Table 2: Estimated Injuries in 2006 among Children under Age Five by Type of Nursery Product

PRODUCT CATEGORY ESTIMATED INJURIES
CY 2006
TOTAL 66,400
Infant Carriers and Car Seats (Excludes Motor Vehicle Incidents) 14,200
Cribs and Mattresses 11,300
Strollers and Carriages 11,100
High Chairs 9,900
Baby Walkers, Jumpers, and Exercisers 4,000
Changing Tables 3,800
Baby Bouncer Seats 2,100
Baby Gates and Barriers 2,000
Portable Baby Swings 1,600
Playpens and Play Yards 1,100
Baby Baths, Bath Seats, and Bathinettes =
Bassinets and Cradles 2
Other" 5,300

Source: NEISS, CPSC.
Note: The injury estimates may not add up to the total due to rounding and because two or more nursery products are sometimes
associated with a single injury.

Deaths Associated with Nursery Products

While all of the Commission’s databases are used to identify nursery product-related deaths, the death
certificates database is the major source. At the time of the writing of this report, the Commission’s death
certificates database was at least 90% complete for 2004 and earlier years. Hence, the deaths reported
here are from 2002 through 2004’. There were a total of 241 deaths - an annual average of 80 deaths -
associated with nursery products during this time period. About 40 percent (97 total or about 32 annually)
were associated with cribs; baby baths and bath seats accounted for a total of 36 deaths (an annual
average of 12 deaths) and playpens accounted for a total of 32 deaths (an annual average of 11 deaths).
The remaining 76 fatalities were associated with a range of products including bassinets and cradles,
infant carriers, strollers and carriages, and bouncer seats, among others.

For certain incident scenarios where direct product involvement or failure was not evident, consultation
with the ES staff was necessary to determine the most appropriate product category for the placement of
the fatalities. The convention followed was slightly different from that in an earlier memo titled “Nursery
Product-Related Injuries and Deaths to Children under Age Five” by Joyce McDonald (EPHA) dated June
28, 2006. Details of the current methodology are provided in the attached Appendix.

Table 3 provides a summary of nursery product-related deaths (total and average annual) for 2002
through 2004, along with annual average deaths for 2001 through 2003. The deaths from the 2001-2003
period presented here were identified using the current methodology as well and are somewhat different
from those reported in the 2006 EPHA nursery product memo. Reasons for the differences are explained
in the Appendix.

* The injury estimates are not presented since they are based on very small sample counts and associated with high coefficients of variation.

“ This category includes baby bottles/nipples, bottle warmers/sterilizers, pacifiers/teething rings, diapers and diaper pails, baby scales, rattles,
youth chairs, youth bed rails, night lights, potty chairs/training seats, baby harnesses, infant shoelace fasteners, diaper fasteners, and safety pins.
* These deaths do not constitute a statistical sample of known probability and do not include all nursery product-related deaths that occurred
during the 2002-2004 period. They do, however, provide a minimum figure for deaths associated with nursery products during that time.

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Appendix

Methodology

Injuries:
.

eooceee

Deaths:

Database: National Electronic Injury Surveillance System (NEISS) from 01/01/2006 through
12/31/2006.

Product codes: 1500-1599.

Age of victim: 0 through 4 years.

Screened to ensure that no motor vehicle incidents were included.

All cases of diaper rash were excluded.

All cases associated with in-scope product codes were included regardless of the severity of the
injury.

After adding additional years of data (2002 and 2003), statistical tests were performed to
determine if any trends exist. While there was a significant increase from 2005 to 2006 (p-
value=0.0287), there was no statistically significant trend observed from 2002 to 2006 (p-
value=0.4414).

Databases: National Electronic Injury Surveillance System (NEISS), Injury or Potential Injury
Incidents (IPII), In-Depth Investigations (INDP), and Death Certificates (DTHS) from
01/01/2002 through 12/31/2004.

Product codes: 1500-1599; 4074 for portable youth bed rails.

Age of victim: 0 through 4 years.

Screened to ensure no duplicates were included; all records of the same incident that were
reported through different data sources were associated.

Miscoded products were correctly recoded. A common example was a playpen miscoded as a
crib.

Careful screening was performed to determine if cases were in or out of scope. An example of an
out of scope case would be an incident where no direct or circumstantial information was
available to determine how the death occurred or if Sudden Infant Death Syndrome (SIDS) was
mentioned in the official report.

In some cases that were considered in scope, the death was not directly associated with the
nursery product. However, hazards in the vicinity of the product, often inadvertently created by
caregivers, led to the deaths. For instance, soft bedding inside the crib, or cords hanging from
window blinds/baby monitors and curtain tie-backs within easy reach from the crib, have led to
some deaths. These deaths have been included with crib deaths. Similarly, placement of toys and
other soft clothing/bedding inside the playpen, alteration of the setup of the playpen for easy
access to the child, or placement of objects on top of the playpen to keep the child inside, have
led to some fatalitigs. These have been counted with playpen deaths. While these deaths were not
strictly due to product failure, they highlight some common misconceptions and oversights in the
usage of these products and were therefore included.

Deaths involving certain products were grouped together. For instance, baby baths and bathinettes
were counted together with bath seats; exercisers were counted with baby walkers and jumpers;
and as noted in the previous bullet, any soft-bedding-in-crib incidents were counted with cribs
while soft-bedding-in-playpen incidents were counted with playpens. These groupings were
different from those used in analyses of nursery product-related hazards in previous years.

The deaths for 2001-2003 were recalculated using the steps above and presented in this report for
comparison purposes. The recalculated death counts for 2001-2003 presented in Table 3 are

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Introduction

This report presents nursery product-related injury estimates for 2006’, as well as comparison with
historic injury estimates. Detailed information on deaths associated with nursery products that were
reported to have occurred during the three-year period 2002-2004 is also presented.

Nursery Product-Related Injury Estimates

There were an estimated 66,400° nursery product-related injuries among children under the age of five
that were treated in U.S. hospital emergency departments in 2006. Table 1 below shows the estimated
injuries for the latest three years as well as the annual average for this three-year period. While there was
no trend observed over the 2004-2006 period, there was a statistically significant increase in the estimated
total injuries from 2005 to 2006 (p-value=0.0287). Annual estimates for 2002 through 2006 are presented
in the attached Appendix.

The leading cause of all nursery product-related injuries reported through the National Electronic Injury

Surveillance System (NEISS) for 2006 was falls. About 42% of the total injuries involved the head,
which was the most frequently injured body part.

Table 1: Estimated Injuries to Children under Age Five Associated with Nursery Products

2004-2006
Calendar Year Estimated Injuries
2004 64,900
2005 59,800
2006 66,400
2004-2006 Average 63,700

Source: NEISS, U.S. Consumer Product Safety Commission (CPSC).

Table 2 shows the breakdown of injury estimates by different product categories. In 2006, there were
more than 30 product codes associated with the injury estimates. They were aggregated into 13 product
categories after consultation with engineering (ES) staff at CPSC. The product categories align closely
with voluntary standards development activities.

When compared with the 2005 injury estimates, the 2006 injury estimates show some increase in certain
product categories such as high chairs, cribs, walkers, and changing tables. However, some of these
product categories are not strictly comparable because of the new grouping protocol followed for 2006.
For instance, crib mattresses are now included with cribs and baby exercisers are included with walkers
and jumpers. In 2005, mattresses and exercisers were included in the “Other” category. The “Other”
category in 2006 includes some new products (such as diaper pails and baby scales) that were not
involved in 2005. It is important to note, however, that while nursery products were involved in these
incidents, the incidents were not necessarily caused by failure of the products.

' The source of the injury estimates is the National Electronic Injury Surveillance System (NEISS), a statistically valid injury surveillance system.
NEISS injury data are gathered from emergency departments of hospitals selected as a probability sample of all the U.S. hospitals with
emergency departments. The surveillance data gathered from the sample hospitals enable the CPSC staff to make timely national estimates of the
number of injuries associated with specific consumer products.

? This estimate has been adjusted to exclude diaper rash from the diaper code.

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Table 3: Deaths among Children under Age Five by Type of Nursery Product

PRODUCT CATEGORY TOTAL DEATHS AVERAGE ANNUAL AVERAGE ANNUAL
2002-2004 DEATHS 2002-2004 DEATHS 2001-2003

TOTAL 241 81 80

\Cribs and Mattresses 97 32 32

|Baby Baths, Bath Seats, and 36 12 13
|Bathinettes

[Playpens and Play Yards 32 Bt ll
\Bassinets and Cradles 28 9

Infant Carriers and Car Seats 17 6 7

(Excludes Motor Vehicle Incidents)

Strollers and Carriages 9 3 1
\Baby Bouncer Seats 6 2 2
Portable Baby Swings 4 1 1
[Baby Walkers, Jumpers, and 3 1 1
|Exercisers

(High Chairs 2 1 2
Changing Tables 1 <1 <1
[Baby Gates and Barriers 1 <1 <1
Other® 5 2 1

Source: In-depth Investigation (INDP), Injury and Potential Injury Incident (IPII), Death Certificate (DTHS) and NEISS
from 2002 to 2004 for reported deaths; CPSC.
Note: The average annual deaths do not add up to the total due to rounding.

A closer look at the top five categories with the largest numbers of deaths provided some insight into the
hazard patterns.

Ninety-seven deaths were associated with cribs between 2002 and 2004. Of these, 46 deaths (47%) were
attributed to soft bedding and, occasionally, sibling overlay. Another 13 incidents (13%) were attributed
to other accessories situated in or around the crib. These included, but were not limited to, window blind
cords, curtain tie backs, baby monitor cords, humidifier cords, and pacifier ribbons. Twenty-four deaths
(25%) resulted from the use of cribs with broken or missing components, and another six deaths (6%)
were results of infants getting wedged in small spaces like that between an ill-fitting mattress and the crib
rail. There were three deaths where infants fell out of the crib and two deaths which resulted from
alterations made to the cribs, contrary to manufacturers’ suggested guidelines. The three remaining deaths
occurred when children were trapped between the crib and another piece of furniture or the wall.

Baby baths and bath seats were associated with 36 deaths between 2002 and 2004. All of the deaths
occurred when parents or caregivers left the infant unattended in the tub, sometimes with an older sibling
in the tub. Many of these incidents described infants having slipped out of bath seats, fallen out of baby
tubs, or tipped forward or sideways into the water.

There were 32 deaths reported in playpens or play yards between 2002 and 2004. Ten of the 32 deaths
resulted from the use of soft bedding in playpens leading to asphyxiation or suffocation. Another death
resulted from the use of a sleeping accessory that may have compromised the infant’s ability to maneuver
out of a position in which she suffocated. Six deaths from asphyxiation or suffocation resulted from
incorrect or intentionally altered installation of playpens. One additional death resulted from the child
managing to unlatch and collapse the playpen trapping himself inside. The use of ill-fitting mattresses or
cushions led to infants getting wedged in the small space between the mattress and the side of the playpen

© This category consists of portable youth bed rails, coded under product code 4074.

-6-


comparable to those for 2002-2004. However, when compared with the 2001-2003 death data
presented in the 2006 EPHA memo, they differ substantially in some product categories. One
reason for this is the difference in product groupings that have been used in the two
methodologies. Another reason is the difference in the data extraction method used. Under the
current methodology, to obtain the death counts for the 2001-2003 period, the data for 2001 and
2002 were extracted anew from the various CPSC databases rather than using data previously
extracted for the 2000-2002 analysis. As such, many new records were identified that were not
among the records included in the previous version of the 2001-2003 analysis.

Historical Data

Injury estimates for the latest five available years are presented in the table and chart below.
Statistical tests indicate no significant trend in the data over the five year period 2002-2006 (p-
value=0.4414).

Nursery Product-Related Emergency Department Treated Injury Estimates; 2002 - 2006

Calendar Year Estimated Injuries 95% Confidence Interval
2002 67,000 54,800-79,300
2003 60,700 50,500-70,900
2004 64,900 52,000-77,800
2005 59,800 48,500-71,100
2006 66,400 53,000-79,800

Source: NEISS, CPSC. Estimates rounded to nearest 100.

Nursery Product-Related Emergency Department Treated
Injury Estimates; 2002 - 2006

, 70,000 = See
+E 60,000
2 50,000
= 40,000
5 30,000
2 20,000
2 10,000
0 r ,
N hcl x 2 &
§ of § § of
Years

Source: NEISS, CPSC. Estimates rounded to nearest 100.

-9-


Nursery Product-Related Injuries and Deaths
Among Children under Age Five

Risana T. Chowdhury

Division of Hazard Analysis

Directorate for Epidemiology

U.S. Consumer Product Safety Commission
Washington, DC 20207

February 2008

This analysis was prepared by the CPSC staff. It has not been reviewed or approved by, and may not necessarily reflect the
views of, the Commission.

CPSC Hotline: 1-800-638-CPSC (2772) CPSC's Web Site: http://www.cpsc.gov


in six cases. There were six strangulation deaths resulting from non-playpen-related cords or ropes, such
as window blind cords, electrical wires, or toy attachment cords situated in the vicinity of the playpen.
One death resulted from an infant rolling into a small storage space that was located between the mattress
and side webbing of the playpen. Another death resulted from the child getting entrapped between the top
rail of the playpen and an adjacent piece of furniture.

The next product category is bassinets and cradles. There were 28 deaths in this category during 2002-
2004, most (22 out of 28) of which were attributed to the use of soft bedding. There were three deaths
from falls out of the bassinets and two deaths from infants becoming wedged between the mattress and
the side of the bassinet. The last death occurred when a child was asphyxiated due to the collapse of the
bassinet.

Finally, there were 17 deaths identified during 2002-2004 that were associated with infant carriers and car
seats. There were eight strangulation deaths from infants becoming entangled in the restraint straps. Two
other deaths occurred when seats were placed on soft surfaces and they tipped sideways or backwards.
These infants got caught either in the straps or in the gaps between different seat parts. There were two
deaths caused by positional asphyxia; one resulted from the seat tipping over inside a playpen and the
other resulted from the seat tipping sideways due to failure to secure it into the car seat base. One infant
died of suffocation while being carried around in a sling-like carrier. One infant drowned when left
unattended and unbuckled in a seat, in a bath tub with water running. One infant’s seat that was placed on
top of the stove caught on fire when the stove was inadvertently lit; the child died of smoke inhalation.
The last two deaths were due to positional asphyxia but details of the circumstances were incomplete; one
mentioned the seat tipping over and the other mentioned the infant being found in an upside down
position in the seat.

The hazard patterns above indicate that while a nursery product was involved, many of the fatalities were
not directly caused by failures in the product.


Table of Contents

Executive Summary .........0..000cccccceccceecceeeeceeeeeesaeeccenaeeseeeeeueeseaeeceeeneeeeaneesesgueseeaa 3
Introduction ........ 00... cc cece cece cece cece cet en eee eeeeee teen eee aneeeeeeeesaeeeeeseeeeseetegaeseeeneenesss 4
Nursery Product-Related Injury Estimates ..................00.020cccccceeeeeecee cee ee eee eeeeeneeeeeeeneaaee 4
Table 1: Estimated Injuries to Children under Age Five Associated with Nursery Products
2004-2006 2... cecc cece ececeeneeeee cece eee e ee eeeseeeeeeesnenseeeeeeeeeceeesaeeeeseeseesensesaeteneeness 4

Table 2: Estimated Injuries in 2006 among Children under Age Five by Type of Nursery Product... 5

Deaths Associated with Nursery Products .
Table 3: Deaths among Children under Age Five by Type of Nursery Product

Appendix ....
Methodology
Historical data ..
Table: Nursery Product-Related Emergency Department Treated Injury Estimates 2002-2006.
Figure: Nursery Product-Related Emergency Department Treated Injury Estimates 2002-2006......

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8
9
9
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Executive Summary

In this report, the U.S. Consumer Product Safety Commission (CPSC) staff presents the latest available
statistics on injuries and deaths associated with nursery products among children under age five.

¢ In 2006, there were an estimated 66,400 emergency department treated injuries associated with
nursery products among children under age five.

e Infant carriers/car seats, cribs/mattresses, and strollers/carriages were associated with the most
injuries. Falls were the leading cause of injury; the head was the most frequently injured body part.

¢ During the three-year period 2002-2004, CPSC staff has reports of 241 deaths - an annual average of
80 deaths - associated with nursery products among children under age five.

Cribs, baby baths/bath seats, and playpens were associated with most of the deaths.

For nursery product-related injuries and deaths, it is important to note that many of the incidents were
associated with a nursery product but not necessarily caused by the product.