Between 1992 and 2006, the percentage of infants sleeping in bassinets doubled, to almost 20%. During the first 2 months of life > 45% of infants routinely
sleep in bassinets; by age 5 to 6 months usage of bassinets has declined to <10% of infants. Despite this frequent use, little information on bassinet safety exists,
and there are no government safety standards for bassinets or cradles. The Consumer Product Safety Commission (CPSC) developed bassinet stipulations that include: sturdy bottom and wide base; smooth surfaces without protruding hardware; locked legs to prevent collapse while in use; a firm tight fitting mattress; and adherence to
the manufacturer's guidelines. In this study, data collected by the CPSC on individual infant deaths while in bassinets were examined to determine risks associated with SIDS.
Pike J, Moon RY. Bassinet use and sudden unexpected death in infancy. J Pediatr. 2008;153(4):509-512. Epub 2008 Jun 25.
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The authors retrospectively reviewed and analyzed infant deaths occurring in bassinets between June 1990 and November 2004 that were voluntarily reported to the
CPSC by police, fire, insurance investigators, coroners, medical examiners, health care personnel, manufacturers, retailers, and consumers. Demographic information, medical history, location of death, cause of death, and details about the death scene, including the position of the infant when placed to sleep and when discovered, and
the presence of soft bedding, were abstracted.
In the 53 cases, the mean age at death was 84 days (range,
9 to 277 days), with 90% of deaths occurring between age
30 and 180 days. Caucasians were the largest group with 34
(64.2%), followed by 11 African-Americans (20.8%),
3 Hispanics (5.7%), and 5 unspecified (9.4%). Almost
40% of infants had a history of recent illness and 15%
had significant past medical problems. Thirteen percent of
infants were exposed to tobacco. The cause of death was anoxia,
asphyxiation, or suffocation in 45 cases (84.9%) and SIDS
in 5 cases (9.4%). In the 3 remaining infants, the causes
of death were “thermal burns,” “anoxia and
heat stress,” and unspecified. Forty-four infants (83.0%)
died in their home, 6 (11.3%) died in a child care setting,
and 3 died in a homeless shelter. Twenty (37.7%) infants
were placed for sleep in the prone position, 5 (9.4%)
were placed on the side, and 9 (17%) were placed supine.
At death, 30 (56.6%) infants were found prone, 3 (5.7%)
on the side, and 2 (3.8%) supine.
Four infants were found in positions resulting from a mechanical
failure of the bassinet, including on the floor face down
in a blanket, in a bassinet lying on its side, hanging from
the bassinet, and partially out of a tipped-over bassinet.
In 56.6% of cases the mode of asphyxiation was described
in detail, for example: “child's face wedged into depression
formed by mattress and the edge of the bassinet wall”.
Six infants were found with their faces wedged against the
side of the bassinet. Only 2 infants were found in the supine
position. One was found in a corner of a collapsed bassinet;
the other was asphyxiated by a beanbag pillow that had fallen
from above. Of the 31 infants found in a non-supine position,
27 had other identifiable risk factors, including objects
in the bassinet, parental smoking, or a mechanical problem
with the bassinet. In 39 (74%) of the deaths, items other
than a mattress, fitted sheet, and a pacifier/rattle were
left (mostly intentionally) in the bassinette, including blankets,
stuffed animals, bottles, plastic bags, and adult-sized pillows.
In 35 (66%) deaths, soft bedding was found in the bassinet.
Mechanical problems including broken legs or wooden slats
and shifting of the mattress due to bending of stabilizing
metal clips were noted in 9 (17%) cases. In 4 cases, the
bassinet had a mechanical swing or pendulum.
The demographics of the infants were similar to those seen in SIDS, including a male predominance (60.3%). Further, the mean age at death was almost 3 months, and
a large (11.3%) proportion of children died while in child care. However, the cause of death was determined to be SIDS in only 5 of these cases. The authors suggest that medical examiners have recently abandoned the diagnosis of SIDS for asphyxia, suffocation, or undetermined cause. Indeed, in many of the cases in this study, the diagnoses of anoxia, asphyxia, or suffocation were not supported other than by the prone position and soft bedding. Generally these cases were indistinguishable from
SIDS cases. All of the infants placed on the side, and many placed supine, were found in the prone position at time of discovery. Seventy-four percent of those infants in which the position found was recorded were found in the prone position. It has been described that infants who roll into the prone position are at exceedingly high risk for SIDS. Soft or loose bedding was a contributing factor in >70% of the deaths. Several of the deaths were associated with mechanical problems unique to bassinets that could allow movement of the infant leading to a more vulnerable sleeping position. Mechanical swings may have contributed to death by migration of the infant.
The authors support the AAP infant sleep guidelines, including
supine positioning, a firm surface, and elimination of soft
objects and loose bedding. The small size of the bassinet
may facilitate a “separate but proximate” sleep
environment (room sharing without bed sharing - see
Fu et al. reviewed herein). Bassinets may suffer mechanical
failures and parents must be vigilant to detect safety hazards
and instability. The authors suggest that a bassinet with
vertical sides of air-permeable material, such as mesh, may
be preferable (reducing the risk of asphyxiation when wedged
between side and mattress); that parents follow manufacturers'
recommendation for infant length and weight; and that items
that could cause suffocation or asphyxia be removed from the
bassinet and areas where they could fall into the bassinet.
Further, health care professionals must be aware of the need
for guidance regarding the unique risks of bassinets.