Infant walker injuries persist in Canada after sales have ceased

Infant Walker-Related Injuries in the United States

OBJECTIVES

To investigate the epidemiologic characteristics of infant walker-related injuries among children <15 months old who were treated in US emergency departments and to evaluate the effect of the 2010 federal mandatory safety standard on these injuries.

METHODS

National Electronic Injury Surveillance System data from 1990 to 2014 were analyzed.

RESULTS

An estimated 230 676 children <15 months old were treated for infant walker-related injuries in US emergency departments from 1990 to 2014. Most of the children sustained head or neck injuries (90.6%) and 74.1% were injured by falling down the stairs in an infant walker. Among patients who were admitted to the hospital (4.5%), 37.8% had a skull fracture. From 1990 to 2003, overall infant walker-related injuries and injuries related to falling down the stairs decreased by 84.5% and 91.0%, respectively. The average annual number of injuries decreased by 22.7% (P = .019) during the 4-year period after the implementation of the federal mandatory safety standard compared with the 4-year period before the standard.

CONCLUSIONS

Infant walker-related injuries decreased after the implementation of the federal mandatory safety standard in 2010. This decrease may, in part, be attributable to the standard as well as other factors, such as decreased infant walker use and fewer older infant walkers in homes. Despite the decline in injuries, infant walkers remain an important and preventable source of injury among young children, which supports the American Academy of Pediatrics' call for a ban on their manufacture and sale in the United States.

Effectiveness of Nurse Counselling in Discouraging the Use of the infant Walkers

Infant walkers are widely used by caregivers in Singapore despite being recognized as a household hazard. The study determined the effectiveness of nurse counselling in dissuading caregivers from using the walker. Caregivers of children 4 months of age were recruited and divided into the intervention group (nurse's advice and illustrated pamphlets), a conventional group (questionnaire alone) and a control group (without any intervention in a separate polyclinic). The percentage of the caregivers, who used the walkers in each group when their child was 9 months old, was taken as a surrogate indicator of effectiveness of nurse's intervention. The study analyzed 708 caregivers. Fewer caregivers (62.7% intervention vs. 80.4% questionnaire alone vs. 83.0% control) used the walker after nurse's advice with illustrated pamphlets. 8% of the users reported walker-related injuries (n=43). Nurses' counselling could be a simple yet effective method to discourage the use of walkers. Asia Pac J Public Health 2004; 16(2): 104-108.

Risk factors for unintentional injuries due to falls in children aged 0-6 years: a systematic review

OBJECTIVE

To identify risk factors for unintentional injuries due to falls in children aged 0-6 years.

DESIGN

A systematic review of the literature.

METHODS

Electronic databases from 1966 to March 2005 were comprehensively searched to identify empirical research that evaluated risk factors for unintentional injuries due to falls in children aged 0-6 years and included a comparison group.

RESULTS

14 studies met the inclusion criteria. Studies varied by the type of fall injury that was considered (ie, bunk bed, stairway, playground or infant walker) and with respect to the quality of evidence. In general, major risk factors for the incidence or severity of injuries due to falls in children included age of the child, sex, height of the fall, type of surface, mechanism (dropped, stairway or using a walker), setting (day care v home care) and socioeconomic status.

CONCLUSION

Despite a high burden, few controlled studies have examined the risk and protective factors for injuries due to falls in children aged 0-6 years. The only study to examine falls from a population health perspective suggests that age, sex and poverty are independent risk factors for injuries due to falls in children.

Preventing product-related injuries: a randomized controlled trial of poster alerts

BACKGROUND

The Product Safety Programme (PSP) of Health Canada is responsible for preventing product-related injuries. If PSP decides a product is dangerous, it can publicize its dangers, prohibit, or control its distribution; but for child products, the preferred option is to publicize its concerns. In the past, this included sending posters to paediatricians' offices and, more recently, placing alerts on the PSP website. This study examines the effectiveness of this process.

METHODS

15 Montreal paediatricians participated in a modified crossover randomized trial. During a randomly chosen intervention week, two product-related notices were posted in the paediatricians' waiting area. In the following or preceding week, these notices did not appear. Parents were interviewed by telephone to determine if they saw the posters and acted on the information received.

RESULTS

We interviewed 808 parents (86%) of the 940 who agreed to participate. Of these, only 16% of the intervention and less than 1% of the control group reported seeing the posters. There were no differences in reported changes in behaviours related to the notices. These findings are unchanged after taking account of socio-economic status. No parents cited the posters, websites, or paediatricians as their main source of information about dangerous products.

CONCLUSION

Product safety notices, whether sent to paediatricians' practices or posted on a website, cannot be relied upon to reach parents of preschool age children. Other approaches require consideration, such as increasing the power of PSP to regulate product safety.

Baby walker injuries

BACKGROUND

Baby walkers (BWs) are still commonly used. The resultant injuries are largely preventable. Understanding the reasons for their use and the circumstances leading to these accidents might lead to prevention.

OBJECTIVES

To study the reasons for using BWs, how accidents occur, types of injury and their management.

METHODS

Mothers of 100 children were interviewed while admitted or in the emergency room. The questionnaire included reasons for BW use, predisposing circumstances and types of injury sustained.

RESULTS

BWs were used by 83% of the children (44% girls, 39% boys), starting at an age between 5 and 8 months. Reasons for use were: to be occupied, 71%; to walk earlier, 54%; to strengthen the legs, 28%. Accidents were sustained by 78 (94%) of the infants as a result of BW use. The reasons were: being pushed by someone, 37%; BW mechanical defect, 36%; tripping, 22%. The commonest place was in a corridor (52%). Head injuries were sustained by 82% and included bruising, epistaxis, cut lip, tooth damage, cut tongue, skin abrasions and skull fracture. Limb injuries were sustained in 17%: laceration and/or abrasion, bruising and joint dislocation.

CONCLUSIONS

Injury from use of BWs is still common. Doctors should discourage their use and parents informed about the attendant hazards. A playpen is a safer place for young children.

Success in the prevention of infant walker-related injuries: an analysis of national data, 1990-2001

OBJECTIVE

Here we describe the epidemiologic characteristics and secular trends of infant walker-related injuries among children who are younger than 15 months in the United States.

METHODS

A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, 1990-2001. Sample weights that were provided by the National Electronic Injury Surveillance System were used in all analyses to adjust for the inverse probability of case selection and make national projections regarding infant walker-related injuries.

RESULTS

An estimated 197200 infant walker-related injuries occurred among children who were younger than 15 months and treated in US emergency departments from 1990 through 2001. Five percent of these children required admission to the hospital. The number of infant walker-related injuries remained relatively constant from 1990 through 1994, averaging 23,000 cases per year. After the introduction in 1994 of stationary activity centers as an alternative to mobile infant walkers and the implementation of the revised American Society for Testing and Materials F977 voluntary infant walker standard in 1997, there was a marked decrease in the number of infant walker-related injuries. Overall, there was a 76% decrease in the number of injuries from 1990 to 2001 from 20,900 injuries in 1990 to 5100 in 2001. Soft tissue injuries and lacerations represented 63% of the injuries. Trauma to the head region occurred in 91% of cases. Skull fractures were the most common (62%) type of fracture. Falls down stairs was the mechanism of injury in 74% of cases.

CONCLUSIONS

The adoption of passive injury-prevention strategies, such as use of stationary activity centers as alternatives to mobile infant walkers and redesign of infant walkers to prevent falls down stairs, were associated with a marked decrease in the number of infant walker-related injuries.

Community-based programmes to prevent falls in children: a systematic review

OBJECTIVE

We systematically reviewed the literature to examine the evidence for the effectiveness of community-based interventions to reduce fall-related injury in children aged 0-16 years.

METHODS

We performed a comprehensive search of the literature using the following study selection criteria: community-based intervention study; target population was children aged 0-16 years; outcome measure was fall-related injury rates; and either a community control or historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors.

RESULTS

Only six studies fitting the inclusion criteria were identified in our search and only two of these used a trial design with a contemporary community control. Neither of the high quality evaluation studies showed an effect from the intervention and while authors of the remaining studies reported effective falls prevention programmes, the pre- and post-intervention design, uncontrolled for background secular trends, makes causal inferences from these studies difficult.

CONCLUSION

There is a paucity of research studies from which evidence regarding the effectiveness of community-based intervention programmes for the prevention of fall-related injury in children could be based.

Do baby walkers delay onset of walking in young children?

Baby walkers have been a source of considerable controversy. Some people suggest developmental benefit from their use while others focus on the potential harm that stems from accidents and even suggest developmental delay. This mini-review aimed to determine if use of a baby walker delays affects the onset of walking. The Cochrane library, Embase, CINAHL and Medline were searched for randomized controlled trials (RCTs) and cohort studies, which compared the onset of walking in infants who used baby walkers with a group who did not. Two RCTs and two cohort studies were identified and available for consideration. All of the studies examined the effect of infant walkers on the onset of walking. The results of the two RCTs did not demonstrate a significant effect on the onset of walking. The cohort studies suggest that the use of infant walkers delayed the onset of walking in young children and a pooled analysis of the four studies suggested a delay of between 11 and 26 days. Although the quality of the studies was relatively poor these studies lend no support to the argument that walkers aid the development of walking. The significance of a delay of this magnitude is however unclear. Further work is required to determine whether walkers are an independent causal factor in accidents.

Still falling: a community-wide infant walker injury prevention initiative

Despite the well-known risk of injury associated with use of infant walkers, they remain popular, leading to large numbers of walker-related injuries. A coalition of health care providers and educators, with the assistance of retailers and medical and human service agencies, undertook an intensive multifaceted, community-wide intervention to educate the general and health care public regarding the dangers of infant walker use and thereby reduce the number of walker-related injuries in our community. Following this intervention, 28% fewer children presented annually at the two area pediatric emergency departments for walker-related falls down stairs than during the 30 months before the intervention. The magnitude of this reduction attributable to the intervention, however, is uncertain, as national trends during the study period revealed a similar decrease in walker-related injuries. Educational interventions alone may significantly reduce but not eliminate walker-related injuries; national policy measures are likely also necessary.

Injuries associated with infant walkers

In 1999, an estimated 8800 children younger than 15 months were treated in hospital emergency departments in the United States for injuries associated with infant walkers. Thirty-four infant walker-related deaths were reported from 1973 through 1998. The vast majority of injuries occur from falls down stairs, and head injuries are common. Walkers do not help a child learn to walk; indeed, they can delay normal motor and mental development. The use of warning labels, public education, adult supervision during walker use, and stair gates have all been demonstrated to be insufficient strategies to prevent injuries associated with infant walkers. To comply with the revised voluntary standard (ASTM F977-96), walkers manufactured after June 30, 1997, must be wider than a 36-in doorway or must have a braking mechanism designed to stop the walker if 1 or more wheels drop off the riding surface, such as at the top of a stairway. Because data indicate a considerable risk of major and minor injury and even death from the use of infant walkers, and because there is no clear benefit from their use, the American Academy of Pediatrics recommends a ban on the manufacture and sale of mobile infant walkers. If a parent insists on using a mobile infant walker, it is vital that they choose a walker that meets the performance standards of ASTM F977-96 to prevent falls down stairs. Stationary activity centers should be promoted as a safer alternative to mobile infant walkers.

Intussusception following a baby walker injury

Serious abdominal injury as a result of a fall in a baby walker has not been previously reported. We present the case of a 13-month-old boy who developed intussusception following a fall down five stairs in a baby walker. Attempted hydrostatic reduction was unsuccessful. At operation, a bowel wall hematoma, serving as a lead point, was identified. This case adds another type of injury to the list of those previously associated with baby walker use.

Babywalker-related injuries continue despite warning labels and public education

OBJECTIVE

To describe the epidemiology of babywalker-related injuries to children treated in a pediatric emergency department despite current prevention efforts, and to investigate the beliefs of parents regarding babywalker use.

DESIGN

A descriptive study of a consecutive series of patients.

SETTING

The emergency department of a large, academic children's hospital.

PARTICIPANTS

Children treated for babywalker-related injuries during the 3-year period of March 1993 through February 1996.

RESULTS

There were 271 children treated for babywalker-related injuries. The mean age was 9.2 months, and 62% of patients were boys. Ninety-six percent of children were injured when they fell down stairs in their babywalker. The number of stairs that a child fell down was significantly associated with skull fracture and admission to the hospital, and a fall down more than 10 stairs had a relative risk (RR) of skull fracture = 3.28 (95% confidence interval, 1.35 < RR < 7.98). There were 159 children with contusions/abrasions (58.6%), 35 concussions/head injuries (12. 9%), 33 lacerations (12.2%), 26 skull fractures (9.6%), 9 epistaxis (3.3%), 4 nonskull fractures (1.5%), 4 avulsed teeth (1.5%), and 1 burn (0.4%). Three of the skull fractures were depressed, and three also had accompanying intracranial hemorrhage. Ten patients (3.7%) were admitted to the hospital, and all had skull fractures resulting from falls down stairs. Supervision was present in 78% of cases, including supervision by an adult in 69% of cases. Forty-five percent of families kept the walker, and 32% used the walker again for the study patient or another child after the injury episode. Fifty-nine percent of parents acknowledged that they were aware of the potential dangers of babywalkers before the injury event. Fifty-six percent of parents favored a national ban on the sale of walkers, and 20% were opposed.

CONCLUSION

Despite the currently used prevention strategies, including adult supervision, warning labels, care giver education programs, and stairway gates, serious injuries associated with babywalkers continue to occur to young children. The US Consumer Product Safety Commission should promulgate a rule, similar to the voluntary standard adopted in Canada, regarding design requirements for babywalkers that will prevent their passage through household doorways at the head of stairs. The manufacture and sale of mobile babywalkers that do not meet this new standard should be banned in the US. A recall or trade-in campaign should be conducted nationally to decrease the number of existing babywalkers.