doll, away from the face down position. Recreations of 29 infant death scenes also showed large CO2 increases on some bedding materials, suggesting these infants could have died while rebreathing.
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To describe the epidemiology of injuries related to cribs, playpens, and bassinets among young children in the United States. A retrospective analysis was done using data from the National Electronic Injury Surveillance System for children younger than 2 years of age treated in emergency departments in the United States from 1990 through 2008 for an injury associated with cribs, playpens, and bassinets. An estimated 181,654 (95% confidence interval: 148,548-214,761) children younger than 2 years of age were treated in emergency departments in the United States for injuries related to cribs, playpens, and bassinets during the 19-year study period. There was an average of 9561 cases per year or an average of 12.1 injuries per 10 000 children younger than 2 years old per year. Most of the injuries involved cribs (83.2%), followed by playpens (12.6%) and bassinets (4.2%). The most common mechanism of injury was a fall from a crib, playpen, or bassinet, representing 66.2% of injuries. Soft-tissue injuries comprised the most common diagnosis (34.1%), and the most frequently injured body region was the head or neck (40.3%). Patients with fractures were admitted 14.0% of the time, making them 5.45 (95% confidence interval: 3.80-7.80) times more likely to be hospitalized than patients with other types of injury. Children younger than 6 months were 2.97 (95% confidence interval: 2.07-4.24) times more likely to be hospitalized than older children. This study is the first to use a nationally representative sample to examine injuries associated with cribs, playpens, and bassinets. 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.
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To document deaths attributed to bumper pads and injuries from their use that are potentially preventable. The US Consumer Product Safety Commission maintains files on cases voluntarily reported to them of deaths and injury related to commercial products. These cases represent an unknown fraction of total occurrences. We searched this database for deaths related to crib bumpers for the years 1985 to 2005. We also searched other Consumer Product Safety Commission databases for crib-related injuries that potentially might have been prevented by bumpers. Additionally, we examined 22 retail crib bumpers and described features that could be hazardous. Twenty-seven accidental deaths reported by medical examiners or coroners were attributed to bumper pads. The mechanism of death included suffocation and strangulation by bumper ties. Twenty-five nonfatal injuries were identified, and most consisted of minor contusions. All retail bumpers had hazardous properties. These findings suggest that crib and bassinet bumpers are dangerous. Their use prevents only minor injuries. Because bumpers can cause death, we conclude that they should not be used.
Article
Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death that occur during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS. The recommendations described in this policy statement include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in the accompanying "Technical Report--SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue of Pediatrics (www.pediatrics.org/cgi/content/full/128/5/e1341).
Article
The goal of this qualitative study was to examine factors influencing decisions by black parents regarding use of soft bedding and sleep surfaces for their infants. We conducted focus groups and individual interviews with black mothers of lower and higher socioeconomic status (SES). Mothers were asked about many infant care practices, including sleep surface and bedding. Eighty-three mothers were interviewed, 73 (47 lower and 26 higher SES) in focus groups and 10 (7 lower and 3 higher SES) in individual interviews. The primary reason for using soft surfaces was infant comfort. Parents perceived that infants were uncomfortable if the surface was not soft. Many parents also interpreted "firm sleep surface" to mean taut; they were comfortable with and believed that they were following recommendations for a firm sleep surface when they placed pillows/blankets on the mattress as long as a sheet was pulled tautly over the pillows/blankets. The primary reasons for using soft bedding (including bumper pads) were comfort, safety, and aesthetics. In addition to using bedding to soften sleep surfaces, bedding was used to prevent infant rollover and falls, particularly for infants sleeping on a bed or sofa. Some parents used soft bedding to create an attractive space for the infant. Many black parents believe that soft bedding will keep their infant safe and comfortable. There is much misunderstanding about the meaning of a "firm" sleep surface. Additional educational messages apparently are needed to change parental perceptions and practices.
Article
The National Child Death Review Case Reporting System (NCDR-CRS) was developed in the USA to provide child death review teams with a simple method for capturing, analysing, and reporting on the full set of information shared at a child death or serious injury review. The NCDR-CRS is a web based system currently being used by 35 of the 50 US states. This article describes the purpose, features, limitations, and strengths of the system. It describes current and planned efforts for the dissemination of the data to inform and catalyse local, state, and national efforts to keep children safe, healthy, and alive.
Article
The goal was to evaluate pictures in magazines widely read by women of childbearing age, for adherence to American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices. Magazines were included in this study if they had an average female readership of >5 million, circulation of >900000, and median age of female readers of 20 to 40 years. Twenty magazines met these criteria. An additional 8 magazines targeted toward expectant parents and parents of young children were included, for a total of 28 magazines. Pictures of infant sleep environments and sleeping infants in articles and advertisements in issues of these 28 magazines were analyzed for adherence to AAP guidelines for decreasing the risk of sudden infant death syndrome. A total of 391 unique pictures from 34 magazine issues were included in the analysis. Only 57 pictures (64%) portraying sleeping infants not being held by an adult portrayed the infants in the supine position, and 14.8% of sleeping infants were portrayed as sleeping with another person. Only 36 pictures (36.4%) of infant sleep environments portrayed a safe sleep environment, as recommended by the AAP. More than one third of pictures of sleeping infants in magazines geared toward childbearing women demonstrated infants in an inappropriate sleep position, and two thirds of pictures of infant sleep environments were not consistent with AAP recommendations. Messages in the media that are inconsistent with health care messages create confusion and misinformation about infant sleep safety and may lead inadvertently to unsafe practices.
Article
To ascertain whether the number of sudden infant deaths as a result of suffocation in cribs, in adult beds, on sofas or chairs, and on other sleep surfaces was increasing whether attributable to increased reporting, diagnostic shift, or an actual increase in suffocation deaths and to compare the risk of reported accidental suffocation for infants on sleep surfaces designed for infants with the risk on adult beds. We reviewed all accidental suffocation deaths among infants < or =11 months of age reported to the United States Consumer Product Safety Commission from 1980 through 1983 and 1995 through 1998. We compared infants' ages and other demographic data, the sleep location and surface used, and the reported mechanism or pattern of death. For 1995-1998, we used data on sleep location from an annual survey of randomly selected households of living infants younger than 8 months, collected as part of the National Infant Sleep Position Study at the National Institute of Child Health and Human Development, to calculate risk for death as a result of suffocation in cribs, in adult beds, and on sofas or chairs. The number of reported suffocation deaths by location were compared between the 1980s and 1990s using logistic regression modeling to calculate odds ratios (OR), 95% confidence intervals (CI), and P values. Comparative risks for suffocation deaths on a given sleep surface for infants in the 1990s were examined by calculating rates of death per 100 000 exposed infants and comparing the 95% CI for overlap. From the 1980s, 513 cases of infant suffocation were considered; from the 1990s, 883 cases. The number of reported suffocation deaths in cribs fell from 192 to 107, the number of reported deaths in adult beds increased from 152 to 391, and the number of reported deaths on sofas or chairs increased from 33 to 110. Using cribs as the reference group and adjusting for potential confounders, the multivariate ORs showed that infant deaths in adult beds were 8.1 times more likely to be reported in the 1990s than in the 1980s (95% CI: 3.2-20.3), and infant deaths on sofas and chairs were 17.2 times more likely to be reported in the 1990s than in the 1980s (95% CI: 5.0-59.3). The sleep location of a subset of cases from the 1990s, 348 infants younger than 8 months at death, was compared with the sleep location of 4220 living infants younger than 8 months. The risk of suffocation was approximately 40 times higher for infants in adult beds compared with those in cribs. The increase in risk remained high even when overlying deaths were discounted (32 times higher) or the estimate of rates of bedsharing among living infants doubled (20 times higher). Reported deaths of infants who suffocated on sleep surfaces other than those designed for infants are increasing. The most conservative estimate showed that the risk of suffocation increased by 20-fold when infants were placed to sleep in adult beds rather than in cribs. The public should be clearly informed of the attendant risks.
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