SIDS: 17 deaths in cribs and more

 Ellen Gabler  Chicago Tribune
CHICAGO — The nanny checked on Madison Morr twice during her afternoon nap. The second time, Madison's skin was blue — her face was pressed against the bumper pad that lined the inside of her crib.
A medical examiner found the 5-month-old baby had suffocated to death, and federal regulators received a death certificate that said she had been trapped against padding in the corner of the crib.
Yet those regulators never examined whether Madison's death involved an unsafe product.
The baby's death in 2006 is one of at least 17 cases where the Consumer Product Safety Commission did not investigate a child's death, even though the agency had reports on file suggesting bumper pads played roles in the fatalities, the Chicago Tribune found.
The Tribune looked into some of the cases and found that medical examiners and coroners said bumper pads were involved in the suffocations.
Now the safety agency is in the midst of trying to decide if the popular nursery products are safe, yet is doing so without having investigated all deaths that involved bumpers, which tie around crib slats.
The agency has been hesitant to take a stand on the products' safety despite warnings from the American Academy of Pediatrics and other organizations urging parents not to use bumpers because they present a suffocation risk.
Commission spokesman Scott Wolfson said officials are examining if there is a scientific link between bumper pads and suffocations or if factors such as blankets, pillows or medical issues played a primary role in the babies' deaths.
That reasoning worries leaders at children's health and safety organizations who believe bumpers shouldn't be in cribs.
"If the baby was found with the face smushed up against the bumper pad, then I don't understand the relevance of the pillow or the blanket," said Dr. Rachel Moon, a pediatrician at Children's National Medical Center and researcher for the American Academy of Pediatrics.
In addition to the 17 cases the agency didn't look into, the Tribune found that officials have investigated at least a dozen deaths where bumpers appeared to play a role. In those fatalities, the safety agency has said bumpers were not clearly the culprit because other factors, such as blankets or pillows, were in the crib too.
But the Tribune found that in many of those cases the babies had their faces pressed into bumper pads.
For instance, in 2007, a 2-month-old baby in Florida was found with her face pressed against a bumper pad, with one of her arms stuck between the pad and crib railing. The medical examiner said she suffocated. A detective who responded to the scene noted that other items were in the crib, but the baby's face was against the bumper.
Pinpointing the sole cause of death can be difficult because death scenes are complicated and often involve various products. But Dr. Marion Burton, president of the American Academy of Pediatrics, said federal regulators don't need to base safety considerations on "cause and effect," which is a high bar to meet scientifically, when there is a strong association between bumper pads and suffocations.
"It's a potential hazard, so don't have it in the child's environment," he said. "I can't think of any reason to have them."
Wolfson said babies have been injured from getting limbs stuck in crib slats, but no fatalities have been reported.
Bumpers were originally made to cover space between crib slats that were too far apart. Regulations changed in the 1970s, mandating less space between slats so babies wouldn't fall out or get their heads caught. Bumpers are still widely sold, often as part of coordinated bedding sets.
For years, regulators and safety groups have promoted "safe sleep" environments, recommending that babies be put to sleep on their backs in cribs without pillows or soft bedding.
Safety experts argue that bumpers are problematic too because they are marketed to parents as a nursery staple and don't display warnings that babies can suffocate against them.
"It is possible for babies to suffocate against a lot of things," said Moon, with Children's National Medical Center. "I'm not sure why bumper pads would be an exception to that."
Three years ago, Washington University pediatrician Dr. Bradley Thach published a report that concluded at least 27 babies' deaths over two decades were attributable to bumper pads.
Wolfson said an outside panel of scientists will review the agency's own assessment of bumper pads but wouldn't say who will sit on the panel.
The children's bedding industry, through its lobbying trade group, has said bumpers are safe and is doing its own study.
The Tribune reported in December that for years federal regulators have received reports of babies suffocating against bumpers but have failed to warn parents or investigate all deaths. In response, the agency said it would reopen files on babies' deaths and assess the safety of bumper pads on store shelves.
Under the Freedom of Information Act, the Tribune requested from the agency all infant death files where bumper pads were mentioned. After three and a half months, the agency turned over 42 of 52 cases since 1990. Officials provided one or two-sentence summaries for the missing files, which they said are still in archives.
The Tribune found 17 cases in which the files contained few details on how the child died, yet the agency failed to ask for further information that could explain what happened. Some deaths are documented only by a death certificate or a brief report from a medical examiner.
Wolfson said some cases that weren't investigated came to the agency's attention years after the tragedies occurred, making it difficult to re-create death scenes, interview parents and analyze products.
The agency relies in part on medical examiners and coroners to alert it to product-related deaths. But the process is voluntary, and many officials don't participate. As a result, the agency buys death certificates from states to try to find relevant cases. Wolfson said the time delay in getting death certificates can make investigations a challenge.
But it is still possible.
By requesting police and medical examiners' reports as well as talking with families and officials, the Tribune could determine that five of the 17 deaths were linked to bumper pads, although other factors were sometimes also present.
A few deaths did not turn out to involve bumpers, or there wasn't enough information available to determine what happened. Federal authorities, however, would likely have greater access to information.
The newspaper was unable to follow up on nine deaths because the agency provided only short summaries of each case and would not release the public documents it has on file. The brief descriptions of each death, however, mentions the child's face being against a bumper pad or the child being wedged between a bumper and something else.
Madison Morr's death in Michigan was among those not investigated by federal officials. Records show that the baby was put to sleep on her back with a wedge placed to one side of her, presumably to prevent her from rolling over.
During her nap, the baby rolled away from the wedge, flipped onto her stomach and became trapped with her face in the bumper, the medical examiner found.
In 2003, Alexis Ferguson, 2 months old, was found dead in her crib with her face in a bumper pad, according to the Cass County Coroner's Office in Indiana. That same year, Jacent Jackson of Detroit was found with his face buried in a bumper pad. The 2-month-old baby's nose and mouth were completely blocked, according to a medical examiner's report.
Pat Tackitt, a pediatric mortality investigator, said Jacent had scooted to the top of his crib after being put to sleep on his stomach. The safety agency has discounted deaths of babies put to sleep on their stomachs because that position is considered a risk factor for sudden infant death syndrome, but it's unclear if officials classified Jacent's death that way.
Experts agree that thorough death-scene investigations are critical to determine how someone died. But the quality and consistency of investigations vary.
Distraught parents often don't want to talk about what happened or can't remember exactly how they found their baby before taking him or her out of the crib. Police reports sometimes do not explicitly explain how a child was found or what was in the crib.
Thach and other experts believe bumper-related suffocation deaths are underreported because they can be wrongly attributed to sudden infant death syndrome if the death is not thoroughly investigated.
Statistics from the National Center for Child Death Review suggest bumper pads are playing a role in more deaths than the safety agency knows about. Since 2008, the federally funded organization has received 14 reports where a bumper pad was relevant in the suffocation of a baby, though other products were sometimes relevant too. Death review teams in about 33 states reported to the organization.
That many deaths tied to a product is cause for concern, said director Theresa Covington. "I really think it needs attention and study," she said.
Last year, the Consumer Product Safety Commission told the Tribune it had reports of 28 infant deaths over two decades that were associated with bumper pads, meaning the product played a role in the death.
The agency then backpedaled on that number earlier this year, stating that in all cases "confounding factors were more likely to have been primary contributors."
But the Tribune found several cases investigated by the agency where bumpers do appear to be primary contributors to the deaths, even though other products were also mentioned.
In 1998, the babysitter of a 7-month old Missouri boy found him with his face pressed into a bumper pad. Police photos of the baby's crib show a stuffed animal and blankets at one end of the crib, but a re-enactment with a doll shows that the baby was found in another corner of the crib with his face in the bumper pad.
Tyler Baker was found pitched forward with his face in a bumper pad at his babysitter's house in 2007. The 5-month-old baby from Wenona, Ill. was put to sleep on his stomach but somehow worked his way to a corner of the crib and ended up, face down, in the bumper pad.
Photos of the crib show a musical toy, blanket and stuffed animal at one end of the crib, but Tyler was found at the other end. A portion of a blanket hanging over the crib edge was under his head as well, according to a police report.
His mother said the baby's bed at home had bumper pads too. "I'd never heard about a child suffocating on anything in a crib," she said.

SIDS: US statistics on crib injuries

Feb 17, 2011
CHICAGO (Reuters Life!) - Crib-related accidents send 26 children to U.S. emergency rooms each day and result in more than 110 deaths annually, a new study has found.The analysis, by researchers in Columbus, Ohio, will be published in the journal Pediatrics. It examined historical data from the National Electronic Injury Surveillance System operated by the U.S. Consumer Product Safety Commission.
The researchers found that between 1990 and 2008, some 181,654 children under the age of 2 were treated in U.S. emergency rooms for injuries related to cribs, playpens and bassinets -- the majority as a result of falls from cribs that caused injuries to the head, neck or face.
Only a small fraction of the injuries over the 19-year period -- just 5.5 percent -- were the result of child becoming caught or wedged in the crib's protective bars. But such accidents accounted for the greatest number of fatalities that could not be related to some other cause, such as sudden infant death syndrome.
The vast majority of the children admitted to the ER for crib-related accidents during the study period -- nearly 94 percent -- were treated and released. But an estimated 2,140 died as a result of their injuries.
The researchers from Nationwide Children's Hospital and Ohio State University said a continued strengthening and enforcement of crib safety standards would protect more young children from harm because the vast majority of the injuries -- 83 percent in all -- occurred in cribs rather than bassinets or playpens.
But they also said parents can do several things to help protect their children, including:
* Select cribs that meet all current safety standards, do not have a drop side and are not old, broken or modified.
* Avoid cribs with cutouts, decorative corner posts, knobs that stick up more than 1/16th of an inch or slats that are more than 2 3/8 inches apart.
* Visit www.recalls.gov to make sure the crib has not been recalled.
(Reporting by James B. Kelleher; Editing by Jerry Norton)
http://www.reuters.com/article/2011/02/17/us-babies-cribs-injuries-idUSTRE71G7DV20110217

SIDS: Consumer Agency Tightens Scrutiny of Baby Sleep Products

By ANDREW MARTIN : Published: January 31, 2011

Three years ago, Dr. Bradley Thach, a professor of pediatrics at Washington University in St. Louis, published findings that had the potential to upend nurseries across the nation, and perhaps save some lives too.

 Dilip Vishwanat for The New York Times

Dr. Bradley Thach’s findings about the dangers of crib bumpers are now getting a second look by the Consumer Products Safety Commission.

Minh Uong/The New York Times

In reviewing data from the Consumer Products Safety Commission, Dr. Thach concluded that crib bumpers — the padding wrapped around the inside of a crib that often matches the bedding—were killing babies. In a 10-year period beginning in 1995, he found 27 suffocation deaths involving bumper pads, and he theorized that many more might have occurred because of inconsistencies in the data.
“Because bumpers can cause death, we conclude that they should not be used,” he warned.
The Consumer Products Safety Commission initially ignored the findings. Last summer, it reached the same conclusion as a trade group representing product manufacturers, which asserted that other factors, like a crib crowded with pillows or babies sleeping on their stomachs, might have been a factor in those deaths, rather than the bumpers. As a result, most parents remained unaware of the debate over the safety of crib bumpers.
Now, prompted by consumer advocates and news reports highlighting potential dangers, the commission has reversed itself and decided to take a deeper look at crib bumpers as part of a broader regulatory crackdown on the hazards of an extensive line of baby sleep products that have been blamed for more injuries and deaths.
The sweeping overview is another sign of a heightened regulatory atmosphere among many agencies in the Obama administration.
For example, in September, the commission, along with the Food and Drug Administration, warned parents not to use sleep positioners intended to keep babies on their backs. Some sleep positioners were marketed to parents as reducing the risks of sudden infant death syndrome, but in fact, the agencies said, the products had caused the suffocation death of 12 babies over the last dozen years or so.
Then, in October, the commission warned parents about the dangers of baby monitor cords and urged them to keep the cords away from cribs, bassinets and play yards. Since 2004, the commission has received six reports of babies being strangled by the cords.
In December, the commission approved the first new mandatory standards for cribs in nearly two decades. The new rules banned existing designs for drop-side cribs, which have been blamed for entrapping and killing at least 32 babies since 2000, and required more rigorous testing on all cribs.
In addition, day care centers will be required to replace over the next two years any cribs that do not comply with the new regulations.
Nancy A. Cowles, executive director of Kids In Danger, a nonprofit organization that monitors the safety of children’s products, said the new crib standards were “a huge leap forward,” after years of relative inaction by the safety commission.
“It’s the safest in the world,” she said of the new standards.
The crackdown on baby sleep products was brought about by a confluence of factors. After an influx of contaminated products, including toys from China, Congress passed the Consumer Products Safety Improvement Act of 2008 which gave the commission — long criticized as toothless — more money and authority.
As part of the new law, Congress mandated that the commission issue mandatory standards for more than a dozen baby products, including strollers, bassinets, high chairs and cribs, replacing voluntary guidelines that had been the norm. News reports documenting baby deaths from unsafe products, particularly in The Chicago Tribune, put additional pressure on the commission.
Since 2007, more than 10 million cribs have been recalled, and Inez Tenenbaum, who was named chairwoman of the commission by President Obama in 2009, said she had made the safety of baby sleep products a top priority, or what she calls the “Safe Sleep” campaign.
In an interview, Ms. Tenenbaum said that when she became chairwoman she put together a team of experts to review 10 years of injury and fatality data on cribs. The result was 19 crib recalls and expedited regulations, actions which she says have “cleaned up the marketplace.”
She said the commission had also tried to educate parents about how to keep a sleeping baby safe, distributing a video to pediatricians’ offices and hospitals.
In the next year, Ms. Tenenbaum said her agency would be writing new regulations for bassinets and toddler beds. She declined to comment on why the commission had not taken more forceful action sooner.
Even with a renewed focus on the safety of baby sleep products, Ms. Tenenbaum and others acknowledge that obstacles remain.
Though the commission has ordered the recall of millions of cribs and other sleep products, many of them are still being used by parents. In addition, some parents and caregivers continue to put babies to sleep on their stomachs; experts recommend that babies be put to sleep on their backs to prevent against suffocation or sudden infant death syndrome, or SIDS.
And for all the attention on defective products, the majority of deaths of sleeping infants are caused by suffocation from pillows and other bedding that crowds a crib.
A commission report from July found that 531 deaths from 1992 to May 2008 were associated with pillows or cushions, an average of 35 deaths a year. In a vast majority of the cases, the babies were placed to sleep on their stomachs. In half the cases, the infants were put to sleep on top of a cushion or pillow.
There also remains some debate about what is safe for babies and what isn’t.
Several small manufacturers offer products that promise to reduce the incidence of sudden infant death syndrome, though medical experts and regulators remain dubious. Indeed, the F.D.A. says products that claim to prevent SIDS would be considered medical devices and therefore would require agency approval.
For instance, the Web site Eve’s Best claims that the BabeSafe mattress cover it sells has been “100 percent successful in preventing SIDS (crib death) for over 12 years.” The cover is promoted as preventing toxic gas from leaking out of the mattress, one controversial theory for the cause of SIDS.
“As a parent, I can tell you that the opinions of ‘government regulators’ as well as the A.A.P. mean absolutely nothing to me,” said Evie Maddox, who runs the Eve’s Best Web site, referring to the American Academy of Pediatrics. She said the cover was so safe that babies could sleep on their stomachs. “There are many well-educated parents out there who feel the same,” she said in an e-mail late last year.
Manufacturers of baby products, meanwhile, have challenged allegations that their products are unsafe. Michael Dwyer, executive director of the Juvenile Products Manufacturers Association, said critics frequently claimed that a product was unsafe based on emotion, whereas his members relied on science-based facts.
After federal authorities warned parents not to buy sleep positioners, the Juvenile Products Manufacturers Association suggested that parents could continue using them, as long as they used them properly.
And the association disputes the Dr. Thach’s findings on crib bumpers. Mr. Dwyer said the association commissioned its own study and found that it was often unclear what caused the babies’ death since there were other things crowded in the cribs, like pillows or soft toys. The association recommends that crib bumpers be firm, rather than pillowlike, and be removed from the crib when a baby is able to stand.
“Whereas bumpers may have been mentioned as being present in the crib, we really challenge whether the bumper was the cause,” he said.
For his part, Dr. Thach said he remained available to talk to regulators and industry officials about his findings. He noted that it was nearly impossible to buy bedding for a crib without bumpers.
“They are still selling them,” he said. “People see these in stores and assume they are safe.”
http://www.nytimes.com/2011/02/01/business/01safety.html?_r=1&src=busln&pagewanted=all