Crib Bumpers Called Too Risky

ST. LOUIS -- The value of bumper pads on baby cribs as a cushion against bumps and bruises may be outweighed by the small risk of death, researchers said.

ST. LOUIS, Sept. 21 -- The value of bumper pads on baby cribs as a cushion against bumps and bruises may be outweighed by the small risk of death, researchers said.

Over the past 20 years, 27 bumper-related suffocation and strangulation deaths have been reported in a national database, said Bradley T. Thach, M.D., of Washington University here, and colleagues, in the September issue of the Journal of Pediatrics.

This directly contradicts the Juvenile Product Manufacturing Association's conclusion that no deaths have been directly related based on an unpublished review of the same database.

But, it confirms concerns raised by the American Academy of Pediatrics, commented Rachel Y. Moon, M.D., of Children's National Medical Center in Washington, D.C., in an accompanying editorial.

"Ever since the first crib bumper pads were sold, they have held a seemingly irresistible appeal to new parents," she said, but physicians "must continue to remind parents that when it comes to sleep time for their infants, soft and cozy do not equal safe."

The researchers searched the U.S. Consumer Products Safety Commission database for potentially bumper-related deaths from 1985 through 2005 among children ages one month to two years.

The database includes death certificates from every state, the District of Columbia, and New York City, as well as information on deaths from medical examiners, coroners, police and fire departments, and articles in the media.

Altogether, the researchers identified 27 infant deaths involving bumper pads. Four involved padded bassinets. A death scene investigation was done in 26 cases with an autopsy in all but one. U.S. Consumer Products Safety Commission personnel conducted an additional investigation in 18 cases.

In about half of the cases (13), the infant was found wedged between the crib bumper and another object, such as the mattress or a sibling.

The next most common scenario saw the infant suffocating with its face against the bumper (11 deaths).

"From past studies, the softest of the retail bumpers examined that had the characteristics of comforters or soft pillows would pose the greatest risk for this type of death," Dr. Thach and colleagues noted.

There were also three deaths in which the infant was strangled or suffocated by the ties attaching the bumper to the crib railing.

Current manufacturing standards state that these ties should not exceed 9 inches. But when the researchers evaluated 22 commercially available bumpers in a retail store, they found two had fasteners that exceeded this length.

"Therefore, a strangulation hazard may still exist for some bumpers on the market," they said.

The investigators also searched for crib-related injuries from 2000 through 2004 in the National Electronic Injury Surveillance System, which contains records from a sample of hospital emergency departments.

They found 25 non-fatal crib injuries, which included contusions, abrasions, and strains. Seven reports of limb fracture or closed head injury were likely intentional injuries rather than accidents, the researchers noted.

They emphasized that injuries are only inconsistently reported to the surveillance system and the actual number of incidents is likely higher than was found in the study.

Furthermore, they said, "we cannot tell from the reports of crib injuries how effective bumpers are in protecting infants, because we do not know whether a bumper was present."

However, their assessment of commercially available bumpers showed that all left an open space between the bumper and the mattress, which could actually contribute to arm and leg entrapment and injury.

Overall, the minor injuries that could have been prevented by padding on the crib were outweighed by the potential, though rare, risk of death, the researchers concluded.

The American Academy of Pediatrics has recommended that if parents do use a bumper pad that it be "thin, firm, well-secured, and not pillow-like."

But, firm pads may have the highest potential for wedging accidents and in at least one case allowed a baby to climb out of the crib to its death, the researchers cautioned.

"Our data does not suggest any way in which changes in bumper design can reduce risk of death," they said. "We conclude that bumpers should not be placed in cribs or bassinets."