Crib bumpers present risk and little likely benefit, safety advocates say

Laura Maxwell researched crib bumpers online before she bought a bedding set that included them for her son, born in February 2010. She didn't see any reports suggesting there might be safety issues, and she thought the bumpers were cute. In April, her husband, Kyle, found their healthy 7-week-old baby dead in his crib.

The autopsy report, reviewed by USA TODAY, listed the cause of death as "asphyxia from the face being wedged between a crib bumper and mattress."

A new study commissioned by the children's product industry refutes research linking dozens of infants' deaths to the use of crib bumpers and says there is "no evidence" to suggest these cushions attached to crib slats are unsafe.

But most child-safety organizations, including the American Academy of Pediatrics and First Candle, warn against using crib bumpers, especially soft, pillow-like ones, because of the risk of suffocation. Maryland is considering banning their sale, and the Illinois attorney general is pushing for a ban.

The conflicting views about the safety of this staple of cribs leaves many parents in a quandary. The Juvenile Product Manufacturers Association (JPMA), which commissioned the new study on bumpers, has warned against the use of pillows, stuffed animals and blankets with infants in cribs for about 15 years because of suffocation risks.

The Consumer Product Safety Commission (CPSC) says it knows of 690 infant deaths associated with pillows and cushions from 1992 to February 2010. Bumpers are the last in-crib item over which there is disagreement.

Crib bumpers are displayed prominently in baby stores and departments. Parents often buy them to dress up cribs but also as a safety device to prevent bumps and bruises and to keep legs and arms from getting trapped between crib slats. JPMA says at least $50 million worth of infant bedding sets that include bumpers are sold each year, along with more than 200,000 bumper pad sets.

Conflicting safety advice

While Canadian health officials warn parents against using bumpers, critics say the CPSC has muddied the matter. In a paper published last fall, its lead scientific researcher on the subject, Suad Wanna-Nakamura, came to the same conclusion as the industry did this month. Of 52 deaths believed caused by bumpers, there were 28 with enough information to further investigate, CPSC says. She concluded there was "no causal link" between the deaths and bumpers. Her work is widely cited by manufacturers.

"Anyone who works on safety says they (bumpers) are not safe," says Nancy Cowles, executive director of the non-profit Kids in Danger. CPSC is "only now coming around to this issue."

CPSC Chairman Inez Tenenbaum is reconsidering what the agency's position should be. She's asked other scientists at the commission to re-examine the deaths and data on bumpers and will take the highly unusual step of having their analysis peer-reviewed by an outside panel.

"We haven't come to a policy decision, but we are working to be able to give parents the best advice we can," says CPSC spokesman Scott Wolfson.

For now, Wolfson says "bare is best" when it comes to what's in cribs, but if consumers buy bumpers they should be "properly and tightly affixed to the crib."

"While CPSC staff carries out their review of bumper pads, I urge all parents and caregivers to place their baby to sleep on his or her back and keep all pillows, blankets and comforters out of the crib," she says.

27 infant deaths

Bradley Thach, a physician and professor of pediatrics at Washington University in St. Louis, did the 2007 report in the Journal of Pediatrics that JPMA hired the research company Exponent to analyze.

Thach's report concluded that 27 infants died because of crib bumpers. JPMA executive director Mike Dwyer says Thach's study was chosen because it prompted most of the warnings about bumpers being unsafe, and Dwyer's "not quite sure how you could come to that conclusion."

Exponent, which often does product liability and litigation research for manufacturers, says there were "confounding variables" in every case Thach cited. These include pillows and other products in the cribs, infants sleeping on their stomachs and bumpers used in makeshift cribs.

Thach says he used medical examiners' reports for his analysis and disputes that other factors absolve the bumpers.

"If the baby's face is pressed into the bumper, then the logical conclusion is that the bumper caused the baby's suffocation," he says. If a baby died while wedged between the bumper and a pillow or other soft surface, "one could conclude that the bumper played a significant role in causing the death."

Along with dismissing safety concerns, Exponent researchers Joseph Sala and Michael Prange say potential injuries, including leg fractures and head injuries, could be prevented by crib bumpers. But most would only be possible after babies are old enough to pull themselves up — typically at about 5 or 6 months old — which is when manufacturers and safety advocates say bumpers should be removed. At that point, they present another danger as babies can use them as a step to get out of the crib, which is even riskier.

On the side of bumper pads

But Prange says there might still be a safety benefit, because the padding in bumpers could "mitigate" some of these injuries.

"As children attempt to stand or pull up, that's when they are the least stable in their actions," he says.

JPMA says there isn't enough research yet to develop industry standards for bumpers, but it hopes standards will eventually clarify what the best designs are and help weigh the value of bumpers against safety concerns.

Safety advocates and doctors say they are convinced the risk of bumpers is so serious that it outweighs any possible benefit.

"Since bumpers can be a cause of death and they might only prevent very minor injuries, bumpers should not be used," Thach says.

The gray areas

Bumpers can put safety groups in an awkward advocacy position. Cowles used to warn against bumpers but would add that if they were used, they shouldn't be "pillow-like." Now, she simply says they should all be avoided. Safe Kids USA says its advice is, "Don't use them."

Many of the bumpers in retail stores today are different than those seen years ago, including new mesh ones, says the CPSC's Wolfson. Cowles is encouraged by such "breathable" bumpers but notes only one company sells them and they haven't been tested, so she's not recommending them. Safe Kids is also concerned they haven't been tested. Few bumpers now sold are the pillowy types that raise the most concerns.

Catherine Hall was so concerned about reports of infant deaths that she started an advocacy group, MISSION (Mothers Investigating Safe Sleep Options for Newborns) and designed a product that she says is a safer version of crib bumpers. Her "Wonder Bumpers" attach vertically to individual slats and don't have ties, which have strangled some infants. She says hers is a safe alternative — and she has doctors who agree — but she doesn't have the lobbying budget to persuade an independent group to test it.

Grieving parent unsatisfied

Cowles doesn't recommend Hall's design either, because she worries any soft padding could be a problem.

Maxwell, of Fayetteville, Ark., is in the process of filing a lawsuit against the company that made the bedding set with the bumpers she blames for her son's death — and the retailer that sold it. Before he wound up against the bumper, Maxwell's son, Preston, had rolled off a "sleep positioner." These cushions were supposed to keep babies on their backs — the position recommended to prevent Sudden Infant Death Syndrome (SIDS) — but were linked to suffocation deaths. The Maxwells are also suing the maker of the sleep positioner.

Last fall, CPSC and the Food & Drug Administration warned that sleep positioners were both unnecessary and unsafe. That led nearly all retailers to stop selling them and manufacturers to stop making them. Cowles sees parallels between bumpers and sleep positioners and is hoping CPSC will warn parents against using bumpers and that it will have a similar effect.

Maxwell wants CPSC to take more drastic action: She says she's tired of warnings and wants an "immediate halt of manufacturing."

"They are totally unnecessary," Maxwell says of bumpers. "If they were taken off the shelf in 2009, my son would still be here."

CRIB SAFETY TIPS:

•Make sure crib, bassinet, or play yard has not been recalled by the Consumer Product Safety Commission.

•Remove all pillows, blankets and bumpers. "Bare is best," says CPSC.

•Check for loose or missing parts or slats.

•Place infants on their backs to sleep.

•Use a firm, tight-fitting mattress.

•Ensure crib has proper hardware that's tightly secured.

•Keep all cords — such as for window blinds and infant monitors — away from the crib.

Sources: CPSC, USA TODAY research