BOSTON -- Pediatricians warned Wednesday baby powder is dangerous for infants and may even cause death by suffocation if inhaled by tots with tracheotomy tubes.

'There's no reason for parents to use it at all,' said Dr. William H. Cotton. 'It just makes babies smell good for a short while but can present a problem for any infant.'


Representatives of Johnson & Johnson, the nation's largest manufacturer of baby powder, countered that the 'product is safe when used as it is intended.'

Cotton and his wife, Dr. Patricia J. Davidson, both pediatricians at the University of Cincinnati's Children's Hospital Medical Center, said the death last summer of a 4-month-old infant with a tracheotomy tube 'shows the danger of an aspiration -- airway occlusion caused by inhalation of baby powder.'

'Since more and more infants are now going home with tracheotomy tubes in place, this potential danger is becoming more widespread,' said the physicians in a letter to The New England Journal of Medicine.

Cotton said the prematurely born baby was having his diaper changed at home when 'baby powder was spilled accidentally and a cloud of powder apparently blocked the child's airway.'

The parents tried to ventilate the child by changing the tube and performing mouth-to-tracheotomy respiration. The boy was resuscitated at the hospital but died the next day, the physicians said, noting the scarred airways of babies with conditions requiring the tubes 'are likely to become even more constricted and obstructed by the baby powder.'

'Usually the infant has some obstruction in the upper airways so that the tube enhances breathing,' Cotton said.

Although Cotton and Davidson said their criticism was directed at all baby powders and they were not singling out any particular brand, Johnson & Johnson spokesman Robert Kniffin said, 'This is the first we've heard of such a problem.'

'While baby powder is particularly dangerous as an inhalant for those with tracheotomy tubes, we see other children who've gotten into trouble at least once a week,' Cotton said in a telephone interview.

'Baby powder is not a necessary infant-care item,' Cotton noted. 'Its absorptive capability is small, its lubricating properties are minimal, and its odor-covering and perfume aspects are short-lived.'

'Studies show Johnson's baby powder is useful to adsorb moisture and reduce friction,' Kniffin said. 'On the general question of safety, both the Food and Drug Administration and the Consumer Products Safety Commission have concluded there is no serious problem with talc inhalation.'

With baby-powder containers resembling feeding bottles, the 'open containers are often grabbed by infants during diaper changes,' the doctors said.

'Any medication delivered as a powder would be better administered in a cream or lotion,' Cotton and Davidson added.

Cotton said the talc is benign if ingested but acts as a pulmonary irritant if inhaled.

'The baby grabs the bottle, squirts it in the face, coughs and chokes,' Cotton said. 'Usually the powder doesn't get further than the mouth, but if the dose is big enough and it gets into the lungs, a chemical pneumonia can result.'