Baby Walker Injuries

(1)

Baby

Walker

Injuries

Louis E. Fazen III, MD, MPH, FAAP, and Pamela I. Felizberto, BA

From Worcester, Massachusetts

ABSTRACT. In a study of 49 children between the ages

of 8 and 14 months, parents were surveyed with a written

questionnaire and a follow-up phone interview to

deter-mine the utilization of baby walkers and the frequency

and severity of baby walker injuries. Most respondents

(86%) placed their children in various types of baby

walkers between 4 months and 1 year of age. Half of the

42 infants who used walkers experienced at least one

accident involving a tip over, a fall down stairs, or finger entrapment. Two of those accidents resulted in injuries

serious enough to require medical management. Both

infants sustained head and neck injuries after falling down

stairs in a walker. Whereas stairway and finger

entrap-ment accidents occurred before the age of 7 months, tip

overs were much more likely to occur after the age of 8

months. Injuries are more common but less severe than

previously reported. Pediatricians and other child health

advocates can inform parents about the health risks, encourage regulatory agencies to improve product

label-ing, and stimulate manufacturers to adjust the product to

age and weight specifications of the growing infant.

Pe-diatrics 70:106-109, 1982; infant injuries, household product safety, baby walkers.

walkers to be beneficial inasmuch as these devices keep infants occupied and allow them to move about freely. The literature review did not reveal any scientifically based studies on the advantages of baby walkers.

An obvious problem associated with the use of baby walkers is that they give infants an advanced degree of mobility prior to the normal

developmen-tel stage of walking. Furthermore, parents may consider baby walkers to be a substitute for con-stant parental supervision. Lack of supervision and environmental factors contribute to a striking num-ber of infant walker accidents.’ The US Consumer Product Safety Commission estimates that in 1978 alone, more than 8,000 individuals received hospital emergency room treatment for injuries associated with baby walkers.2 However, this number under-estimates the total number of infant walker acci-dents as it does not include those accidents that resulted in subclinical injury or significant injuries treated outside of the emergency room.

A 1-year-old boy crashes down the basement stairway in his plastic infant walker. He is imme-diately removed to an emergency room where an extensive parietal bone fracture is diagnosed. The plight ofthis index case provoked a literature review and a population based study of baby (infant) walk-ers. Epidemiologic data on baby walker injuries are notably absent from pediatric periodicals and cur-rent textbooks ofpediatrics. Although various forms of infant walkers have been in use since the 17th century, they did not rise in popularity until the post-World War II baby boom.’ In recent years, use of the X-frame and circular frame baby walkers

(Fig 1) has been especially common. From personal patient encounters, it seems that parents perceive

Received for publication Aug 18, 1981; accepted Nov 13, 1981. Reprint requests to (L.E.F.) 295 Lincoln St., Suite 203, Worces-ter, MA 01605.

American Academy of Pediatrics.

METHODS

The purpose of this study was explained to the parents of 55 infants between the ages of 8 and 14 months (100% private office sample). After review-ing office records by age, all registered patients who met the age requirements were asked to take part in the study. The parents of 49 infants (89% re-spouse) consented to a written questionnaire and a follow-up phone interview. The six-month age range was chosen to give the optimal recall of infant walker use. The index case.described above was not included in the study population because of age requirements and the possibility of over-represen-tation of cases. Nonrespondents had either left the practice without leaving a forwarding address or chose not to respond.

(2)

cau-Fig 2. Patient with head trauma following fall down

stairs. X-Frame walker shown was not involved in this

accident.

ARTICLES 107

Fig 1. X-Frame (left) and circular frame (right) baby

walker (after US Consumer Product Safety

Commis-sion’).

tiously in reference to other geographic, economic,

and social practice settings.

RESULTS

Frequency and Severity of Injury

The results of the study can be summarized by

separating the children into three distinct

cate-gories (Table): category A, infants who had never

used a walker; category B, infants who had used a

walker but had not experienced an accident; and category C, children who had at least one accident while using the baby walker. Eighty-six percent of parents placed their children in infant walkers. Of those using the walkers, half experienced at least one episode of tipping over, falling down stairs, or finger entrapment. In spite of this common occur-rence of accidents among infants using walkers, most of the injuries sustained were not severe enough to require emergency room treatment or

even phone notification to private pediatrician.

However, two male infants in accident category C required prompt medical evaluation after they fell down stairs in their walkers. The first patient fell down one flight of stairs at the age of 6 months. He landed on his head and was hospitalized for a cerebral concussion and extensive facial bruises (Fig

2). The second boy at 7 months of age fell down half of a flight of stairs. He incurred multiple

ecchy-moses and abrasions to head and shoulders. A

tem-porary unilateral facial paresis was noted on

follow-up.

Children who had experienced accidents

(cate-gory C) were slightly older than those who had not

(category B). This age difference was not significant

by Student’s t test. The average period of exposure

(Table) did not differ between categories B and C. Although there were twice as many female as male infants in this study, this sex ratio did not change significantly in category B compared with category C.

The average age at which the initial accident

occurred was also determined. Tip overs were re-ported at an average of 8.5 months of age whereas younger children (approximately 6 months of age) were more likely to be involved in falls down stairs and finger entrapments. Many children experienced more than one accident between 4 months and 1 year of age. The total number of accidents in each age group was not determined.

Utilization Pattern

Most of the infants were first placed in their walkers at the age of 5 or 6 months. However, eight of those who used walkers (20%) began sitting in the walker at 4 months of age. Use of the walkers

was usually discontinued by 10 to 12 months of age.

TABLE. Baby Walker Utilization and Acci dent Fre-quency

Category No. of

Infants in Each Category

Av Age at Time of Study

(mo)

Av Pe-nod of Exposure

in Walker

(mo)

A. Walker never used 7 (14%) 10.8 NA

B. Walker used without 21 (43%) 10.8 4.4 accident

C. Accident reported in 21 (43%) 11.4 4.6 walker

* Abbreviation used is: NA, not applicable.

at Viet Nam:AAP Sponsored on September 7, 2020

www.aappublications.org/news

(3)

Those who experienced accidents sometimes stopped using the walker at an earlier age. Most study children who were at least 1 year old were placed in infant walkers for a six-month period. Nearly all families used the walker on a daily basis.

Environmental Factors

Both X-frame and circular-frame walkers were involved in tip over accidents and falls down stairs.

For example, infants often tipped over while trying to maneuver their walkers onto carpets and over

thresholds. The open stairway door enabled infants

in their walkers to slide the walkers to the edge of the staircase and fall down the stairway. Finger entrapment appeared to be a problem associated

with the X-frame walkers, which have collapsible frames for storage. Parents reported that children frequently caught their fingers in the hinges or in the springs of the various models of X-frame

walk-ers.

Product Inspection

On-site inspection of five types of infant walkers on display in local stores revealed very limited safety labeling. Instructions simply advised parents not to leave children unattended. No information about the appropriate age or size of infant for each brand of walker was available.

Parental Perspective

When asked about the perceived benefits of the baby walkers, parents credited these devices with

providing children with exercise, freedom, and

in-dependence. Many parents believed that baby walkers, in addition to keeping infants occupied, assisted children in learning to walk.

DISCUSSION

The only comprehensive publication describing baby walker injuries was produced by the US Con-sumer Product Safety Commission in 1974.’ Their hazard analysis was based on 176 emergency room surveillance reports and 100 personal interviews of selected cases. Emergency rooms reported that 86% of injuries resulted in lacerations, contusions, and abrasions. These data represent the tip of the cm-ical spectrum when contrasted to the vast majority of accidents in our study that did not result in discernible clinical injury.

The personal interviews conducted by the US Consumer Product Safety Commission also tended to emphasize the more severe cases. Falling down stairs was the initiating factor leading to injury in 29% of cases compared with 10% of children with

accidents in this study. Our population based report presents a different perspective on baby walker injuries inasmuch as it defines the frequency and severity of accidents experienced by infants at home.

The frequency of injuries in the present study may be underestimated because of a number of factors. Some parents discontinued the use of the walker after the first accident, thereby reducing exposure. Each child at risk may have more than one accident although we only recorded the first accident. Finally, the study was completed one to two months before some of the children had out-grown their walkers.

IMPLICATIONS

The implications from this study of baby walker injuries should be considered tentative. If subse-quent studies can substantiate the frequency of utilization and the morbidity pattern in children,

important consequences could be anticipated.

Reg-ulatory agencies may need to take a closer look at

baby walker injuries in terms of frequency of

acci-dent cases per population at risk over time. Acci-dent severity should be evaluated from the home setting as well as from emergency room data, as previously reported.2

Manufacturers of infant walkers may also be responsible for providing information that would enable the parents to match the walker to the infant in relation to age and size of the infant. From

standard growth charts, the body proportions in

relation to length and head circumference are changing rapidly during infancy. The average weight of a child increases by more than 50% be-tween the ages of 4 to 12 months.

Baby walker accidents may represent a new

un-recognized cause of pediatric morbidity inasmuch as most of the accidents are not reported to the family physician. Pediatricians can play a role by informing parents about the risk of infant walker-associated accidents. As the beneficial effects are poorly understood, future studies may examine the impact of baby walkers on developmental mile-stones. Parents should be aware that different models result in different types of injuries and that unattended stairway doors are associated with the most severe injuries as a result of head trauma. Pediatricians can also actively work through pedi-atric associations and public health groups to stim-ulate manufacturers to package their products with more specific information for parents. Regulatory agencies such as the US Consumer Product Safety

Commission should be encouraged to improve

(4)

SUMMARY ACKNOWLEDGMENTS

ARTICLES 109

From our private practice survey, baby walkers are almost universally used during infancy. Nearly half of the users of baby walkers wifi be involved in an accident resulting from a tip over, a fall down stairs, or a finger entrapment. The majority of these accidents result in subclinical injuries that are not reported. When injuries do occur, head trauma is the most likely problem noted. Our results indicate that injuries are more common but less severe than have previously been reported. Child health advo-cates, manufacturers, and regulatory agencies may be able to reduce the frequency of baby walker injuries.

This study was supported in part by the Worcester

Hahnemann Hospital Fund for Pediatric Education and

Research.

We thank Sally Holden, RN, for her assistance.

REFERENCES

1. US Consumer Product Safety Commission: Baby Walker

Injuries: Hazard Analysis, NIC-1508-74-H003. Washington

DC, Bureau of Epidemiology, April 1974

2. Baby Walkers, US Consumer Product Safety Fact Sheet,

No. 12, revised. Washington DC, US Consumer Product

Safety Commission, September 1979

OPHTHALMOLOGISTS’ BLIND SPOT

[A blind person has poignantly summarized] his impression of ophthalmolo-gists’ attitudes toward patients who are becoming blind: “We are interested in vision but have little interest in blindness.”

In one of Shakespeare’s most horrifying scenes, Lear’s monstrous daughter Regan, having just incited Cornwell into tearing old Gloucester’s eyes from their sockets, commands her servants, “Go thrust him out at gates, and let him smell his way to Dover” [King Lear, iii. 7.92-2]. ...

Assuredly, no ophthalmologist would be anything but appalled at the prospect of bidding a nearly blind patient to “smell his way to Dover.” Yet, from what [has been reported] about the paucity of help. . .received from the professionals

in coping with blindness, the effect is much the same. ...

Some years ago my son, a victim of congenital glaucoma, received expert surgical treatment at a major New England medical center, but when he was ready to learn how to see with what vision remained, the response of staff ophthalmologists ranged from bored indifference to crude and insensitive (and unhelpful) improvisation.

Dealing with one of nature’s most isolated and self-contained organs, ophthal-mologists-perhaps more than their brethren in other specialties-can be for-given for not seeing “the person for the eyes.” One hopes that they will take [these] observations to heart.

Submitted by Student

From John H. Gilchrist: Coping with blindness, in a Letter to the Editor. N Engi J Med Dec 10,

1981.

(5)

1982;70;106

Pediatrics

Louis E. Fazen III and Pamela I. Felizberto