Research
A research team from Nationwide Children’s Hospital in Columbus, Ohio sought to quantify the extent of injuries related to bottles, sippy cups, and pacifiers in order to “educate parents, other caregivers, and health professionals about [such] injuries; help improve product design; highlight existing recommendations; and ultimately prevent [such] injuries.”

Dr. Sarah A. Keim and her team obtained data from the National Electronic Injury Surveillance System (NEISS) of the Consumer Product Safety Commission (CPSC) for patients who were treated in hospital emergency rooms between January 1, 1991 and December 31, 2010. They looked particularly at cases related to use of baby bottles, sippy cups, and pacifiers; they excluded cases in which oral use of the device was not the mechanism of injury (e.g., a child got a splinter when reaching for a pacifier, or a child was injured when a sibling threw a bottle). They also excluded fatalities (e.g., due to aspiration of the liquid, or strangulation by a rope on a pacifier).

The researchers looked at the children’s age, which body part was injured, what type of injury occurred, and outcome (e.g., hospitalization or discharge). Mechanism of injury was classified as “fall” or “other,” which included product malfunctions and burns, such as from a heated liquid in a child’s bottle.

Results
Dr. Keim and colleagues estimated that 45,398 infants and toddlers were treated in emergency rooms for injuries related to the use of sippy cups, bottles, and pacifiers. About two-thirds of these injuries (66.4 percent) occurred in 1 year olds. More injuries occurred in boys (61.2 percent) than girls.

Most injuries involved bottles (65.8 percent), but almost one in five involved pacifiers. Sippy cups were involved in 14.3 percent of injuries overall; predictably, sippy cups were seen more with injuries among 2 year olds than 1 year olds.

The mouth was the site of most injuries (71.0 percent) followed by the head, neck, or face (19.6 percent). Lacerations were the most common injury (70.4 percent), while pacifiers were associated with injuries to the soft tissue and teeth.

Since the researchers relied on emergency room data only, their estimates provide a limited look at injuries related to these products. This study did not include injuries that were treated at home, in child care settings, or in doctor’s offices.

Recommendations
Knowing that injuries due to falls while using bottles, pacifiers, and sippy cups are preventable, here are some tips for keeping your child injury-free:

• Give these products to your child only during their recommended ages. For example, the American Academy of Pediatrics (AAP) recommends that parents wean their babies from the pacifier by 1 year of age.
• Use bottles, pacifiers, and sippy cups with your child only when they’re not mobile. For example, use the pacifier only when your infant is sleeping or napping, in accordance with the AAP’s SIDS prevention guidelines. Hold your child in your arms or settle him in a high chair when you give him a bottle.
• Transition your child to an open cup between 12 and 18 months of age, as the AAP recommends.
• Stay aware of product recalls. A small number of instances in this study were related to product failure, such as pacifiers coming apart. The CPSC has recalled more than 16 million pacifiers since 1991 and more than 1 million sippy cups due to safety concerns.

Last but not least, keep your toddler safe by adopting the “don’t drink and walk” rule.

Problem: Young children can unexpectedly disengage the toilet locks and gain access to water in the toilet, posing the risk of drowning. The cabinet locks are being recalled because young children can disengage the lock, posing the risk of injury from dangerous or unsafe items stored in the cabinet.

Action: Consumers should immediately remove the recalled locks and contact Dorel Juvenile Group (DJG) Inc. for a free replacement lock of a different model. When removing the recalled locks, consumers are urged to immediately store dangerous items out of reach of children and to prevent unsupervised access to bathrooms.  To learn more, including how to contact DJG, click here.

The AAP urges parents to give their baby a pacifier at naptime or bedtime to reduce the risk of SIDS. However, the AAP adds that there is no need to insist if your baby refuses the pacifier or to reinsert the pacifier if your baby spits it out. The AAP recommends waiting about 4–6 weeks to offer the pacifier to ensure that breastfeeding is firmly established. The AAP also recommends stopping “binkies” at around 1 year of age. Some health care provides suggest that parents wean their children from the pacifier once they are mobile, to reduce the risk of fall-related injuries.

Despite these recommendations, many parents give their children pacifiers throughout the day, when they are awake, and beyond the age of 1.

Extended pacifier use can increase the risk for recurrent ear infections, speech impairment (for children 2 years of age or older), and permanent tooth and jaw misalignment (in children 4 years of age or older). Talk with your child’s health care provider or dentist about your child’s specific risks.

If your child has had unlimited access to a pacifier, you may want to wean slowly. Here are things to consider when weaning:

• Consider when your child uses the pacifier. Is it an all-day companion? A sleep aid? Does it help her deal with stress? When does she seem to need it more, or less?
• Set reasonable, low-stress limits. Children can understand and accept simple rules, such as “the pacifier stays at home.” Later, you can modify it to, “the pacifier is only for sleep.” Eventually, you’ll be able to eliminate the pacifier altogether. If your child is an infant, no explanation may be necessary. Just engage your baby with a variety of other comfort measures, including swaddling, babywearing (in a sling or other suitable carrier), rocking, singing, and dancing. Infant massage may also help.
• Observe your child’s reaction. While you don’t want a years-long weaning process, there’s no reason to rush your child, or expect her to give up her pacifier cold turkey. While some children can easily find other ways to comfort themselves, many need time to accept the transition.
• Engage your child in other distractions. Play with your child; physical activity that gets their whole body moving can help. You may want to offer a soft toy or blanket as a substitute object. (If your child accepts a substitute, you may want to have a duplicate, as a back-up!)
• Don’t backslide. It’s hard for anyone to give up something they rely on, but if you give in and return your baby’s pacifier, you’ll start a negative cycle that will be hard to break. You can help your child through the difficult times with reassurance and distraction.
• Arrange a visit from the “Binky Fairy.” Similar to the Tooth Fairy, the Binky Fairy visits to collect something (in this case, the child’s binkies) and leaves something (often a desired toy) in exchange.
• Stage a ceremony. Some children enjoy a special ceremony in which they discard their pacifier and receive some special recognition or reward in return. Some are more receptive to hearing their pacifiers will be “recycled” rather than “thrown away.”

Whichever approach you use, be compassionate and consistent. Weaning from the pacifier is a big step for your growing child!

Problem: Infants and toddlers are at risk of serious injury or death due to strangulation and entrapment hazards presented by these products. Tots in Mind recalled the play yard tents in July 2010 and offered a repair kit that is no longer available. The company is no longer in business and has stopped all sales.

Action: CPSC staff urges parents and caregivers to stop using these crib tents and play yard tents immediately. Do not attempt to repair these products. To learn more, including how to receive a refund or store credit, click here.

Problem: The latches that attach the bassinet base onto the metal frame can appear to be locked in place but still remain unlocked. This allows the bassinet to become detached from the metal frame, causing the bassinet to fall and the infant to be injured.

Action: Consumers should immediately stop using the recalled bassinets and contact the firm by phone toll-free at (888) 624-1908 between 7 a.m. and 6 p.m. ET Monday through Friday or visit the firm’s website at www.kolcraft.com to receive a repair kit and instructions for securing the latches to the metal frame. In the meantime, parents are urged to find an alternate, safe sleeping environment for the child, such as a crib that meets current safety standards or play yard depending on the child’s age. To learn more, click here.

Yes, that’s right: bike to school. May 9, 2012 is the first-ever Bike to School Day, scheduled in conjunction with National Bike Month. The event is organized by the National Center for Safe Routes to School, a group dedicated to “connecting the trip to school with safety, health, community, and choice.”

For 15 years, Safe Routes has coordinated a Walk to School Day each autumn; in 2011, the event involved 3,700 schools and “hundreds of thousands” of schoolchildren. Participation for this year’s bike event is small by comparison, but a total of 700 events in 49 states is still robust for an inaugural event.

Why participate?
The purpose of the event is threefold:

• to enhance children’s health by increasing physical activity
• to improve air quality and the environment by reducing automotive pollution
• to create safer routes for walking and bicycling

Participants are invited to register their event, map their route, and download materials on the event website.

Bike safely
Although bicycle riding is recommended by the Let’s Move initiative, many children don’t ride their bikes regularly. The National Wildlife Federation maintains a searchable database of trails that may be useful to parents planning family bike outings designed to help children develop biking skills. After all, according to one Boston initiative to bring bicycles to low-income children, two of the leading barriers to biking to school are not feeling comfortable on a bike in traffic and not understanding how to properly operate a bike.

If your children bike to school, you’ll want to keep some safety tips in mind:

• Use a proper fitting helmet. In the event of a crash, bike helmets can reduce the risk of head and brain injury by as much as 85–88 percent. Make sure your child’s helmet fits and that she knows how to put it on correctly. Teach your child the Eyes, Ears, and Mouth Test: (1) Eyes: With the helmet on their head, your child should be able to look up and see the bottom rim of the helmet; it should be one to two finger-widths above the eyebrows, (2) Ears: The straps must form a snug but comfortable “V” under your child’s ear when buckled, (3) Mouth: Have your child open her mouth as wide as she can. The helmet should “hug” her head, and the buckle should be flat against her skin.
• Use a proper fitting bike. An oversized bike is especially dangerous, since your child may not have the coordination needed to keep it under control. Sitting on the seat of her bike, your child should be able to put both of her hands on the handlebars and both of her feet on the ground. Bikes with footbrakes ensure better control for younger bike riders.
• Stay on sidewalks and bike paths. Safe Kids USA recommends that children should bike only on sidewalks and bike paths until they are 10 years of age and understand the rules of the road, including hand signals, riding on the right side of the road (with traffic), and interpreting and following traffic signals.
• Plan the safest route. Choose a route with the fewest street crossings, and whenever possible, plan crossings at intersections with crossing guards. Tell your children to obey all traffic signals, signs, and authorities.
• Supervise your child. Until you know your child is a skilled bicyclist, you should not let her ride to school on her own. Even older children who ride their bikes to school should use the “buddy system,” and ride with a friend.
• Don’t bike in the dark, or in low-visibility conditions. Equip your child’s bike with reflectors and have her wear light-colored clothes and accessories to improve her visibility to motorists.

For more tips about bike safety, check out Safe Kids USA or the American Academy of Pediatrics. Also see our school safety tips here on baby gooroo.

And remember: If you like Bike to School Day, you just might love National Bike to Work Week. That event kicks off Monday, May 14, 2012.

Problem: The ear on the bunny sippy cup can poke a child in the eye area while using the cup for drinking, posing an injury hazard.

Action: Consumers Consumers should immediately stop using the recalled sippy cups and return them to any Target store for a full refund. To learn more, click here.

Problem: The clear spheres on each end of the rattle can break, releasing small parts, posing a choking hazard to small children.

Action: Consumers should immediately take these rattles away from young children and return them to the store where purchased for a full refund. To learn more, click here.

While many parents steer their toddlers and preschoolers away from the dangers of active equipment intended for older children (such as monkey bars), they often adopt a more hands-on approach to playground slides, placing their child on their lap to ride down together. This way, many parents reason, their child won’t topple from the top of the slide. Safe from the risk of falling, the child—and parent—can be free to enjoy the thrill of the swooping ride to the ground. Or so the reasoning goes.

Unfortunately, the ride doesn’t always end with a laugh. As explained in a recent New York Times article, when toddlers go down slides on their caregivers’ laps, falls don’t happen, but broken legs sometimes do.

Injury data not collected
Data on playground injuries are scarce, but the Centers for Disease Control and Prevention (CDC) estimates that more than 200,000 children 14 years and younger visit the emergency room annually as a result of playground-related injuries.

A 2009 study of tibia fractures among children ages 17 years and younger seen during an 11-month period at an emergency room or doctor’s office in New York state found that 14 percent involved children younger than 3 years old, and that all of the studied injuries resulted from riding down a slide on a caregiver’s lap.

Parents unaware of risk
The physician who conducted that study, Dr. John Gaffney, reports that he has treated three such fractures within the past month for children sliding in the lap of a grandparent, a parent, and a babysitter. Such cases are common “as soon as the weather gets warm,” Gaffney observes in the New York Times article, because parents think they are “doing something good” for their child by “having them sit on [a] lap.”

If parents are aware of the risks, the injury is “entirely preventable,” says Dr. Edward Holt, the orthopedic surgeon at Maryland’s Anne Arundel Medical Center. In the New York Times article, he explains injury typically occurs when the child’s shoe catches on the side of the playground slide. When a child is sliding down on his own, the friction will slow or stop his progress, allowing him to lift his limb or twist his foot free before continuing down the slide. But when he is on the lap of a caregiver, the friction is not enough to overcome the downward force of their combined body weight. The limb is twisted and the leg bone broken as the pair continues down the slide.

The fracture may not be obvious right away, but the child will complain of pain and may be unable to put weight on the leg. Treatment is a cast from the foot to above the knee for 4–6 weeks.

In an effort to raise awareness, Dr. Holt developed a two-minute YouTube video on the problem and its prevention. To date, the video has over 60,000 views. He also designed a poster for use in doctor’s offices.

As summer approaches and families spend even more time at their neighborhood playgrounds, there remains a widespread need for heightened awareness of this particular playground risk.

What parents can do
Although playground injuries will never be eliminated, parents of young children can reduce the risk of injury while still enabling their children to have fun at the playground. Here are a few tips for keeping toddlers and preschoolers safe on slides:

• Supervise young children. There’s a backlash against “helicopter parents” in the popular media, but parents of young children need to be ever-present, especially on the playground. According to the American Academy of Orthopaedic Surgery (AAOS), “close supervision by a responsible adult may be the most important factor in preventing playground injuries.”
• Choose age-appropriate equipment. Some playgrounds have toddler-size playground equipment, including shorter slides, and young children can be steered to those items. If shorter slides aren’t available, baby swings or sandboxes can be a safer option.
• Assist, but don’t ride. Dr. Gaffney suggests that children not be allowed to use playground slides until they are able to do so independently, climbing stairs or ladders on their own and maintaining a sitting position while sliding downward. Another option is to place young children on the slide at the halfway point and stand alongside while they ride to prevent toppling.
• Consider the footwear. To reduce the risk of friction-related stops while your child is sliding, remove his shoes before he slides. Of course, running around in socks or bare feet at a public playground can pose other risks (such as hot or sharp surfaces), so you’ll have to weigh those risks.
• Talk about the dangers. Dr. Holt’s Maryland-based poster campaign is a good start, but too few parents have heard about the dangers of riding down a slide with a young child in their lap. Tell other parents about the risks; share this article. The first step to preventing slide injuries is awareness.

For more about summer safety concerns, read “Sail Into Summer Safely”. For more about public playground safety, see the Consumer Protection Safety Commission (CPSC)’s handbook or the AAOS guidelines.

A recent study of infant feeding (exclusive breastfeeding, exclusive formula-feeding, or a combination of the two) and sleep found no difference in sleep for mothers who fed their babies formula before bedtime and those who breastfed.

“Efforts to encourage women to breastfeed,” the authors suggest, “should include information about sleep. Specifically, … that choosing formula does not equate with improved sleep.” (A summary of this study is available elsewhere on baby gooroo.)

A similar, earlier study showed that giving formula in the evening can actually lead to less sleep for babies—and, therefore, less sleep for parents. Parents of infants who were breastfed in the evening and/or at night “slept an average of 40–45 minutes more than parents of infants given formula.” Parents of infants who received formula at night also reported “more sleep disturbances” than parents of those who were exclusively breastfed. It’s unclear why, but it may be related to breast milk being easier to digest and causing less gastrointestinal upset than formula.

Baby sleep habits
Most babies are wired to sleep for short periods of time. Frequent night awakenings is a sleep pattern shared by all babies during their first year of life, and likely protects against sudden infant death syndrome (SIDS).

During the first few months, babies tend to awaken frequently during the night, as they shift between quiet sleep and active sleep, then back to quiet sleep. During extended periods of sleep, infants are less responsive to biological cues, such as low oxygen and increased carbon dioxide. While the cause of SIDS remains unknown, many experts believe it is related to a disruption in the baby’s breathing during sleep. In fact, the peak incidence of SIDS occurs at about 3 months of age—around the same time when most babies seem to start sleeping for longer periods of time. Many researchers hypothesize that awakenings from sleep may be essential for proper breathing in babies whose breathing mechanisms are not yet fully developed at birth. In other words, frequent awakenings are a biological necessity for infants and—as tired as parents may feel as a result—they are a positive sign of your baby’s overall health and safety.

Since breastfeeding is also protective against SIDS, for the safest sleep possible, all mothers are urged to breastfeed.

To learn more about babies and their sleep habits, read “Good Night, Sleep Tight”.