By Mark A. Brandenburg, MD
Excerpted from Child Safe: A Practical Guide for Preventing Childhood Injuries
Your baby's crib should be a haven of safety and comfort. He will certainly spend many hours here, both at play and at sleep. A good crib, you will find, is a place where you can keep your baby safe while sleeping or taking some time for yourself.
Government manufacturing standards set in 1973 have greatly improved crib safety; so most new cribs sold in the U.S. are very safe. Despite this, cribs continue to be associated with the highest child injury rates of any nursery item. Approximately 50 infants each year are killed and another 9,000 are injured in crib-related accidents in the U.S.
Safety, Safety, Safety!
When shopping for your baby's crib the three top features to consider are safety, safety and then safety. Once you have found several safe cribs to choose from, then and only then should you consider shape, style, and color. Make safety the top priority when searching for your baby's crib.
Does Your Crib Measure Up?
Regulations from the Consumer Product Safety Commission are required to insure crib safety. Before you purchase a crib be sure the following safety standards are met.
The vertical bars or slats must be no further apart than two and three-eighth inches or 60 mm, to prevent infants from slipping through or becoming stuck between them. An infant's head is relatively larger than the rest of his body and could become stuck between bars that are too far apart if his body slips through.
Any openings at the end walls of your crib, such as decorative cutouts, must not exceed two and three-eighth inches, because they might also allow an infant's body to slip through.
If a vertical bar on a crib side is broken off, the gap between the remaining bars will likely be dangerous to an infant inside. Be sure the crib bars are sturdy and intact.
Injury can also occur if an infant crawls or climbs over the side of a crib. Be sure the top of each crib side is not less than 9 inches at its lowest position and 26 inches when raised.
Sometimes baby furniture, such as cribs and dressers, get passed down from grandparents to parents or sold in antique stores, garage sales and used furniture stores. Beware of secondhand cribs—over 25 million unsafe cribs are still out there! Some were made long before crib safety was considered important, while others were just made without regard to recent safety standards. Older cribs very likely will not have the safety features required of cribs manufactured today. Although you will pay more, a new crib is well worth having for the reason alone that it is up-to-date on safety standards.
Cribs with high corner posts (greater than a sixteenth inch or one-and a-half mm) can catch an infant's clothing and cause strangulation. Manufacturers have voluntarily stopped designing cribs with elevated, decorative corner-posts because of this danger. Many such cribs are still being passed around to family members and friends or sold in garage sales and used furniture stores. If your infant's crib has elevated corner posts and you prefer not to purchase another, saw them off and sand the edges down. If you cannot correct the defects, destroy such a crib rather than sell it. Do this to protect other infants in your community.
Cribs on Rollers
Cribs on rollers can be dangerous if older children are in the home. Playful siblings, who might be inclined to push a crib around, could tip it over or push it down a flight of stairs. Also, by leaning against a wheeled crib you might inadvertently shove it away from you. Hardwood floors allow for easy rolling with such cribs so be extra careful here, too. Obviously a crib without any wheels is the safest way to go. Look for a crib with casters that can lock the wheels and prevent rolling, or better yet , get a crib with no wheels at all.
Crib Mattresses & Mattress Covers
The two most important qualities in a crib mattress are firmness and fit. A firm mattress is necessary in order to minimize the risk of suffocation. If a mattress is too soft it can allow an infant's mouth and nose to be engulfed in the fabric. An infant could then be at risk for re-breathing his own exhaled air that is high in carbon dioxide and low in oxygen, leading to extreme drowsiness, coma or even death. Soft mattresses have been responsible for some deaths that were initially attributed to SIDS. This is part of the reason your baby should not sleep face down. Always place your infant face up when he sleeps.
A mattress should fit snugly against each side of the crib. A mattress that does not properly fit the crib can pose a risk to an infant who might crawl beneath it. If you can fit two side-by-side fingers between the side of the crib and the mattress, the mattress is too small. The standard mattress size is 51 5/8" x 27 1/4". Be sure your baby's mattress fits his crib.
Mattress hangers support the floor of the crib and can be used to lower or raise the mattress to a desired height. As your infant grows taller, you will need to lower the floor of the crib to prevent him from climbing out. Be sure each hanger is always securely fastened to the corners of the crib.
Mattress bumper pads are soft cushions that fit around the inside of a crib and help prevent your baby from hitting his head against the crib bars. Secure all bumper pads to the crib and cut the strings as short as possible after being tied. This will eliminate the danger of strangulation. Once your infant can pull himself up, remove all pads and crib toys, to keep him from standing on them in attempts to climb from the crib.
Mattress covers have also been associated with suffocation injuries. Be sure the mattress cover in your crib is made of a tough material that cannot be torn or punctured. This will prevent your infant from crawling beneath. Never use plastic garbage bags as mattress covers. They are much too weak. Tie into knots and discard any plastic wrapping material that came with your new crib. Several suffocation deaths have been caused by wrapping material that was left lying around.
Crib Cushions, Quilts & Comforters
Crib accessories such as cushions, quilts and comforters with their bright colors and designs can certainly beautify any room. They may seem harmless at first, but the dangers they pose to infants are very real. Nearly 2,000 cases of infant suffocation each year are caused by cushions, quilts and comforters. Recently, the Consumer Product Safety Commission placed a manufacturing and sales ban on crib cushions, crib pillows and crib comforters. Never place cushions, quilts and comforters in your baby's crib.
So, what can you put in your infant's crib?
Limit what you put in your baby's crib to small, age-appropriate toys, a crib bumper that is properly secured and a pacifier. If you dress him in a cozy, warm body suit you will only need a lightweight cotton blanket to keep him warm. Such blankets are porous and present the least risk of smothering a baby. When using a light blanket, tuck it around the mattress at the foot of the bed allowing it only to cover up to your baby's chest. The safest bet, however, is to use sleepwear rather than a blanket.
Using Your Crib Correctly
No matter how sturdy and well built, a crib is only as safe as the parents who use it. Keep crib safety in mind and remember a few basic rules.
Always raise the crib sides to full height and lock them when your infant is inside.
If a drop-side does not have a locking, hand-operated latch, replace it.
Once your infant is able to sit unassisted, adjust the floor of the crib to a lower position. And when he can stand put the floor in it's lowest position in order to prevent him from climbing out.
Avoid placing large toys and pillows in your baby's crib. They might just enable him to climb out.
When your child reaches a height of 32 to 35 inches (usually about two years of age), he should no longer sleep in a crib, because it may no longer hold him. Your toddler could outgrow a crib due to his size or activity level well before reaching this height, so pay attention to his physical abilities and look for signs that he may be learning to escape. For instance, if he can pull herself up off the crib floor by grabbing the crib sides or if he can climb up the sides, he is too big and strong for a crib. When this occurs, he should then begin sleeping in a toddler bed.
Crib gyms are toys attached to strings that can hang above your baby's crib. Many infants have been strangled when a gym fell into their cribs. Injuries can also occur if a standing infant becomes entangled in a toy or pulls it down. You might want to avoid this hazard completely by not having a crib gym at all.
Be sure that any crib gym you place above your baby is well fastened to the sides of the crib so it does not fall.
When your infant can stand up or when he reaches five months of age, remove the gym.
The location of your baby's crib is of extreme importance. It is tempting to move the crib next to a large piece of furniture so diapers, clothing and other accessories are close by. However, placing a crib next to a dresser or other piece of furniture puts your infant at risk of getting wedged in between the two pieces of furniture if he climbs from the crib. This same type of injury can also occur if a crib is placed against a wall. Another dangerous location for a crib is next to a long drapery cord. Strangulation injury can occur when a crib is situated too close to any type of window dressing pull cord.
Pull your crib at least one foot away from all furniture and walls.
Never place your baby's crib next to a drapery or window blind cord.
Frequent inspections of your baby's crib will help you identify wear and tear before an injury occurs.
Periodically check the slats and end-boards to be sure they are not loose and check all nuts and bolts, tightening them when necessary.
Be sure no screws or nails are protruding from the wood as they can catch your baby's clothing or scratch his skin.
If your crib has defects that cannot be fixed, dismantle it and throw it away. This will prevent it from being used by another family. Never sell a bad crib. The few dollars you gain will not be worth the injury that may be caused to somebody else's baby.
Portable cribs are very convenient to have when visiting a friend or relative. During vacations it will be tempting to use a portable crib at night for your baby. But a portable crib is not a substitute for a full-sized crib. Significant differences exist that could place your infant at risk. In fact, safety standards don't even exist for portable cribs. Most manufacturers simply adhere to the regulations for playpens.
When using a portable crib, check the top rails and be sure they are locked before your baby is placed inside. The fabric sides of portable cribs are comparable to playpens and can cause suffocation if a wall collapses or is left down.
Look for holes in the sides that could cause your infant to become stuck and strangled.
The greatest difference between standard cribs and portable cribs is the level of supervision required. Just like a playpen, never leave your infant unattended while he is in a portable crib.
Follow the safety rules and tips that apply to playpens.
Bassinets, Cradles & Carrycots
Three other types of baby furniture that parents often purchase are bassinets, cradles and carrycots. Bassinets, cradles and carrycots are smaller than cribs and require less floor space. They are also portable and can easily be carried from room to room, often being used in the parents' bedroom for close monitoring of a sleeping infant. Federal guidelines for the manufacturing of bassinets, cradles and carrycots are lacking so it is incumbent upon you to search out the safest one for your baby.
Most bassinets are quite small and on wheels, so they are easy to push from room to room. These features also make it easier for them to be accidentally pushed across a room or knocked over by you or an older child.
Bassinets have one other major drawback. Because they are so small, they will be outgrown and obsolete by the time your baby is only a few months old. Bassinets can be quite dangerous to older infants who might climb out. A bassinet can even be tipped over by an active infant inside.
If older children are in the home, do not use a bassinet for your baby.
Always use a bassinet with great caution and avoid placing your baby in one without close supervision.
When shopping for a bassinet, look for one with a wide, sturdy base that will be the least likely to get knocked over.
Do not place your infant in a bassinet after she has reached three months of age.
Since bassinets rarely have the required safety features of cribs, do not substitute a bassinet for a good quality crib.
Some bassinets are made to fold at the legs. Be careful to check the leg locks on this type of bassinet. You want locks that are reliable and will prevent the bassinet from collapsing with your baby inside.
Additionally, the mattress pads of bassinets tend to be softer than crib mattresses. Studies show that approximately fifteen to twenty infants each year die while sleeping face down in bassinets. Many of these are probably SIDS deaths, but there is some suspicion that the softer mattresses could be partly to blame.
Did you know that rocking cribs or cradles could be deadly? In Australia and New Zealand, where rocking cradles are popular, numerous infant deaths have been attributed to rocking cradles. Injury occurs when a baby rolls so far to one side that the cradle fails to rock back in the other direction. If the cradle becomes angled to a degree that prevents an infant from moving off the railings, pressure against her chest can become great enough to prevent breathing. While most cradles have a safety pin that prevents angling too far to either side, danger exists if this pin breaks or falls out. Never place your infant inside a cradle.
A carrycot is a small infant bed with a handle that can be used to transport a sleeping infant. Two basic types of carrycots exist, those made of woven wicker and those of fabric. The wicker models are less comfortable to carry and more prone to wear and tear.
Use a carrycot for short naps only and never substitute one for a crib.
Be sure your carrycot has a wide base and remains very stable when your baby is in it.
Be sure the handles are firmly attached and widely spaced.
As with cribs, avoid placing pillows, blankets, soft cushions or stuffed animals in a carrycot.
Never let your carrycot serve as a substitute for a car safety seat.
Mark A. Brandenburg, M.D., is a practicing emergency physician at the Trauma Emergency Center (TEC) of St. Francis Hospital in Tulsa, the busiest emergency department in Oklahoma with approximately 70,000 patient visits each year. Dr. Brandenburg received his undergraduate degree in biology from West Virginia University in Morgantown, West Virginia. He attended medical school at the University of Oklahoma in Oklahoma City, graduating in 1992. His emergency medicine residency training took place at the University of Oklahoma in Oklahoma City at University Hospital and Children's Hospital of Oklahoma.