“And Things that Go Bump in the Night”: Nothing to Fear?
Article Outline
Abbreviations: AAP, American Academy of Pediatrics, CPSC, Consumer Product Safety Commission, SIDS, Sudden Infant Death Syndrome
Ever since the first crib bumper pads were sold, they have held a seemingly irresistible appeal to new parents. All parents, after all, are protective of their children and do their best to keep them from harm. This includes lumps, bumps, and other injuries. Childhood rhymes, such as “he went to bed and bumped his head, and couldn’t get up in the morning,” and traditional prayers equating “things that go bump in the night” with “ghoulies and ghosties” provide reinforcement that bumps are dangerous and to be avoided at all cost. Protection from these injuries is often provided in the form of a soft surface that can cushion a fall or bump. Thus, it is no surprise that parents are often unable to resist providing a soft environment that will protect their vulnerable infant’s head and body from bumping up against the hard dangers of the wooden crib slats. And in fact, crib bumper pads initially became popular as a means to protect infants from injury at a time when crib slats were spaced to permit wedging of the head between the slats. However, since 1986, crib safety requirements have mandated that crib slats be no more than 2-3/8 inches apart, to prevent a head from slipping between the slats.
See related article, p 271
Nonetheless, 20 years after crib bumper pads were made obsolete by crib safety standards, they continue to be extremely popular. Anecdotal reports from my practice and from my perusal of parenting websites suggest that parents buy and continue to use crib bumper pads for 1 of 3 main reasons: (1) The infant likes to sleep with his or her head in the corner of the crib, and the bumper pads provide a soft surface; (2) the infant’s extremities might become wedged between the slats or the infant will be bruised by bumping up against the crib; and (3) bumper pads look adorable and make the crib a “cozy” environment for the infant.
The use of crib bumper pads has recently become more controversial. The American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome (SIDS) has not made a recommendation about bumper pad use, except to recommend that bumper pads be “thin, firm, well-secured, and not pillow-like.”1 In contrast, the Canadian Paediatric Society and Health Canada issued recommendations in 2004 against using bumper pads, because of the concern that the softness could create a potential SIDS or suffocation risk for the infant.2
Now a study reported by Thach, Rutherford, and Harris3 in this issue of The Journal confirms these concerns. Using Consumer Product Safety Commission (CPSC) data, the authors describe 3 distinct mechanisms by which bumper pads can contribute to sudden infant death: strangulation by ties, suffocation against the bumper pad, and entrapment between the bumper pads and another object. In addition, resourceful children can use the bumper pads to step on and raise themselves up in an effort to reach outside of or climb out of the crib.
Thach et al provide data that can be used to make a stronger case against bumper pads to families reluctant to give them up. For those parents who use bumper pads to provide a soft surface because their infants like to wedge themselves in the crib corner, the descriptions and photographs clearly demonstrate the risk of wedging between the bumper pad and the mattress. In fact, the authors consider the “firm” bumper pads deemed acceptable by the AAP Task Force on SIDS to have the highest potential for wedging accidents.
Parents are very concerned about the potential for injury from the infant bumping up against the crib or getting an extremity wedged between crib slats. They should be reassured by the CPSC data that clearly show that infants suffer essentially no long-term injuries from contact with the crib slats themselves, making bumper pads unnecessary for infant safety.
Another argument against crib bumper pads not mentioned by Thach et al is that they obscure visibility. Particularly now with the new emphasis on room-sharing without bed-sharing as the preferred sleeping arrangement for parents and their infants, improved visibility of the infant in the crib may provide an additional impetus to avoid bumper pads.
Perhaps those parents who find crib bumper pads adorable can be convinced of the risks of maintaining such a “cute” or “cozy” crib environment. This is clearly more difficult than it may sound, however. Many parents ask me why stores that carry baby merchandise are selling so-called “dangerous” blankets and comforters, with the implied assumption that if an item were truly dangerous, then stores would stop selling it. However, if “truly dangerous” were actually a criterion for determining whether or not an item should be sold, then many items no longer would be on the shelves. We cannot necessarily expect merchants to stop selling an item as long as there is consumer demand for it. Instead, we as a medical community need to be more proactive in alerting parents to the dangers of soft bedding in the infant sleep environment. Parents often confuse safety for their child with objects that are soft. Although it is true that a soft surface can help cushion a fall, we must continue to remind parents that when it comes to sleep time for their infants, soft and cozy do not equal safe.
References
- . The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. 2005;116:1245–1255
- . Recommendations for safe sleeping environments for infants and children. Paediatr Child Health. 2004;9:659–663
- . Deaths and injuries attributed to infant crib bumper pads. J Pediatr. 2007;151:271–274
PII: S0022-3476(07)00490-8
doi:10.1016/j.jpeds.2007.05.028
© 2007 Mosby, Inc. All rights reserved.
Refers to article:
- Deaths and Injuries Attributed to Infant Crib Bumper Pads , 28 July 2007
