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Citations
Objective:
The goal of this study was to determine the epidemiology of injuries associated with nursery products among young children treated in US emergency departments.
Methods:
Data from the National Electronic Injury Surveillance System were retrospectively analyzed for patients aged <3 years who sustained an injury associated with a nursery product from 1991 through 2011.
Results:
An estimated 1 391 844 (95% confidence interval, 1 169 489-1 614 199) nursery product-related injuries among children aged <3 years were treated in US emergency departments during the 21-year study period, averaging 56.29 injuries per 10 000 children. The annual injury rate decreased significantly by 33.9% from 1991 to 2003, followed by a significant increase of 23.7% from 2003 to 2011. The decrease was driven by a significant decline in baby walker/jumper/exerciser-related injuries; the increase was driven by a significant increase in concussions and closed head injuries. Nursery product-related injuries were most commonly associated with baby carriers (19.5%), cribs/mattresses (18.6%), strollers/carriages (16.5%), or baby walkers/jumpers/exercisers (16.2%). The most common mechanism of injury was a self-precipitated fall (80.0%), and the most frequently injured body region was the head or neck (47.1%).
Conclusions:
Although successful injury prevention efforts with baby walkers led to a decline in nursery product-related injuries from 1991 to 2003, the number and rate of these injuries have been increasing since 2003. Greater efforts are warranted to prevent injuries associated with other nursery products, especially baby carriers, cribs, and strollers. Prevention of falls and concussions/closed head injuries associated with nursery products also deserves special attention.
In most post-industrial countries injury is a leading cause of death, particularly premature death. In Australia, for example, over two thirds of all deaths among persons aged 15 to 24 years are the result of injury. Transport, particularly road transport, is the single most frequent setting for fatal injury. Despite these facts injury research is under-funded and uncoordinated. There is only a fledgling science and little underpinning theory. There is a plethora of unlinked data sets, each reflecting the institutional responsibility of the collecting agency. Even within transport there is little cross modal contact. While the complexities of service delivery demand institutional segregation no such case exits for the segregation of research.
This article describes the methods and findings of an analytical study of potential risk and protective factors for infants presenting with head injuries to emergency departments of seven hospitals in NSW. The Injury Prevention Policy Unit, NSW Department of Health, conducted a case-control study that examined baby-walkers, stairs and nursery furniture.
an update of a larger study undertaken by MUARC for the Consumer Affairs Division of the then Department of Industry, Science and Tourism. The major purpose of the study was to provide information on the hazards associated with nursery furniture and potential solutions in order to underpin an injury reduction program in this area. It has been estimated that there are at least 6,540 medically treated injuries annually associated with nursery furniture in Australia. Of these, at least 540 (8.3%) result in hospital admission. The major nursery furniture products associated with injury were found to be prams, cots, high chairs, baby walkers, strollers, change tables and baby exercisers (bouncers). Cots, both in Australia and the US, were most commonly associated with death, whereas baby bouncer (exercisers) and high chair injuries were the most likely to be admitted to hospital. Eighty-four percent of nursery furniture injuries occurred to children aged under two. The most frequent injuries were bruising, inflammation and swelling (31%), lacerations (16%) and concussion (11%). Injuries to the head and face represented 64% of injuries, reflecting that the majority of nursery furniture injuries result from falls and babies and toddlers are 'top heavy'. The proportion of baby walker injuries has dropped from 19% of total nursery furniture injuries in 1989 to 10% in 1996-97, at a sample of Victorian hospitals. Such injuries are more frequent in Queensland where homes more commonly have steps/stairs and in the US. There is currently no Australian/New Zealand standard for change tables. The voluntary standard for prams and strollers is under review. Australian/New Zealand standards for high chairs and baby walkers are currently being developed.
Objective and methods
In the 1st year of life a fall from a changing table is one of the most common causes of injury. In a retrospective study we identified 159 infants who attended the department after a fall from a changing table within the 4-year study interval. 82 families filled in questionnaires inquiring about the circumstances of the accident.
Results and discussion
81% of the accidents occurred in children below 1 year of age. The injuries involved mainly the head: vault fractures (17%), mild closed head injuries (15%), and head contusions (65%). Sixty percent of the parents were not distracted at the time of the accident. Unexpected sudden movements of the baby (36%) or hectic behavior of the parents (21%) were observed. The children fell off the lower end (47%) or side of the changing table (33%). To prevent these accidents, changing tables should be equipped with elevated padding on the side and lower end. Carpets should be placed around the changing table to soften a possible fall. Fidgety and freshly oiled or bathed infants should be swaddled on a towel placed on a bed or on the floor.
To examine the potential of the New South Wales baby-walker regulation to reduce injury.
Injury surveillance data were used to reconstruct baby-walker injury incidents, which were examined in conjunction with the 2000 NSW baby-walker regulation, which requires a specified level of stability and a gripping mechanism to stop the walker at the edge of a step.
Injury surveillance data on injuries to 381 babies collected from hospital emergency departments in South Australia and Victoria, 1986-2000.
Injury events that would still have occurred with the regulation in place.
About half (46%; 95% CI, 32.5%-59.8%) of the serious baby-walker injuries (ie, requiring admission to hospital) are caused by the walker enabling babies to reach hazards other than steps and stairs.
The New South Wales regulation has the potential to eliminate only about half the baby-walker injuries. Banning baby walkers altogether is preferable.
To describe the epidemiology of infant-furniture-related fatalities and hospitalizations in New Zealand, for children aged 0-4 years.
Infant-furniture-related deaths and hospitalizations were selected from the New Zealand Health Information Service databases for the 10-year period 1987-1996. Intentional injuries were excluded.
Forty-three fatalities were identified. Twenty-two fatalities (51%) occurred in cots, while 13 (30%) occurred in beds. Other products involved were prams, push chairs, high chairs, car seats, portable cots and walkers. A total of 1679 infants were hospitalized through infant-furniture-related injuries. Increasing trends in hospitalizations for baby walkers, beds and bunks were observed.
On average, four infants die each year from injuries related to infant furniture, and hospitalizations from injuries associated with infant furniture use are increasing. Mandatory standards are one measure to reduce these numbers, but education is also necessary.
To characterize children's bunk bed-related injuries.
Data are from the 2001-2004 National Electronic Injury Surveillance System - All Injury Program. Cases were defined as children aged 0-9 years treated for a non-fatal, unintentional injury related to a bunk bed.
An estimated 23 000 children aged 0-9 years were treated annually in emergency departments for bunk bed fall-related injuries, including 14 600 children aged <6 years. Overall, 3.2% were hospitalized. The injuries sustained were largely fractures, lacerations, contusions and abrasions, and internal injuries, with 25.2% injured in a fall from the top bunk. The most commonly injured body region was the head and neck.
Strategies are needed to reduce the most serious injuries. Bunk beds should meet CPSC standards, and the youngest children should not sleep or play in the upper bunk or on ladders. Making care givers aware of the risks, and modifying the living environment are essential.
