Maryland could become the first state in the nation to ban the sale of bumper pads that line the inside of cribs after a state panel recommended Friday that health officials declare them a hazard because they can suffocate or strangle babies.
The recommendations made by the four-member task force of mostly pediatricians will now go to Dr. Joshua M. Sharfstein, secretary of the state Department of Health and Mental Hygiene, who will decide whether to write them into regulation.
The recommendations would not prevent parents from using the crib bumpers — which have been attributed to at least two dozen infant deaths nationwide — or buying them in other states.
Sharfstein's decision could put Maryland at the forefront of a controversial issue over infant safety. He didn't say when he would make his decision and gave no indication of where he stands on the issue.
"This is something that, if it is made into regulation, could cause a significant ripple across the country and will impact infant safety," said Joseph M. Wiley, a member of the task force and chairman of the pediatrics department at Sinai Hospital of Baltimore.
Some studies have shown that babies can roll into the bumpers and get their faces stuck, causing them to suffocate. Others have been found dead with the strings from the bumpers wrapped around their necks.
But manufacturers of the bumpers have argued that they pose no danger if installed correctly.
No other state has regulations addressing the use of bumpers, according to the American Academy of Pediatrics, which has guidelines on sleeping standards for babies and infants.
Illinois Attorney General Lisa Madigan called earlier this year on the Juvenile Products Manufacturers Association, which oversees the manufacturing of bumpers, to push for a halt to the production and sale of the devices. She also issued an alert to parents urging them to remove bumpers from cribs.
The U.S. Consumer Product Safety Commission has just begun to study the issue.
Bumper pads are cushions that line the crib. Manufacturers say bumpers prevent babies from hitting their heads on the cribs and suffering bruises, fractures and brain injuries.
However, members of the task force argued during a two-hour meeting Friday that research has shown that there are no safety benefits to the bumpers. Most babies can't exert the force to bump their heads hard enough to sustain such injuries, they argued.
Studies have found that babies are being hurt by a product that is supposed to keep them safe.
A Washington University pediatrician, Dr. Bradley Thach, published a report three years ago that found 27 baby deaths over two decades caused by bumper pads. The study also found 25 nonfatal injuries in infants attributed to bumper pads.
A recent review of records at the Office of the Chief Medical Examiner in Maryland found one child who asphyxiated because of the use of bumpers in the crib. There were nine deaths in cribs where bumpers were documented to be in use. Those deaths were attributed to SIDS, which means a death with no identifiable causes, but can have an asphyxial component.
Dr. Peter L. Beilenson, a task force member and Howard County health officer, said the bumper pads serve more of a cosmetic purpose than one of safety.
Panel members noted that more research needs to be done to determine how widespread deaths from bumpers are, but were in favor of banning them to prevent even one death.
"I think one death is a substantial risk in my mind," said panel member Gaurov Dayal, vice president and chief medical officer of Adventist HealthCare in Rockville.
The panel also said it was going to send a letter to the consumer commission supporting its work on the issue, but said it didn't want to wait on the federal agency to take action in Maryland.
"If it's important enough to do, it's important for us to do," Dayal said.
Dr. Tina L. Cheng, chief of the division of general pediatrics and adolescent medicine at Johns Hopkins Children's Center, was the only task force member who had reservations about regulating the use of bumpers. Instead, she favored educating parents about the dangers of the devices.
She said a ban could lead to "unintended consequences," such as parents using blankets instead of bumpers, which could also potentially smother kids. Cheng also said more research needed to be done to see how substantial deaths from bumpers are.
In their recommendations, the panel said the ban should be phased in over a year and that an education campaign should be included. They said many parents mistakenly believe the bumpers are protecting their children.
The Juvenile Products Manufacturers Association didn't return calls Friday. It has argued in news releases that bumpers aren't inherently dangerous but that precautions should be taken when using them.
The group commissioned an independent analysis of studies and found that there was "no reliable evidence supporting a causal relationship between crib bumper pad use and infant death."
The association said on its website that if pads are used, they should be removed when the baby begins to stand so that they can't be used as a step. The JPMA also recommends that parents and caregivers select bumper pads that extend around the entire crib perimeter, and tie or snap securely into place.
Child safety advocates praised the task force's recommendation. Nancy Cowles, executive director of Kids in Danger, which advocates for safe child products, said Maryland's decision might not necessarily prompt changes in other states, but bringing attention to the issue is beneficial.
"Banned or not banned, so many parents have no idea of the risk that bumpers pose," Cowles said. "They see them in the magazines and they see them in all the stores. This certainly helps to educate parents there are dangers to using bumpers."
The American Academy of Pediatrics recommends that bumper pads be "thin, firm, well-secured, and not "pillow-like." It also suggests that loose bedding and soft objects such as quilts, comforters and stuffed toys be kept out of cribs as well. The organization is updating its recommendations and expects to issue them this summer.
A member of the academy's task force looking at the recommendations said the decision by the Maryland task force shows the increased scrutiny being placed on the issue.
"I think we are going to see more states look at this," Robert Darnall said. "Whether they choose to pass legislation or not, we will have to see."