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Bassinet safety update.

For their baby's first few weeks or months of life, many parents choose to use a bassinet (cradle, co-sleeper, portable play yard) instead of a full-sized crib. Since the American Academy of Pediatrics (AAP) recommends that parents share a room--but not a bed with their newborn, a bassinet seems to be the perfect solution.

A bassinet's smaller size and portability make it easy for parents to set up in their bedroom for a few weeks or months so they can hear their baby's cries and quickly tend to the baby, and parents don't put the baby at risk by sleeping in the same bed with it. Parents may be surprised to learn, then, that though cribs are subject to federal regulations regarding their design, bassinets are not.

Both the AAP and Consumer Products Safety Commission (CPSC) have issued bassinet safety guidelines in the past, but many parents are still unaware of the risks associated with bassinet use. Given that 53 infants died from sleeping in a bassinet from 1990-2004, there is a need for clearer and perhaps stricter guidelines regarding bassinet use.

A recent study in The Journal of Pediatrics evaluated bassinet use and the risk of sudden unexpected death in infancy (SUDI). Researchers Jodi Pike, MD and Rachel Y. Moon, MD from the Children's National Medical Center in Washington, DC found that 85% of the 53 SUDIs were from asphyxiation, anoxia or suffocation, and 15% were attributed to sudden infant death syndrome (SIDS).

Two findings from this study are surprising. In 39 of the 53 cases (73.6%), additional items other than the mattress, fitted sheet and pacifier (or rattle) were found in the bassinet with the infant. These included items that the AAP has specifically warned parents against using since they significantly increase the risk of suffocation: blankets, stuffed animals, adult-sized pillows, bottles and even plastic bags. (In one case, a small beanbag pillow from a shelf above the bassinet fell on top of one of the infants.)

Since 1992, the AAP has recommended that babies not be put to sleep in the prone (stomach) position since it places them at higher risk for SIDS; their current recommendation is that babies be put to sleep only on their backs (supine). So the second finding is especially surprising.

Of the entire study's 53 infants, 20 (37.7%) had been placed to sleep on their stomachs (prone). And, of the 26 infants for whom Pike and Moon had information on both the position the infants were put to sleep in and the position they were found in, 14 (53.4%) had been placed to sleep on their stomach; all but one were found prone. Seven (26.9%) had been placed to sleep on their back; when they were found, five were on their stomach, one was on its back and one was on its side.

Bassinet failure also played a small role in contributing to some of these infants' deaths. In nine (17%) cases, some mechanical problem with the bassinet was mentioned, and four (7.6%) of the cases the infants were in a mechanical swing or pendulum that may have shifted the infant to a position that put it at risk for suffocation.

Pike and Moon caution that their study is neither large enough, nor representative enough, to determine an actual risk for SUDI. But, despite the study's limitations, they have several conclusions. Parents should adhere to the AAP's recommendations for infant sleep in a bassinet (including supine position and eliminating soft bedding and objects). Parents should also make sure the bassinet is safe and stable. Breathable mesh or other type of air-permeable sides are preferred, and parents should adhere to the manufacturer's recommendation for infant length and weight for bassinet use. And, parents should always check above and around the bassinet to ensure that nothing can fall into the bassinet unexpectedly.

Often the sudden unexpected death of a child can't be prevented. But parents should take it upon themselves to learn certain risk factors that may increase their child's chance of experiencing any adverse event, including SUDI and SIDS. Some of the best places to educate yourself on the latest policies and guidelines regarding child safety are the AAP ( and CPSC ( websites. Your pediatrician, medical journals, and to a lesser extent other parents and parenting magazines are other possible sources of information. These all go a long way to preventing tragedies like bassinet and crib deaths.
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Author:Sloviter, Vikki
Publication:Pediatrics for Parents
Geographic Code:1USA
Date:Oct 1, 2008
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