Keep a Sick Child Safe: Learn to Use a Hospital Crib

As any parent whose baby has spent some time in the hospital knows, all cribs are not created equal. In most cases, hospital cribs (also called pediatric medical cribs) differ significantly from what’s in your child’s bedroom at home.

“Each type of crib is specially designed for safe use in the environment in which it is being used,” says Victoria Wagman, M.A., a senior science health advisor at the Food and Drug Administration (FDA).

And it’s important that you, as a parent, know how to use these cribs correctly, both in and out of the hospital—especially if your special needs child uses one of these cribs at home.

Caring for Your Child in the Hospital

In the hospital, pediatric medical cribs provide easier access to sick or special needs babies who are hooked up to medical devices or otherwise need frequent attention or treatment, most often provided by medical staff. Unlike home cribs, hospital or medical cribs have fixed or movable bed end rails, movable and latchable side rail components, and a mattress designed to fit the crib. Hospital nurses and other staff are well trained in operating these cribs safely.

Often when babies need to stay in the hospital overnight or for several nights, the parents stay there, too. “If your baby has rotavirus, for example, you might be the main caretaker in charge of feeding or constant diaper changing throughout the night,” says Joan Ferlo Todd, R.N., M.S. a senior nurse consultant at FDA.

“If so, you need to ask the nursing staff to train you in the proper use of pediatric medical cribs,” she adds.

“Naturally enough, parents in this kind of situation are often frazzled, sleep-deprived and anxious,” Todd says. The last thing they need is to feel uncomfortable or inept in how to operate the crib.

Among other things, Todd explains that parents whose children are using hospital cribs in either setting need to become skilled in the safe use of the crib and comfortable with:

• latching, locking and opening side rails;
• raising and lowering the side;
• raising and lowering the mattress;
• angling the mattress if necessary; and
• locking and unlocking the wheels.

“If you are switching off with another caregiver, make sure that person is also proficient in using the crib correctly,” Todd says. If the other caregiver is much taller, for instance, knowing how to raise and lower the mattress can be essential, both for the baby and for the caregiver, who doesn’t want to add back injury—a common problem among caregivers—to the mix.

New safety requirements for pediatric medical cribs:

Download this high-resolution graphic from Flickr.

Caring for Your Child in the Home

The same goes if you have bought a pediatric medical crib for use at home. While these cribs are currently available from manufacturers, a new FDA regulation proposes that they will need to be prescribed by a physician for home use.

“Parents with sick children should evaluate the risks and benefits of using a pediatric medical crib in their private home and discuss whether it is medically necessary with their child’s health care professional,” Wagman adds.

If your doctor ever prescribes a pediatric medical crib for home use, it’s important not to continue to use the crib once your baby is well, or to use it for another child. “Just as you would not give your child’s prescription drug to a sibling, do not use the prescribed pediatric medical crib for the other child’s care,” Todd says.

By the same token, if you find your daycare facility is using a pediatric medical crib for your child who does not have special needs, make sure your child is transferred to a non-pediatric medical crib.

“Healthy kids are ingenious at pushing latches and accidentally lowering side rails,” Todd says. “Pediatric medical cribs should be used only with sick children who need easy access from the caregiver.”

Regulating Cribs for Safety

Just as such equipment as wheelchairs and walkers are considered medical devices and as such regulated by FDA, so too are pediatric medical cribs. “For this reason, we have proposed that these cribs should be physician prescribed for use at home,” Wagman says.

Cribs used for nonmedical purposes at home are considered consumer products and are regulated by the Consumer Product Safety Commission (CPSC).

In 2011, CPSC prohibited the making or selling of drop-side rail cribs for non-medical purposes. Children had been suffering frequent injuries, including entrapment and strangulation due to slat and side rail disengagement. CPSC instituted rules to improve slat strength, make hardware stronger, prohibit traditional drop sides, improve mattress support durability, and make safety testing more rigorous.

Since that time, the FDA has been conducting a full-scale review of the best available data on pediatric medical cribs and medical bassinets.

In addition to proposing that pediatric medical cribs be physician-prescribed, FDA’s proposed regulation includes special controls for cribs used in hospitals and other medical facilities that align with those proposed by CPSC in 2011. These controls include establishing standards for spacing between crib slats and improving the quality of hardware and crib testing.

“Many hospitals are already using cribs that meet the FDA’s proposed standards,” says Wagman. “But we need to be sure that every pediatric medical crib is engineered specifically for child safety.”

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Sharing Bed With Infant is Dangerous

Roughly 14 percent of infants share bed with adult or child. NIH-funded study shows physician advice can reduce potentially life-threatening practice

The percentage of nighttime caregivers who reported that an infant usually shares a bed with a parent, another adult, or a child more than doubled between 1993 and 2010, according to researchers at the National Institutes of Health and other institutions.

Over the 17 years of the study, researchers recorded increases in bed-sharing among all racial and ethnic groups; however, the increases were most notable among African American and Hispanic families. Bed-sharing can increase the risk of unexpected infant death, including SIDS, which is also more common among African American infants, the researchers said.

The researchers also found that advice from physicians could significantly reduce the potentially life threatening practice. Caregivers who perceived physicians’ attitude as against sharing a bed were about 34 percent less likely to report that the infant usually shared a bed than were caregivers who received no advice.

Based on responses from nearly 20,000 caregivers, the researchers reported that the proportion of infants sharing a bed with another person rose from 6.5 percent to 13.5 percent over the 17-year period of the study. The majority of bed sharing, 85 percent, was with parents.

Sharing a bed, with an adult or another child, increases an infant’s risk of death from sudden infant death syndrome, or SIDS or other sleep-related causes. To reduce infants’ risk of sleep-related deaths, the American Academy of Pediatrics (AAP) recommends  that infants sleep in the same room, but not in the same bed, as caregivers. Cribs, portable cribs bassinets, or playpens that meet safety standards can be placed next to the caregiver’s bed. Infants should not be placed to sleep on an adult bed at any time.

Caregivers were much less likely to report that the infant shared a bed if they perceived that their physicians were against the practice. The researchers also found that if physicians gave advice that caregivers perceived as neutral regarding bed sharing, their infants were more likely to bed-share than were infants of caregivers whose physicians didn’t give them any advice at all.

“It’s important for doctors to discuss sleeptime habits with new parents in order to convey the risks of bed sharing clearly,” said Marian Willinger, Ph.D., study co-author and special assistant for SIDS at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

SIDS is the unexplained death of a child within the first year of life. In 1992, the AAP issued its recommendation that infants be put to sleep on their backs. Two years later, the NICHD and its partners launched the Back to Sleep campaign. The rate of SIDS in the United States has fallen 50 percent since. However, in that time, researchers have reported an increase in other unexpected infant deaths, resulting, for example, from accidental suffocation, entrapment in bedding material or other causes.

Based on new recommendations from the AAP, in 2011 the NICHD and its partners expanded the Back to Sleep campaign to include information that parents and caregivers can use to reduce the risk of other unexpected sleep-related causes of infant death, in addition to SIDS. These include entrapment and suffocation. The expanded campaign is known as Safe to Sleep.

Each year from 1993 to 2010, researchers with the National Infant Sleep Position Study surveyed more than 1,000 caregivers about their infant sleep practices. About 85 percent of respondents were the infant’s mother.

The researchers found that over the course of the17-year study, bed-sharing became more common among all ethnic and racial groups. Using a three-year moving average calculation, they found that among white infants, the proportion of those usually bed-sharing increased from 4.9 percent in 1993 to 9.1 percent in 2010. For Hispanic infants, the percent usually bed-sharing rose from 12.5 percent in 1993 to 20.5 percent in 2010. With African-American infants, the percentage of those usually bed-sharing increased from 21.2 percent to 38.7 percent during the same time period.

“The disparity in nighttime habits has increased in recent years,” said Dr. Colson. “Because African-American infants are already at increased risk for SIDS, this trend is a cause for concern.”

More than half of the caregivers surveyed since 2006 reported that they had not received advice from their doctor about bed sharing.