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Bumpers and Crib Mattresses

by Randall Neustaedter OMD

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Question:

In your book Child Health Guide it says, “Babies can get trapped between the mattress and bars of a crib, so you must use bumpers on a crib. Each bumper should have at least six ties, and each tie should be no longer than six inches to avoid strangulation.” Everything I have read in the past 12 months from says bumpers are NOT recommended as the baby’s face may get buried in the padding and suffocate.

Dr. Neustaedter’s Response:

As most of you know, I am a proponent of parents sleeping with their babies, in the same bed or using a cosleeper next to the parents’ bed. Some parents may choose to use a crib, or graduate their baby to a crib at some point. The question revolves around the issue of suffocation. Will a baby suffocate in pillows or pads, or can a baby get caught in between the mattress and the side of the crib and benefit from having a pad there to block that space?

There are conflicting opinions about bumper pads and no research. So the verdict is still out. Regardless of whether parents use a bumper pad or not, mattresses may exude a gas that is toxic to babies, and all mattresses should be covered with polyethylene sheeting or a mattress cover designed to keep these gases from escaping. An alternative is to purchase a safe baby mattress.

Here is what Dr. William Sears says about pads

Make sure crib bumpers fit snugly around the entire perimeter of the crib and are secured by at least six ties or snaps. To prevent your baby from chewing on the ties and becoming entangled in them, trim off excess length. Remove bumpers and toys from the crib as soon as the child begins to pull himself or herself up on the crib rails, because they can be used as steps for climbing over the rail.

Don’t place breathing blockers in baby’s crib (or baby’s sleeping environment). These include anything that could obstruct baby’s breathing passages or collect dust (which is an irritant that can lead to stuffy little noses). Breathing hazards include: decorative pillows, fuzzy stuffed animals and toys, string-toys, tiny chokable toys, straps or ties on bumper pads.

And here is a summary of the anti-bumper pad argument

Some major children’s safety organizations have recently suggested that parents and child care providers should remove crib bumper pads from baby cribs. The groups include: American Academy of Pediatrics, Health Canada, National Center for Health and Safety in Child Care, the Consumer Product Safety Commission and the First Candle/National SIDS Alliance. Some state and regional Back to Sleep campaigns now recommend removing bumper pads, as well.

One reason child safety organizations recommend against crib bumpers is that they pose a risk of suffocation. Just like a pillow or thick blanket, crib bumper pads can restrict a baby’s breathing if the bumper is up next to the baby’s nose or mouth. Suffocation risk is greatest when babies are very young and unable to move themselves away from potential hazards.

Rebreathing of air is another concern with crib bumper pads. The bumper reduces the flow of fresh air around baby during sleep. The American Academy of Pediatrics suggests that some infants, when they are overheated or lack sufficient oxygen during sleep, are unable to arouse themselves enough to prevent hypoxia and death. The AAP states that re-breathing of air may in fact be a contributing factor to SIDS.

Since many infant safety organizations now recommend that nothing be inside the crib at all, the safest route for parents and babies would be to remove crib bumper pads altogether. For day care centers, the push for increased sleep safety may soon result in states mandating that child care providers no longer use crib bumper pads. For parents who are still concerned about their child sticking arms and legs through the crib slats, and feel that they must use a bumper pad, there are new mesh crib bumpers on the market today that allow more air to flow through the crib.

For anyone concerned about the safety of bumper pads, Dr. Sears may have the most practical advice.

Be sure the mattress fits the crib perfectly. An undersized mattress will leave a gap along the side or end of the crib where an infant’s head can get caught, causing suffocation. To check the fit of a crib mattress, push it to one corner. There should be no more than a 1½ inch (4 centimeter) gap between it and the side or end of the crib. If you can fit more than two fingers between the mattress and the crib, the mattress is too small. Remember, the firmer the mattress, the safer. Beware of hand-me-down or secondhand cribs in which the mattress may be different from the one designed to fit the crib.

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