The killer you didn’t know was lurking in your child’s bedroom

Which of these are the most dangerous to your infant?

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Last year, 1,181 children under the age of 1 died of unintentional injury. 91 died in a motor vehicle accident, 45 died from drowning, 25 died from fire or burns, and 22 died from poisoning. We’ve accounted for about 16% of the total unintentional injury deaths. So where do the rest of come from? Would you believe…this:

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Suffocation was the leading cause of unintentional injury deaths among children, with 907, or 77% of the total deaths caused by unintentional injury. Accidental suffocation or strangulation in bed (ASSB) has for quite some time been the leading killer of children in this category. Rollovers during bedsharing and unnecessary crib bedding, including bumper pads, have been the primary cause. The recommendations are generally well-known against bedsharing between parents and infants, but many parents who put their infants in a crib may not realize the dangers that suffocation poses in a seemingly safe environment.

It’s important to understand that ASSB is not SIDS. SIDS happens mostly spontaneously, the causes, as well as the cause of death, are largely unknown, and while there are things parents can do to lower the risk of SIDS, it’s not necessarily preventable. ASSB is when we do know the cause of death for the child, and it happened in their bed. It’s known now that babies should be laid on their back for bed, with no loose blankets, pillows, or other obstructions that the child can entangle themselves in.

However, crib bumpers are still a very prominent piece to both cribs and crib bedding sets that are sold in stores. What’s not to like about them? They’re pretty, they match the sheets, and they provide a necessary barrier to keep your infant from getting his/her legs caught in the railings or hitting their head, right?

Not so much. Evidence is lacking that crib bumpers actually prevent bodily injury, for an infant can hardly propel themselves at a crib railing at the velocity needed to cause serious injury, and with the new regulations of crib railings, both in size and the ban on drop-down sides, children aren’t at risk for even breaking limbs, let alone losing one.

Instead, crib bumpers are becoming a hazard to children. Older children can pull themselves up on the bumpers and use them to fall over the side, the strings can become loose and cause a choking or strangulation hazard, and most of all, for small infants, they pose a serious suffocation hazard. The Consumer Product Safety Commission, a reactive consumer protection agency, has investigated incidents where a crib bumper was thought to have played a role in an infants death and indeed, has targeted dozens of cases where the crib bumper contributed or caused the death of the infant by strangulation or suffocation. Some descriptions are displayed in this table, though I warn you, they are graphic. Many of the children became wedged between the crib bumper and the mattress, many more simply had their face pressed against the bumper, and even a few died when their limbs went through the crib bumpers and they were unable to get their faces away from the bumper.

The American Academy of Pediatrics (AAP) in 2011 expanded its sleeping guidelines for infants, which included recommending that crib bumper pads never be used in infants’ cribs. According to the AAP, there is no evidence that the crib bumpers protect against injury, but that they do carry a risk of suffocation, strangulation, or entrapment because infants lack the motor skills or strength to turn their heads should they roll into something that obstructs their breathing. Some parents have turned to mesh, ‘breathable’, bumpers, but the AAP still sees no evidence that the bumpers are protecting infants, so why have something in the crib if it’s not there for a reason? Both the State of Maryland and the City of Chicago have banned crib bumper sales as a result and more locations are considering such measures.

At this time, the recommendation is a well-built fixed-sides crib, firm crib mattress, and a single, tightly fitting sheet. It’s boring, plain, and safe.

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