Maryland health officials proposed Tuesday a ban on the sale of crib bumpers, which have been linked to the asphyxiation of at least two dozen infants across the country — a move that would make it the first state to prohibit the bumpers.
The pads have little safety benefit and pose a small, but potentially deadly risk, according to members of a state task force formed this year to advise state health officials.
"Crib bumpers are not part of the safe sleep ABCs — babies should sleep alone, on their backs in a crib," Dr. Joshua M. Sharfstein, secretary of the state Department of Health and Mental Hygiene, said at a news conference announcing the proposal. "And we're adding a fourth letter, 'D' for 'Don't use crib bumpers.'"
Sharfstein, who reviewed the panel findings before moving ahead with the proposed ban, said education will be important to convey the risk to the public.
The state's move follows a ban by the city council in Chicago two weeks ago. The federal Consumer Product Safety Commission is also investigating crib bumpers.
The actions in Chicago and Maryland brought a swift reaction from the Juvenile Products Manufacturers Association, which maintains that the pads, when used properly, are not only safe but protective. They can keep infants from bruising their heads and entrapping their limbs.
Further, the group said, banning pads could have unintended consequences.
"It is very risky behavior to use makeshift bumper pads," Michael Dwyer, executive director of the association said in a statement. "Our fear is that the elimination of bumpers from the marketplace will encourage parents to use towels, adult blankets or pillows as a protective barrier from the hard wooden surface of the crib slats."
The group urged the state to adopt safety standards and educate parents on the safe use of pads, tied securely to the crib, rather than impose a ban.
For now, the American Academy of Pediatrics recommends that bumper pads be "thin, firm, well-secured, and not "pillow-like." It recommends that loose bedding and stuffed toys be kept out of cribs. The organization reports that it is updating its recommendations.
Sharfstein said the state is collecting public comments on the bumpers. The comments will be reviewed by health professionals before a formal regulation is proposed, and the ban would go into effect January 2013.
That would put the bumpers on a list of potentially dangerous products Sharfstein has led the charge against or criticized as a public health official, including lead in children's jewelry, cough syrup for young children and Four Loko, a caffeinated alcoholic beverage.
So far, Sharfstein said, the only comments collected by the state panel supporting the use of crib bumpers came from manufacturers. But the panel found that the bumpers can lead to strangulation or suffocation.
Dr. David Fowler, chief medical examiner for Maryland, said the bumpers don't even have to touch the infant's face for a child to asphyxiate. The closeness of pads, pillows and other items can prevent the air from flowing, and an infant can use up the available oxygen close by.
"Objects can cut off the refreshing of air, and they only have to be close to restrict air flow," he said.
Studies nationally have found that 27 baby deaths can be directly attributed to bumper pads in the last two decades, and another 25 infants suffered nonfatal injuries.
In Maryland, records at the Office of the Chief Medical Examiner show one child asphyxiated by crib bumpers, though there were nine deaths in cribs where bumpers were in use. Those deaths were attributed to sudden infant death syndrome, and no specific cause was identified.
But as in Chicago, Maryland officials did not want to wait for federal action. The state task force had recommended in May that a ban be phased in over a year, along with an education campaign.
Baltimore health officials have been recommending against using the pads for at least three years as part of a "safe sleep" campaign. Infant mortality dropped 19 percent in the city last year, and sleep-related mortality dropped 40 percent. Some of the improvement was likely due to the effort, said Dr. Oxiris Barbot, city health commissioner.
As part of the campaign, city officials visit new mothers, and videos on safe sleep practices are shown in maternity wards and jury waiting rooms.
Task force members and other health care professionals at Tuesday's news conference, from Johns Hopkins and Sinai hospitals and Adventist HealthCare, said they also already advise against using crib bumpers.
"The risk is low, but it's real," said Dr. Gaurov Dayal, vice president and chief medical officer for Adventist Healthcare.
Andrea Gielen, director of the Center for Injury Research and Policy, added that injury remains the leading cause of death among children. But she is optimistic that the educational campaign associated with the state proposal "might help parents become more aware of childhood injuries."
The proposed ban in Maryland would apply to pads intended to be used around the sides of a crib until an infant is able to pull up to stand, the state said. This would exclude pads for older infants or for special-needs children.
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