Deaths Associated with Infant Carriers -- United States, 1986-1991

In the United States, injuries are the leading cause of death and disability among children aged 1-4 years and the sixth leading cause of death and disability among infants aged less than 1 year (1-4). Small children and infants can be injured when left unattended, even in environments that appear safe. Often such injuries and deaths are associated with use of consumer products, including products designed for children aged less than 1 year (i.e., strollers, walkers, car seats, and infant carriers (ICs)). From January 1986 through October 1991, the U.S. Consumer Product Safety Commission (CPSC) received reports of 26 fatalities associated with IC-related injuries. To inform public health and health-care providers about potential risks associated with use of ICs, CDC summarized epidemiologic information and related details regarding these incidents.

CPSC receives or identifies injury-related reports on consumer products -- including reports of IC-related deaths -- from a variety of sources such as consumers, attorneys, private health-care providers, death certificates, and newspaper articles and through the Medical Examiner/Coroners Alert Project (MECAP). For this study, an IC was defined as a product that is intended to carry and/or transport an infant or child and that does not mount on a bicycle or is not worn by an adult. Car seats used as ICs and ICs improperly used as car seats were included. Car-seat-related deaths caused by motor-vehicle crashes were excluded.

Deaths occurred in 16 states. Six deaths occurred in 1989 and in 1990, five in 1987 and in 1991, two in 1988, and one in 1986; in one case, date of death was unknown. Of the 26 decedents, 13 were female, 11 were male, and sex was unknown for two. Twenty-one deaths occurred among children aged less than 1 year; the median age at death was 7 months (range: 2-66 months). Causes of death were asphyxiation (18 deaths), blunt trauma (five), and burns (three).

Of the 18 deaths resulting from asphyxiation, nine occurred because the infant or child had become entangled in or hanged by the restraining straps on the IC. For example: 1) an IC placed on a dining room chair overturned, and the unattended 4-month-old infant hanged by the neck from a safety shoulder strap on the IC; and 2) a 10-month-old infant died when the restraint strap of a car seat, being used as an IC in the home, became wrapped around the child's neck.

Of the nine remaining asphyxiation cases, five involved ICs that overturned after being placed on an adult's bed or waterbed, causing the infant/child to suffocate in the pillows or linens on the bed. In three instances, asphyxiation occurred when the infant turned around in the carrier/seat and suffocated in the padding or seat covers of the IC.

Of five blunt-trauma-associated deaths, three were caused by falls. For example, a grocery cart containing an IC in which the infant was riding overturned, throwing the infant to the ground.

The remaining blunt-trauma-associated and burn-associated deaths involved motor vehicles. For example, an IC improperly used as a car seat failed to restrain the child. The three deaths by burns occurred among infants restrained in ICs who were left unattended in cars with siblings who started fires inside the cars, then escaped, leaving the restrained infant in the car. In two of the three cases, rescue workers reported having difficulty extracting the child from the IC. Reported by: Consumer Product Safety Commission, Washington, DC. Surveillance and Programs Br, Div of Environmental Hazards and Health Effects; Div of Injury Control, National Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Although commercial baby products are designed to improve the convenience and safety of child mobility, all products have some risk associated with their use. The value of car seats and the number of lives saved through their use is well established (5-7); in comparison, the benefits and risks of ICs have not been well characterized.

Public health and health-care providers should emphasize to parents and other persons who provide care to young children the following considerations regarding use of ICs and car seats in the home and car. First, beds, especially waterbeds, do not provide a stable surface for ICs or car seats. Second, only car seats approved for use in an automobile should be used in the car to restrain children. Third, children and infants should never be left unattended, even when they appear safely strapped in a carrier/seat. Fourth, straps and restraining buckles on ICs and car seats should be fastened for each use; in addition, they should be adjusted to fit comfortably, and to prevent the infant from turning in the seat. Cross-straps should be placed low enough to avoid the infant's neck, even if the infant slips down in the carrier/seat. Fifth, manufacturers' recommendations and instructions should be read and carefully followed (8).

Problems, complaints, and/or defects related to products that could result in injury should be reported to the CPSC Hotline, telephone (800) 638-2772. Deaths associated with consumer products should be reported to MECAP, telephone (800) 638-8095.

References

1. Eichelberger MR, Gotschall CS, Feely HB, Harstad JD, Bowman LM. Parental attitudes and knowledge of child safety. Am J Dis Child 1990;144:653-62.

2. Children's Safety Network. A data book of child and adolescent injury. Washington, DC: National Center for Education in Maternal and Child Health, 1991.

3. CDC. Childhood injuries in the United States. Am J Dis Child 1990;144:627-46.

4. NCHS. Advance report of final mortality statistics, 1989. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992. (Monthly vital statistics report; vol 40, no. 8, suppl 2).

5. CDC. Child passenger restraint use and motor-vehicle-related fatalities among children--United States, 1982-1990. MMWR 1991;40:600-2. 6. Partyka SC. Papers on child restraint: effectiveness and use. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1988; DOT report no. DOT-HS-806-890. 7. Kahane CJ. An evaluation of child passenger safety: the effectiveness and benefits of safety seats. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1986; DOT report no. DOT-HS-807-679. 8. National Highway Traffic Safety Administration, American Academy of Pediatrics. 1991 Shopping guide to car seats. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1991; DOT publication no. HS-807-567.

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