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Safety Tips 

The American Academy of Pediatrics, Centers for Disease Control and Prevention (CDC), and U.S. Consumer Product Safety Commission have provided the following safety tips to reduce the chances of suffocation and strangulation among infants and young children in your care.

At Bedtime

• Place babies to sleep on their backs on a firm, flat mattress.
• Do not use pillows or heavy comforters in your baby's crib.
• Make sure your baby's crib mattress is big enough for the crib. The space between the crib slats and the mattress should be smaller than the width of two adult fingers.
• Never let your baby sleep in bed with you. Babies have died when their breathing was blocked by pillows, bedding, and even their parents.
• Never let a baby sleep on a waterbed.

Around the House

• Keep plastic shopping, garbage, and dry cleaning bags away from babies and children. Never use a plastic shipping bag or other plastic film as a mattress cover.
• Choose a toy chest without a lid. If your child's toy chest has a lid, make sure it has a safety latch that stays open in any position. And make sure there are holes in the back or bottom of the chest to allow air flow, in case your child gets stuck inside.
• Lock your car–including the trunk–when it's not in use. Keep the car keys away from children. Children have died after climbing into car trunks and becoming trapped. Always supervise children around cars.

In the Crib

• Check with the U.S. Consumer Product Safety Commission before buying a new or second-hand crib to make sure it hasn't been recalled.
• Make sure the slats on your crib are no more than 2 3/8 inches apart–this is really important for second-hand cribs that are a few years old. If slats are wider than 2 3/8 inches apart, babies can slide through the slats and strangle when their heads get stuck.
• Do not use a crib with cut-outs in the end panels or with corner posts more than 1/16 inch higher than the end panels. Strangulation can occur if a baby's clothing gets caught on a high corner post or if a baby's head gets caught in a cut-out.
• Remove your baby's bib before bedtime or nap time.
• Remove mobiles and crib gyms as soon as your baby is five months old or can push up on hands and knees.

Around the House

• Pull drapery and mini-blind cords out of children's reach and away from cribs. If the cords have a loop, cut the loop and attach separate tassels to avoid strangulation.
• If your child has a bunk bed, check the guard rails on the top bunk. There should be only a very small space between the rail and the mattress or bed frame so your child's body cannot slide through.
• Don't let your child lie in or play with a hammock that doesn't have spreader bars (wooden strips at the ends of the hammock that stop the netting from bunching up). Mini-hammocks, often used to store toys and stuffed animals, are also a hazard. Your child can get entangled in them.
• Remove hood cords and drawstrings from your child's clothing. These cords can get caught in playground equipment or on crib parts and strangle your child.

Remove loose ribbons or strings on toys and stuffed animals. Never use a string or ribbon to tie a pacifier or toy to your baby.

Who Is Affected?

Each year, products that are thought safe for children–namely cribs and clothing-cause deaths from suffocation or strangulation. Approximately 50 babies suffocate or strangle each year when they become trapped between broken crib parts or between parts of an older crib with an unsafe design. Clothing with drawstrings also presents a hazard for children. Drawstrings can become entangled in playground equipment, fences, and furniture, causing strangulation. Such entanglements were associated with 17 deaths and 42 nonfatal incidents between 1985 and 1995.

Car trunks present a special risk for children. Between 1987 and 1998, nearly 20 children between 2 and 6 years old died from being trapped inside car trunks. The children had either climbed into trunks that were open or managed to open the trunks themselves, with or without keys. While hyperthermia (becoming too hot) was the most frequent cause of death, asphyxia (suffocation) was a contributing factor in half of the cases.

Safety Resources 

American Academy of Pediatrics

The AAP offers toy safety guidelines for parents (www.medem.com), which include tips for preventing choking, strangulation, and suffocation.

U.S. Consumer Product Safety Commission

Visit the CPSC home page (www.cpsc.gov) to search for information about toy safety, crib safety, and choking and strangulation hazards.

Juvenile Products Manufacturers Association

Check out "Safe & Sound for Baby," (www.jpma.org/public/safe-sound.html) a publication of JPMA that shows parents how to properly use products made for children.

National Safety Council

NSC offers a fact sheet on baby-proofing your home (www.nsc.org/library/facts/babyprf.htm)

References 

The data and safety tips in this fact sheet were obtained from the following sources:

American Academy of Pediatrics. Toy safety: Guidelines for parents. Available at www.medem.com. Accessed July 15, 1999.

American Academy of Pediatrics. Infants at increasing risk of suffocation death. Press release, May 3, 1999. Available at www.aap.org. Accessed July 15, 1999.

CDC. Fatal car trunk entrapment involving children–United States, 1987-1998. Morbidity and Mortality Weekly Report 1998;47(47):1019-1022.

Juvenile Products Manufacturers Association. Safe & Sound for Baby: A guide to juvenile product safety, use and selection. JPMA, 1997. Available at www.jpma.org/public/safe-sound.html. Accessed July 26, 1999.

National Safety Council. Baby-proofing your home. Available at www.nsc.org/library/facts/babyprf.htm.  

U.S. Consumer Product Safety Commission. Strings, cords, and necklaces can strangle infants: Safety alert. CPSC document #5095. Available at www.cpsc.gov/cpscpub/pubs/5095.html. Accessed July 27, 1999.