The danger of freely rocking cradles

Anthropo-Mechanical Cradles: A Multidisciplinary Review

Domestic cradles are beds that are movable but non-mobile for babies up to five months of age. The "anthropo-mechanical" cradle simulates the physiological movement of the human body. The article reviews scientific literature discussing the impacts of swinging on infants, provides classifications of all currently used cradles due to how the child moves, and briefly describes modern technologies within cradle automation. This made it possible to calculate and propose safe motion parameters within mechatronic cradles. The main conclusions of the article are as follows: (1) the scientific literature reports the beneficial effects of harmonic movement on a child, (2) motion analyses substantiating the classifications of all cradles into six types (tilting, yawing, hammock, Sarong, swing, and surging cradle; the classification criterion included the nature of the cradle movement in relation to the planes and anatomical axes of the child's body), (3) modern technologies allowing for the use of movement with thoughtful parameters, thus, safer for a child, (4) movement within the parameters similar to the motion and speed passively performed by the child in the womb while a mother is walking was considered beneficial and safe, and (5) the use of advanced technology allows for the possibility to devise and create an automatic mechatronic cradle with a child-safe motion. Future innovative anthropo-mechanical cradles that follow physiological human motion parameters can be used safely, with a vertical amplitude ranging from -13 to + 15 mm and a frequency of up to 2 Hz.

Injuries associated with cribs, playpens, and bassinets among young children in the US, 1990-2008

OBJECTIVE

To describe the epidemiology of injuries related to cribs, playpens, and bassinets among young children in the United States.

METHODS

A retrospective analysis was done using data from the National Electronic Injury Surveillance System for children younger than 2 years of age treated in emergency departments in the United States from 1990 through 2008 for an injury associated with cribs, playpens, and bassinets.

RESULTS

An estimated 181,654 (95% confidence interval: 148,548-214,761) children younger than 2 years of age were treated in emergency departments in the United States for injuries related to cribs, playpens, and bassinets during the 19-year study period. There was an average of 9561 cases per year or an average of 12.1 injuries per 10 000 children younger than 2 years old per year. Most of the injuries involved cribs (83.2%), followed by playpens (12.6%) and bassinets (4.2%). The most common mechanism of injury was a fall from a crib, playpen, or bassinet, representing 66.2% of injuries. Soft-tissue injuries comprised the most common diagnosis (34.1%), and the most frequently injured body region was the head or neck (40.3%). Patients with fractures were admitted 14.0% of the time, making them 5.45 (95% confidence interval: 3.80-7.80) times more likely to be hospitalized than patients with other types of injury. Children younger than 6 months were 2.97 (95% confidence interval: 2.07-4.24) times more likely to be hospitalized than older children.

CONCLUSIONS

This study is the first to use a nationally representative sample to examine injuries associated with cribs, playpens, and bassinets. Given the consistently high number of observed injuries, greater efforts are needed to ensure safety in the design and manufacture of these products, ensure their proper usage in the home, and increase awareness of their potential dangers to young children.

Accidental hanging deaths in children in Konya, Turkey between 1998 and 2007

In general, hanging cases are the result of suicide, and accidental and homicidal hanging cases are rarely seen. This study retrospectively investigated 4571 death examinations and autopsies that were performed at The Konya Branch of the Forensic Medicine Council (Turkey) between 1998 and 2007; hanging was involved in 201 (6.5%) of the cases. There were a total of 13 accidental hanging cases, where 12 of these involved children. In seven of the cases, the accidental hanging involved a scarf that wraps around swing-like cradles and is intended to prevent infants from falling down. It was concluded that accidental hanging deaths can be reduced by replacing swing-like cradles with cribs that are designed for children, removing ropes in and around the house, and preventing children from reaching and/or playing with rope-like objects.

Hazardous infant and early childhood sleeping environments and death scene examination

Infants and young children are at risk of accidental asphyxia from unsafe sleeping environments Specific dangers include wedging/entrapment and positional asphyxia when infants slide into gaps between mattresses and cot sides or between beds and walls. Faulty cot construction may result in defects through which infants may fall and become suspended, or in spaces which entrap the head. Projections on the inside of cots may ensnare clothing causing hanging, as may nearby curtain cords and restraining harnesses. The mouth and nose may be covered by plastic sheeting or by the mattress in partially filled waterbeds. Rocking cradles with excessive angles of tilt may also place infants' heads into positions where breathing is compromised. Finally, external pressure by adults in shared sleeping situations may result in fatal chest compression or airway occlusion. In many of these situations the autopsy findings are entirely nonspecific and do not help in establishing a cause of death. Thus, careful death scene examination with later formal review of findings may be the only way to accurately determine the manner of death.

Accidental childhood death and the role of the pathologist

The following study provides an overview of accidental childhood death. This study is based on a review of 369 cases of fatal childhood accidents taken from the records of the Department of Histopathology, Women's and Children's Hospital, Adelaide, Australia, over a 34-year period from 1963 to 1996. Data provide information on deaths due to motor vehicle accidents, drownings, accidental asphyxia, burns, poisonings, electrocution, and miscellaneous trauma. In addition, certain categories have undergone further examination, including asphyxial deaths due to unsafe sleeping environments and unsafe eating practices, drowning deaths, and deaths on farms, following identification of significant child safety problems in these areas as part of the "Keeping Your Baby and Child Safe" program. Previously unrecognized dangers to children detected through this program include mesh-sided cots, V-shaped pillows, and certain types of stroller-prams. The production of information pamphlets and packages for parents and the recall of certain dangerous products following recommendations made by pathologists demonstrate that pediatric and forensic pathologists have an important role to play in preventive medicine issues and in formulating public health strategies.

Accidental asphyxia in bed in severely disabled children

OBJECTIVE

To determine whether there are specific situations which may increase the risk of accidental asphyxia during sleep in children with physical and mental disabilities.

METHODOLOGY

Review of all cases where death was attributed to accidental asphyxia caused by unsafe sleeping situations in children listed in the Department of Histopathology database over a 10-year period from March 1989 to February 1999.

RESULTS

A total of 26 cases were found (M:F, 19:7; age range, 1-48 months; average age, 7.4 months). Of those cases, two involved children with significant mental and physical impairment. Case 1: A 4-year-old boy with Klippel-Trenaunay-Weber syndrome, macrocephaly and severe developmental delay, was found dead with his head hanging over a wooden board attached to the side of his bed. Case 2: A 4-year-old boy with lissencephaly and severe developmental delay was found dead wedged between a retractable mesh cot side and the side of his bed. In both cases the devices resulting in death had been put in place to prevent the boys from falling out of bed.

CONCLUSIONS

Accidental asphyxia in physically and mentally impaired children may be caused by devices that have been used to prevent injury from falling out of bed. Careful assessment of the specific developmental problems that children suffer should be undertaken before their beds are modified. It may be safer for these children either to have no barrier, or to have drop-sided cots/beds that meet recognized safety standards.

Accidental death or sudden infant death syndrome?

OBJECTIVE

To describe the reasons why it is difficult to decide whether to attribute some infant deaths to accidents or to SIDS.

METHODOLOGY

To extract from infant deaths data in South Australia those where the cause of death is debatable.

RESULTS

The risks associated with rocking cradles, bed sharing, bedclothes, couch sleeping, unsafe cots or beds and the prone position are presented.

CONCLUSIONS

Uniform worldwide death scene investigations for all infant deaths should help identify unsafe sleeping conditions for infants.