The "Back to Sleep" campaign, as well as organizations such as First Candle and The SIDS Alliance, has done a lot to bring issues of sleep safety to the forefront. Thanks to the efforts of childbirth educators and healthcare professionals, key messages about back sleeping, avoidance of overheating, a smoke free environment, and a crib containing nothing except a tight fitting mattress and fitted sheet have become a common element in parent education. Newer recommendations including use of a fan in the room and fixed side cribs currently present new education challenges for educators and healthcare teams.
What is the real take home message with the "fan" study? (Archives of Pediatric and Adolescent Medicine, October, 2008; vol 162: pp 1-6). Parents have heard about it and ask "What kind of fan?" “How close should the fan be to the crib?" "What should the speed of the fan be set at?" The study found that using a fan cut the risk of SIDS by 72%. The use of a fan in a room with a temperature higher than 69 degrees Fahrenheit was associated with a 94% decreased risk of SIDS compared with no fan use. We spoke with Pam Borchardt NCBF, Co-Executive Director of the Illinois SIDS alliance. "The real issue here is about good ventilation, the prevention of re-breathing, and the avoidance of overheating. These have always been our recommendations. Parents who want an added measure of safety should use a low speed ceiling fan." Pam further stressed that everyone needs to remember that "fan use" is no substitute for placing an infant to sleep on their back, which is the primary risk reduction factor.
For the past few years, main stay "crib" education has focused on checking for recalls, not using a crib manufactured before 2000, and use of the crib as the only sleep environment. Until recently, there has not been a lot of news about the design of the crib itself. Now, the dangers of drop-side cribs have exploded, leading to the largest crib recall in history. Since 2007, there have been 21 major drop side crib recalls involving 10 different brand names and over 4.2 million cribs. Among the major manufacturers are Delta, Simplicity, Jardine, Munire, and Stork Craft. The drop-side has been implicated in the death of at least five babies when missing hardware caused the drop side to separate from the crib; creating a gap that trapped and suffocated the infant.
So, what is the problem with drop-side cribs? We have been using them for years. Let's start with some facts about federal regulation and safety testing:
1. Cribs are the only sleep environment for babies that are required to meet safety standards set by the federal government. There are no such standards for bassinets, cradles, or co-sleepers.
2. Required safety standards for cribs do not include durability standards. Cribs are tested when they are new and assembled according exactly per the manufacturers, using all the required hardware. Furthermore, active toddlers are tough on cribs.
3. Most crib manufacturers also voluntarily comply with The American Society for Testing and Materials International (ASTM) which set a more comprehensive standard indicated by the Juvenile Products Manufacturing Association (JPMA) sticker on products. While ASTM includes some durability standards for cribs, it does not require testing for spindle strength or failure of loosening of drop-side hardware due to repeated use.
Weak safety standards are not the only issue. Consumers themselves are an added variable. Most cribs are assembled by the parents. Incorrect assembly, failure to inspect the crib periodically for damage, and failure to replace broken or missing hardware can make the crib less safe. Additionally, parents reuse the cribs for multiple children or pass them down to other family members. When the cribs are disassembled and then reassembled the risk of defects causing dangerous conditions greatly increases.
The good news is that most major retailers, including Toys R Us, Pottery Barn Kids, Land of Nod, have stopped ordering drop side cribs. Consumers shopping for new cribs at many retailers will have no choice but to purchase cribs with stationary sides. Additionally, many groups including ASTM, The United States Senate, the Consumer Product Safety Commission, and consumer advocate groups have joined forces to move towards stricter, safer standards for cribs. This includes banning the use of drop-side cribs. Additionally, Toys R Us has also contracted with an outside safety firm to conduct testing on all cribs they sell.
Although not as widely available, the other alternative for parents is the drop-gate crib. In these cribs, part of the crib side folds down. In this type of crib, the moving parts do not extend down next to baby's sleeping space, so there is less risk that a hardware failure could create an entrapment hazard. Also, because the mechanism in a drop-gate crib is simpler than a drop-side crib, there isn't as much risk of incorrect assembly or of the hardware failing and posing a serious safety problem. However, drop-gate cribs may present their own potential safety hazard. The horizontal bar created by the folding gate portion can give industrious older babies a foothold for climbing out. Keep in mind, there could be safety issues with drop-gate cribs that have not surfaced yet, due to their limited availability and usage.
Where can educators go for the best safe crib and safe sleep resources?
• The Consumer Products Safety Commission recently established the Online Crib Information Center to provide education and help parents manage crib recalls - http://www.cpsc.gov/cribs.html
• The consumer products safety commission also has several brochures that can be downloaded and printed at www.cpsc.gov/cpscpub/pubs/cribsafe.html
• A safe sleep poster can be downloaded and printed at www.cpsc.gov/nsn/safesleep.pdf
• Struggling with the blanket/swaddling "message" Halo's newer sleep sack allows for swaddling. Halo offers free First Candle literature and a sleep sack as part of it's educator package; go to www.halosleep.com
• Kids In Danger offers a free "Safe Sleep Tips" brochure at www.kidsindanger.org
• Are your moms still buying and using bumper pads? Is it hard to convince them that you are not being "over the top". This issue is not just folklore - there really is research to support the dangers of bumper pads (Journal of Pediatrics 2007; 151:271-4)
We believe that the real teaching opportunity for the next few years resides with the parents who are expecting baby number 2 or 3. Many of these moms have transitioned baby #1 to a big kid bed and plan on re-using their drop side crib. We spoke with Nancy Cowles, executive director of Kids in Danger, and asked her specifically about these multiparious moms. Do these moms need to throw away their 2 ½ year old drop side crib that appears to be working just fine? According to Nancy Cowles, "Not necessarily. But there are steps they need to take to help ensure the crib's safety". Together with Baby developed this one-page handout for educators and parents to help them determine if their drop-side crib is OK to use. Click here to download the Crib Safety Handout.
Copyright 2009 Together with Baby; special thanks to Nancy Cowles at Kids in Danger; www.kidsindanger.org; Together With Baby, LLC provides the materials contained in this handout for information purposes and such information is an expression of opinion only and Together With Baby, LLC. makes no warranty of any kind whether express or implied. Any questions regarding you or your families' health should be directed to your health care provider. Any links to other publicly available Websites are provided as a convenience and Together With Baby, LLC makes no claims, promises or guarantees about the accuracy, completeness, adequacy of the information contained in this handout or in such other sites or materials.
Expectant and new parents often ask childbirth educators and nurses their opinion about car seats. Which one do you like? Which one is safest? The "non-liable" party-line answer from professional organizations such as the AAP and NHTSA is often something like: "The right car seat is the one that fits your car, your baby, and is used properly every time". This response is not very helpful. Parents still don't know which car seat to buy. Parents look to their health care team for guidance, and yes, their "professional" opinion. According to Brooks Watson, certified Child Passenger Technician and owner of Safety Squad, "there are a lot of variables and every car seat and vehicle model is a unique situation. However, there are tips you can offer parents to guide them with their purchasing decision and use of their car seat". Below are 5 tips you can share with parents:
• Consider a 30 pound weight limit infant seat. Infant seats have different upper weight limits. Many have a 22 pound upper weight limit, but Peg Perego, Graco, and Chicco all manufacture 30 pound seats. This allows your baby to remain in his or her rear-facing infant seat longer. Rear facing is 4X safer for infants and toddlers. The AAP recently endorsed "rear facing until the age of 2" as a best practice. This may also offer a "cost" advantage, as parents may need to only purchase one more car seat after their 30 pound infant seat. Most often, baby can go from a 30 pound infant seat into a "combination" seat (combination seats use a 5-pt harness up to a certain weight/height and then convert into a booster seat).
• Fitting baby into the carrier correctly is just as important as installing the base correctly. Newborns come in all different sizes, so look for a seat that offers maximum flexibility. This may be especially important if you are at risk for a smaller baby, such as a history of pre-term labor or pregnant with twins or triplets.
• Consider an infant seat with a lower weight limit of 4 pounds instead of 5. There is one seat on the market with a weight range of 4-30 pounds, offering both of the "weight limit" advantages.
• Look at how many harness level slots are available on the infant seats - some have 3, others have 4 or more. Also look at the location of the lowest harness slot. How far down is it towards the seat bite. Harness slots for rear facing use need to be "at" or "below" the baby's shoulders.
• Does the seat offer detachable cushioning/padding or head wraps? These may help with "fit" especially for smaller babies NOTE: cushioning, padding, head wraps, sleeping bag type covers should never be added to a car seat because these things have not been tested with the car seat. They may also interfere with harness tightness and position. Only use items that came in the box with your car seat.
• Look to see how easy it is to move the harness to higher heights. This varies widely from seat to seat. Some seats include features such as a splitter plate that make this much easier. Parents often struggle with changing the harness straps which leads to improper use and decreased safety.
• Choose your car seat first: then purchase your car seat compatible stroller. Safety first, then convenience and style. Many expectant parents spend lots of time choosing their stroller, and then just register for whichever car seat fits the stroller.
Use the services of a professional, certified National Child Passenger Safety (CPS) technician. It is tricky business installing your infant seat correctly - in the correct vehicle position, with the correct tightness, and at the right angle. In fact, 83.9% of infant seats are used or installed incorrectly. Visit www.nhtsa.gov to learn more. You can search for certified car seat technicians in your area. Brooks Watson also recommends calling the technician before your appointment and asking him or her questions. "A professional CPS team has experience with thousands of installations. They should be able to offer you insight on any potential compatibility issues between your car seat and your particular vehicle".
Copyright 2009 Together with Baby; special thanks to Brooks Watson at Safety Squad; www.safetysquad.com; may be reproduced for education purposes. Together With Baby, LLC provides the materials contained in this handout for information purposes and such information is an expression of opinion only and Together With Baby makes no warranty of any kind whether express or implied. Any questions regarding you or your families’ health should be directed to your health care provider. Any links to other publicly available Websites are provided as a convenience and Together With Baby, LLC makes no claims, promises or guarantees about the accuracy, completeness, adequacy of the information contained in this handout or in such other sites or materials.