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.

The recent fall in postperinatal mortality in New Zealand and the Safe Sleep programme.

AIM: Postneonatal mortality rates changed very little from 2000 until recently. There has been a decrease in mortality in New Zealand from 2009 to 2015. This study describes an infant Safe Sleep programme and postulates it is the cause for the recent decrease in deaths. METHODS: The Safe Sleep programme involved as follows: a focus on preventing accidental suffocation, a 'blitz' approach to SUDI education, the targeted provision of portable infant Safe Sleep devices (ISSD) and the development of Safe Sleep policy across all district health boards (DHBs). RESULTS: Participation in the education 'blitz' by health professionals exceeded one in 23 live births, distribution of Safe Sleep leaflets exceeded two for every live birth, and over 16 500 ISSDs have been distributed to vulnerable infants. Postperinatal mortality fell 29% from 2009 to 2015 (2.8 to 2.0/1000 live births). The fall has been greatest for Maori and in regions with the most intensive programmes. CONCLUSION: The recent fall in postperinatal mortality has not happened by chance. It is likely that the components of end-stage prevention strategy, a focus on preventing accidental suffocation, the education 'blitz', the targeted supply of ISSDs and strengthened health policy, have all contributed to varying degrees.

Recent trends in child restraint practices in the United States.

OBJECTIVE: To assess the success of recent outreach activities to promote appropriate child restraint in motor vehicles by examining trends in restraint types used by children under age 9 in 3 large regions of the United States. METHODS: Cross-sectional study was conducted of children who were under age 9 and in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. A probability sample of 8730 crashes involving 10,195 children, representing 128 291 crashes involving 149,820 children, was collected between December 1, 1998, and November 30, 2002. Parent report was used to determine restraint type used in the crash. Logistic regression models were used to analyze the secular trend of restraint type use. RESULTS: Overall, for children under age 9, seat belt use decreased significantly from 49% to 36% between 1998 and 2002; for 7- and 8-year-olds, from 97% to 92%; and for 3- to 6-year-olds, from 63% to 34%. Concurrently, gains were achieved in overall child restraint use from 49% to 63%, for 7- and 8-year-olds, from 2% to 5%; and for 3- to 6-year-olds, from 35% to 65%. Child restraint use remains stable for children from birth to 2 years of age (from 97% in 1998 to 98% in 2002). Both the use of child safety seat and belt positioning booster seat increased significantly, whereas shield booster seat use decreased significantly. CONCLUSION: Although considerable achievements have been realized over a short period of time, substantial inappropriate restraint still remains: 62% of children aged 4 to 8 remain inappropriately restrained in adult seat belts. Parents hear safety messages when they are relevant to their children. As a result, sustained efforts about appropriate restraint must continue to maintain and improve the gains achieved in appropriate child restraint use. The additional benefits realized by recent changes in child restraint laws remain to be evaluated.

Shifts in child restraint use according to child weight in the United States from 1999 to 2002.

From 1999 to 2002, 32% fewer US children between 9 and 36.4 kg (20-80 lb) were restrained inappropriately in seat belts and the most prevalent form of restraint shifted from seat belts to child restraints with harnesses. There was a significant increase in the use of combination child restraint/booster seats with harnesses by children 9.1-18.1 kg (20-40 lb). Among children weighing 14.1-18.1 kg (31-40 lb), the inappropriate use of seat belts and shield boosters decreased. Among children weighing 18.6-27.2 kg (41-60 lb), the use of belt-positioning booster seats increased while the inappropriate use of seat belts decreased. Of note, by the end of 2002, 27% of children weighing between 18.6 and 22.7 kg (41-50 lb) were restrained in child restraints with harnesses. These children were of weights typically above the manufacturer's recommended limit. Despite progress, substantial inappropriate restraint still remains and continued investment in outreach efforts is necessary. The risk of injury for heavier children in child restraints with harnesses should be monitored.

Maternal use of baby walkers with young children: recent trends and possible alternatives.

OBJECTIVES: To examine recent trends in baby walker and exersaucer use, and to assess maternal motivations for choosing to use or not use these devices with children. SETTING: Small, Midwestern city in the United States. METHODS: Retrospective telephone survey with a sample of 329 mothers who provided information about their use of walkers and exersaucers with 463 children born in Columbia, Missouri between January 1994 and April 1999. RESULTS: Baby walker use in the sample declined fairly steadily from 1994 to 1999, whereas exersaucer use increased during the same period. Altogether 88% of mothers were aware of the injury risks associated with walkers, and this knowledge was the most commonly reported reason for abstaining from walker use. Remarkably, 38% of participants with knowledge of walker risks nevertheless used these devices. Participants reported many reasons for using walkers and exersaucers, including child entertainment, perceived developmental benefit, easy availability, and improved safety of exersaucers. CONCLUSIONS: Public knowledge of the hazards of walkers seems to be high, and this awareness is a likely factor in many caregivers' decisions not to use them. Future interventions should focus particular attention on those caregivers who continue to use walkers despite knowledge of the associated risks. In addition to persuasive interventions, alternatives to walkers should be encouraged. Exersaucers represent one viable alternative, and should be promoted as such by the media, pediatricians, and other child care professionals.