Binky, Sippy Cup Can be Source of Trip to the ER
The vast majority of the estimated injuries occurred after the toddler fell (86.1%, 95% CI 33,103 to 45,097) in the home, usually while drinking from a baby bottle, which caused lacerations or contusions to the mouth or face, reported Sarah Keim, PhD, from the Research Institute at Nationwide Children's Hospital in Columbus, Ohio, and colleagues in Pediatrics.
Almost all infants and toddlers use bottles, pacifiers (often referred to as a binky), and sippy cups for supplying nutrition, comfort, and convenience, but parents don't always include these items as part of a baby-proofing scheme. "Parents do a lot of things to baby proof their home and make sure children's toys are safe, but often don't give a second thought to these products," Keim told MedPage Today.
This study is the first to use a nationally representative sample to examine injuries associated with these products, the authors stated.
They analyzed data from the National Electronic Injury Surveillance System (NEISS) and found that an estimated 45,398 children under age 3 were treated in emergency departments for bottle-, pacifier-, or sippy cup-related injuries between 1991 and 2010, amounting to one child being treated every 4 hours.
The children were stratified according to gender and age, from less than 1 year, 1 year, and ages 2 to 3.
The analysis found that 66.4% of injuries (95% CI 25,538 to 34,740) occurred in children younger than 1 year because of falls while using a bottle (57.5%) or a pacifier (33.8%).
Compared with younger children, 1-year-olds were 7.62 times more likely to fall (95% CI 4.84 to 12.02). At this age, children are just learning to walk, are unsteady on their feet, and are prone to falls, Keim noted. Most injuries occurred among boys (61.2%), who tend to be more active, she added.
The most commonly injured body regions were the mouth (71%), followed by the head, face, or neck (19.6%).
Overall, most injuries involved a bottle (65.8%, 95% CI 25,245 to 34,525), followed by a pacifier (19.9%, 95% CI 7,108 to 10,935), and a cup with a drinking spout lid (14.3%, 95% CI 4,454 to 8,512).
Although lacerations were the main diagnosis across all products, pacifiers were associated with a higher likelihood of soft tissue injuries (OR 1.86, 95% CI 1.12 to 3.10) and dental injuries (OR 3.25, 95% CI 1.75 to 6.04) than bottles or sippy cups.
"With older children, one reason for falling could be not paying attention to where they are walking while drinking from a bottle or sippy cup, which could be compared to adults being distracted by texting while walking," Keim suggested to MedPage Today.
The national data likely underestimated the number of injuries because of a lack of reporting, Keim said. "Some pediatricians and dentists see some of these injuries in their practice, and many minor injuries are also treated at home," she said.
Data from the NEISS came from a network of around 100 hospitals, representing a stratified probability sample of 6,100 hospitals with ≥6 beds and a 24-hour emergency department. Population estimates used to calculate injury rates were derived from the U.S. Census Bureau.
No national rate could be calculated for 2010 because population estimates were unavailable, but actual injuries treated in EDs were estimated at 2,194.
The study was limited by a lack of comparable data for injuries treated outside the emergency department and a lack of comparison data of injuries that were unrelated to these products. The authors also had no information on which product characteristics were most involved in the injuries.
In 2005, the American Academy of Pediatrics issued guidelines recommending pacifier use as one mechanism for preventing sudden infant death syndrome (SIDS).
At the time, the Academy cited evidence from case-controlled studies that the arousal threshold may be reduced for infants put to sleep sucking on a pacifier. But the AAP stressed that suffocation by soft bedding and by infants sleeping on their stomachs were stronger risk factors.
Since the "Back to Sleep" campaign was initiated by the National Institute of Child Health and Human Development in 1994, the rate of SIDS has since dropped by 50%, but has lately plateaued. An AAP report noted earlier this year that sharing a bed with a parent has emerged as a prominent risk factor.
However, since SIDS remains the leading cause of death among infants, the AAP still recommends pacifier use at bedtime as a preventive measure until age 6 months, Keim noted.
Given the number of injuries from bottles, pacifiers, and sippy cups, Keim and co-authors advised that children not use these products beyond intended ages recommended by the AAP, and parents help their children transition to a lidless drinking cup around age 1.
The authors also recommend that parents encourage children to sit while they drink or eat, rather than walk around with a bottle or cup during the day and 'graze,' not only as a way of reducing accidents but also to develop better eating habits.
The authors have no relevant financial relationships to disclose.
There was no external funding for this story.
There was no external funding for this story.
Primary source: Pediatrics
Source reference:
Keim S, et al "Injuries associated with bottles, pacifiers, and sippy cups in the United States, 1991-2010" Pediatrics 2012; 129; DOI: 10.1542/peds.2011-3348.
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