Lice infestation

Crib Bumpers: Soft and Snug--or Deadly Decor?

By Top Papers Of The Month LARISSA HIRSCH, MD and CHARLES A. POHL, MD--Series Editor Dr Hirsch is an instructor of pediatrics at New York Presbyterian Hospital, Weill Cornell Medical Center in New York City. She is also a medical editor for Dr Pohl is professor of pediatrics and associate dean of student affairs and career counseling at Jefferson Medical College in Philadelphia.

Do the risks of using bumper pads in infant cribs outweigh the benefits?

When preparing a nursery, most parents buy bumper pads to soften the sides of the crib and to add a decorative touch. Traditional thinking has been that bumpers protect infants' heads from the hard sides of the crib and prevent arms and legs from becoming stuck between crib rails. The AAP recommends that if bumpers are used, they should be thin and firm.1 They advise parents to avoid pillow-like bumpersand to remove them when the child is pulling to stand.2 However, a study recently published in The Journal of Pediatrics may lead us to rethink what we tell parents about the dangers of decorative bedding.

Thach and colleagues3 used US Consumer Product Safety Commission (CPSC) databases from 1985 to 2005 to examine the number of crib deaths attributed to bumper use. Included in the CPSC databases are death certificates from all 50 states, as well as death and injury reports from various sources. The authors searched the databases for deaths of children between the ages of 1 month and 2 years that included the words "bumper," "pad," or "padding." The authors also used the CPSC's injury surveillance database to look for reports of crib injuries in infants 6 months or younger from 2000 to 2004. Then they examined 22 different bumpers for softness, size, length of ties, and potential space between the bumper and the mattress.

The authors found 27 deaths involving bumpers--most as a result of the infant becoming wedged between the bumper and another object or the infant's face being against the bumper. Of the bumpers that the authors examined, those found to have the highest potential for wedging were the firmer and thicker bumpers. There were also 3 deaths related to bumper ties that were wrapped around the infant's neck.

The authors found 25 cases of injuries in the crib, but most of these did not note the presence or absence of bumpers. Seven of these incidents involved fractures or closed head injuries; however, the majority were minor injuries, such as contusions.

In an accompanying editorial, Dr Rachel Moon writes that bumpers originally became popular when crib slats were placed further apart, but now that there are federal guidelines about crib slat spacing, their use is antiquated.4 Dr Moon points out that the Canadian Paediatric Society and Health Canada have recommended since 2004 that bumpers not be used in cribs. This recommendation is supported by the findings of Thach and colleagues, who conclude that the risks of using bumper pads in infant cribs outweigh the benefits. Disturbingly, even the firm bumpers previously recommended by the AAP were found to have a high probability of wedging.

The main limitation of the study is incomplete reporting of events related to bumpers. The authors state that the CPSC does not receive reports of all deaths, and there are probably more injuries in cribs than have been reported through the databases. Therefore, both deaths and injuries may be underrepresented in this study. In addition, it is not clear which of the injuries were sustained when bumpers were present, and which occurred in their absence. Without this information, it is difficult to determine whether bumpers are at least preventing injuries, or are only serving to increase the risk of asphyxiation.

While the significant risks associated with bumper use and their effectiveness in injury prevention need to be further investigated, for now, we should consider discussing bumper avoidance with parents when we review other aspects of crib safety. *