In view of the unacceptable rates of injury, including deaths, in babies and young children that are linked to cribs, playpens and bassinets, US researchers are calling for greater efforts to increase awareness of their dangers, for products to be better designed for safety and for standards to be enforced more rigorously.

The first study to use a nationally representative sample to analyze injuries associated with cribs, playpens, and bassinets in the US appeared online on 17 February in the journal Pediatrics.

In December 2010, the United States Consumer Product Safety Commission (CPSC), after issuing recalls for more than 11 million cribs and receiving reports of more than 30 infant and toddler deaths in the past decade, voted unanimously to ban drop-sided cribs, the sort where a side rail can be lowered to allow a child to be lifted in and out more easily.

From June 2011 it will be against the law in the US to manufacture, sell or lease drop-sided cribs.

In a first study of its kind, researchers from the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital in Columbus, Ohio, analyzed data covering 1990 to 2009 on children under 2 years old who received treatment in emergency rooms in the US for injuries related to cribs, playpens, and bassinets. The data came from the National Electronic Injury Surveillance System which is operated by the CSPC.

Dr Gary Smith, who is director of the Center for Injury Research and Policy and senior author of the study, told the media that:

“Despite the attention given to crib safety over the past two decades, the number of injuries and deaths associated with these products remains unacceptably high.”

For the 19-year period they reviewed, he and his colleagues found that:

  • Each year, an average of 9,500 injuries and more than 100 deaths occuring in US emergency departments among children under 2 years old were linked to cribs, playpens, and bassinets.

  • Most of the injuries involved cribs (83%).

  • The most common injury was soft-tissue injury (34%), followed by concussion or head injury (21%).

  • The most frequently injured part of the body was the head or neck (40%), followed by the face (28%).

  • Two thirds of injuries were due to falls, and the percentage attributed to falls went up with age.

  • Babies under 6 months old were nearly 3 times more likely to be hospitalized than older children.

The researchers concluded that:

“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.”

However, although there are risks, a crib is still considered the safest place in which to place a baby to sleep. Given this, there are several things parents, childminders and caregivers should bear in mind when choosing a crib and placing a child to sleep in one, says the Research Institute at Nationwide Children’s Hospital:

  • Look up www.recalls.gov to make sure the crib has not been recalled.

  • Make sure the crib is not old, broken or modified, meets all current safety standards and does not have a drop side.

  • Avoid cribs with cutouts, decorative knobs or corner posts that stick up more than 1.6 mm (1/16th in).

  • Make sure the slats are no more than 6 cm (2 and 3/8 ins) apart.

  • Ensure the mattress fits tightly in the crib: if you can fit two fingers between the crib and the mattress it is too small – get a bigger mattress.

  • Examine the crib frequently and make sure nothing is broken or loose and it is in good condition.

  • Read and follow the assembly instructions closely.

  • Always place babies on their backs to sleep.

  • Don’t add pillows, blankets, sleep positioners, cuddly toys or bumpers in the crib. The safest crib is a bare crib.

  • Don’t put tents and mesh canopies over the crib: children can become tangled up in them and strangle themselves trying to get out.

  • Don’t put the crib near a window, especially if it has sashes, cords and drawstrings for blinds, shades or curtains.

  • Children often develop faster than we think so keep checking what they can do: once a child can push up onto hands and knees, and definitely by the age of 5 months, you should remove all mobiles and nearby hanging toys.

  • Once they can pull up to standing, move the mattress to the lowest position and make sure the sides of the crib are at least 66 cm (26 in) above the mattress to stop them falling out.

  • Your child will most likely be too big for his or her crib when they near 90 cm (about 35 in) in height. Check the manufacturers’ information about their advice on when the crib will be too small for your child.

  • If you put your child in a bassinet or playpen, make sure it has a wide and sturdy base and it is within the safety limits for your child’s height and weight.

Smith, who is also Professor of Pediatrics at The Ohio State University College of Medicine, said:

“Unlike other child products that require adult supervision for their safe use, cribs, playpens and bassinets must be held to a higher standard because we expect parents to leave their child unattended in them and walk away with peace of mind.”

He said educating parents and carers about how to use these products safely and be alert to the possible dangers they pose would not be enough. It was important also to improve their design so they provide automatic protection to keep children safe.

“Injuries Associated With Cribs, Playpens, and Bassinets Among Young Children in the US, 1990-2008.”
Elaine S. Yeh, Lynne M. Rochette, Lara B. McKenzie, and Gary A. Smith.
Pediatrics published online 17 February 2011
DOI:10.1542/peds.2010-1537

Please Note: This article has been amended to correctly state that you should place babies on their backs to sleep. The previous version said the opposite, a typographic error in the text. We would remind readers always to check with their healthcare professional before following advice from articles: even though the current advice is to put babies to sleep on their backs, there may be a good reason why your pediatrician recommends another position in the case of your particular child.

Additional source: Nationwide Children’s Hospital (press release, 17 Feb 2011).

Written by: Catharine Paddock, PhD