ESTIMATED INJURIES.
CY 2007
‘TOTAL 62,500
Infant Carriers and Car Seat Carriers (Excludes Motor Vehicle Incidents) 13,700
7 _ ___ 11,000
High Chairs _ 9,600
Strotlers/Carriages 9,300
Changing Tables 3,700
Baby Walkers/Jumpers/Exercisers 3,600
Baby Gates/Barriers __. 2,600
Baby Bouncer Seats 2,100
Playpens/Play Yards _
Portable Baby Swings
|. Bassinets/Cradles

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 98% complete for 2005 and earlier years. Hence, the deaths reported
here are from 2003 through 2005°, CPSC staff is aware of a total of 238 deaths - an annual average of 79
deaths - associated with nursery products during this time period. About 38 percent (90 total or about 30
annually) were associated with cribs/mattresses; baby baths/bath seats/bathinettes accounted for a total of
39 deaths (an annual average of 13 deaths) and playpens/play yards accounted for a total of 32 deaths (an
annual average of 11 deaths). The remaining 77 fatalities were associated with a range of products
including bassinets/cradles, infant carriers and car seat carriers, strollers/carriages, and bouncer seats,
among others.

For certain incident scenarios where direct product involvement or failure was not evident, consultation
with engineering staff was necessary to determine the most appropriate product category for the
placement of the fatalities. Details of the methodology are provided in the attached Appendix.

‘Table 3 provides a summary of nursery product-related deaths (total and average annual) for 2003
through 2005, along with annual average deaths for 2002 through 2004 for comparison purposes.

The injury estimates are not presented since they fail to meet standard reporting criteria for NEISS that the estimated number of injuries be
1,200 or higher, sample size be 20 or larger, and coefficient of variation be less than 33%,
This category includes baby bottles/nipples, bottle warmers, pacifiers/teething rings, diapers &

juding diaper-rash cases, rattles, crib

° Thes

durin

do not constitute a statistical sample of known probability and do not include all nursery product-related deaths that oceurred
5 period. They do, however, provide a minimum figure for deaths associated with nursery products during that time

5.



Appendix

Methodology
Injuries:
¢ Database: National Electronic Injury Surveillance System (NEISS) from 01/01/2007 through
12/3 1/2007,

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 (2003 and 2004), 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 2003 to 2007 (p-
value=0.6231).

eooeee

Deaths:

© Databases: National Electronic Injury Surveillance System (NEISS), Injury or Potential Injury
Incidents (IPI), In-Depth Investigations (INDP), and Death Certificates (DTHS) from
01/01/2003 through 12/31/2005

* Product codes: 1500-1558; 4075 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, cords hanging from
window blinds or 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 fatalities. 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.

One report to CPSC of a nursery product-related incident that occurred outside of the U.S.A. was
excluded,

© 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.

-8-



Introduction

‘This report presents nursery product-related injury estimates for 2007”, 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 2003-2005 is also presented.

Nursery Product-Related Injury Estimates

There were an estimated 62,500° nursery product-related injuries among children under the age of five
that were treated in U.S. hospital emergency departments in 2007. Table | below shows the estimated
injuries for the latest three years as well as the annual average for this three-year period. While there was
a statistically significant increase in the estimated total injuries from 2005 to 2006 (p-value=0.0287), the
decrease in estimated injuries from 2006 to 2007 was not statistically significant (p-value=0.3973). In
addition, there was no trend observed over the 2005-2007 period. Annual estimates for 2003 through
2007 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 2007 was falls. About 44% 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

2005-2007
Calendar Year Estimated Injuries
2005 59,800
2006 66,400
~ “3007 62,500
3005-2007 Average 62,900

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

Table 2 shows the breakdown of injury estimates by different product categories. As in 2006, there were
more than 30 product codes associated with the injury estimates in 2007. Similar to 2006, the products
have been aggregated into 13 product categories that align closely with voluntary standards development
activities.

° The source of the injury estimates is the Nationaf Electronic Injury Surveillance System (NEISS), a statistically valid injury surveillance system
| ry gatheted from emergency departments of hospitals selected as a probability sample of all the U.S. hospitals with
emergency departments. ‘The surveillance data gathered trom the sample hospitals enable the CPSC staff to make timely national estimates of the
number of injuries assceiated with specific consumer products.

‘This estimate has been adjusted to exclude diaper rash from the diaper cede.

4.

|
i


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

PRODUCT CATEGORY TOTAL DEATHS | AVERAGE ANNUAL | AVERAGE ANNUAL
2003-2005 DEATHS 2003-2005. DEATHS 2002-2604

(TOTAL 238 79 80
Cribs/Mattresses 90 30 32
Baby Baths/Bath Seats/Bathinettes 39 13 12
Playpens/Play Yards 32 i Ul
Bassinets/Cradles 25 8 9
Infant Carriers and Car Seat 20 7 6
‘Carriers (Excludes Motor Vehicle
Incidents)
Strollers/Carriages 10 3
Baby Bouncer Seats _ 4 1
Portable Baby Swings 4 1
Baby Walkers/Jumpers/Exercisers 3 1 i
Baby Gates/Barriers 3 1 <1
High Chairs 1 <1 I
Changing Tables a i <1 <I
Other 6 2 2

Source: In-depth Investigation (FNDP), Injury and Potential Injury Incident (IPH), Death Certificate (DTHS) and NEISS
from 2003 to 2005 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 deaths were associated with cribs/mattresses between 2003 and 2005. The majority of these
deaths were attributed to the presence of bedding in the crib which often led to asphyxiation of the infant,
Approximately 30% of the deaths resulted from a range of hazards such as incomplete assembly; missing,
broken, or non-functioning components; or ineffective repairs made to the crib. Some of these incidents
occurred on older, re-assembled or second hand cribs. Strangulations resulting from hazardous
surroundings near the crib, such as window blind cords, curtain tie backs, baby monitor cords, humidifier
cords, and pacifier ribbons, were the next most common cause of crib fatalities.

Baby baths/bath seats/bathinettes were associated with 39 deaths between 2003 and 2005. 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/play yards between 2003 and 2005. The majority of the deaths
were due to positional asphyxia from wedging between the mattress and the side of the product and
strangulations or suffocations resulting from the presence of a hazardous environment in or around the
product. More than half of the wedging incidents involved the modification of the sleep area through the
addition of extra mattresses and/or cushions. Suffocation on bedding accounted for the next largest
number of fatalities involving this product.

The next product category is bassinets/cradies. ‘There were 25 deaths in this category during 2003-2005,
the majority of which were attributed to bedding. More than half of the suffocation deaths on bedding

"This category consists of portable youth bed rails, coded under product code 4075

-6-


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 2003-2007 (p-
value=0.623 1).

Nursery Product-Related Emergency Department Treated Injury Estimates; 2003-2007

i Estimated Injuries 95% Confidence Interval
i "2003 _ 60,700 50,500-70,900
3004 64,900 $3,000-77,800
2005 59,800 48,500-71, 100
3006 66,400 53,000-79,800
2007 62,300 51,400-73,600

Source: NEISS, mates rounded to nearest 100,

Nursery Product-Related Emergency Department Treated
Injury Estimates; 2003-2007

, 70,000
£60,000
50,000
= 40,000
5 30,000
= 20,000
5 10,000
%. g
0
hed » io & N
§ g ES
& = § § e
Years

CPSC. Estimates rounded to nearest 100.

j
:
i
:

-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 2009

y the CPSC staff. It has not been reviewed or approved by, and may not necessarily reflect the

Axoserspr

= ~
VTLBLI OF
PRODUCTS a Oe eye

Web Site: htto:/ivww.cpsc.gov ~-EXCEPTED BY: PETITE E
RULEMAKING ADMIN PacDg i

~— WITH PORTIONS REMOVED:

This analysis

was prepared
e Commission

CPSC Hotline: 4

SPSC (2772) CF

ee


involved pillows. Entrapment or wedging between the mattress and the bassinet frame was the next most
common cause of bassinet-related deaths.

Finally, there were 20 deaths identified during 2003-2005 that were associated with infant carriers and car
seat carriers. The majority of these were strangulation deaths resulting from infants becoming entangled
in the restraint straps while the second most common scenario involved the carriers tipping over, many of
which were placed on soft surfaces.

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.

-7-


Table of Contents

we

Executive Summary

Dee SETS E SEES SSSSEESTSSSSOS 4

Nursery Product-Related Injury Estimates .................... 4
Table 1: Estimated Injuries to Children under Age Five Assoc

2005-2007 4

Table 2: Estimated Injuries in 3

Deaths Associated with Nursery Products .
Table 3; Deaths among Children under Age I

by Type of Nursery Product .

Appendix
Methodology
Historical Data .
Table: Nursery Product-Related Emergency Department Treated Injury Estimates
Figure: Nursery Product-Related Emergency Department Treated Injury Estimates 2003-200

. 8
8
9
9
9

-2-



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. It is
important to note that the incidents covered by this report were associated with a nursery product but not
necessarily caused by the product’.

« In 2007, there were an estimated 62,500 emergency department treated injuries associated with
nursery products among children under age five.

«Infant carriers and car seat carriers. cribs/mattresses, high chairs, 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 2003-2005, CPSC staff has reports of 238 deaths - an annual average of
79 deaths - associated with nursery products among children under age five.

¢ Cribs/mattresses, baby baths/bath seats/bathinettes, and playpens/play yards were associated with
most of the deaths.

H
t
i
i
:

Not all of these incidents are addressable by an action the CPSC could take; however, it was not the purpose of this
the incidents, but rather to update estimates of emergency department treated injuries and to quari
staff

port to evaluate the
the number of fatalities

reported to CP