24 February 2011

Unhealthful News 55 - Cribs are not a safe alternative

Last weeks news included a report that revealed, based on a review of hospital records, that each year in the U.S., 10,000 young children end up in the emergency room because of crib and playpen related injuries.  Cribs in the U.S. are governed by a remarkable number of regulations for such a simple object – not as many as there are for cars, but far more than for the more complicated and dangerous device, bicycles.

There is some good reason for this.  Regulations like maximum distance between the bars on the side, preventing infants from getting their head jammed between them or pushed clear through which can have fatal consequences, make perfect sense.  There is no reason anyone would want a crib that created that risk, but it is not reasonable to just demand parents all figure this out themselves.  I know that some of my readers are adamantly opposed to most regulations that are intended to protect people from their own decisions, but I suspect you have to agree that this one is a good idea.

On the other hand, some of the regulations are of the "deciding for someone how they want to trade off risk versus other calculations" variety, tending toward nanny state behavior.  For example, "drop-side" cribs, those with a side that can slide down to allow easier access to the bed and baby, are now banned because if the side is left lowered babies and toddlers are at greater risk of falling out and if mis-assembled the moving parts created a risk of catching or pinching the baby.  This new regulation was mentioned in most of the recent stories and cited as a reason to expect that the injury rate would go down.  Not mentioned was the burden this placed on a 5 foot tall mom, who cannot reach into a crib if the side does not drop, and how she might not be able to get her baby out of the crib until he learned how to crawl to the near side so she could reach him.  (Our society is a hostile place for short women to have kids without a man around.)  Regulations like the drop-side ban and associated recalls of products are so onerous that regular furniture stores seem to have gotten out of the business of selling cribs at all, leaving them entirely to baby product specialty stores that are used to dealing with such hassles.

As for the alarming injured baby statistic, it was noted that 1- and 2-year-olds account for most of the injuries, which is about 10 million at risk in the study population (that is a conservative estimate since older and younger kids were also at risk).  So we have less than 1/1000th of the at-risk population experiencing an event each year.  This would be a disturbing number if many of the events were highly serious, but there is no indication of this.  Deaths were in the order of less than 1/100,000 per person-year.  To put that in perspective, the risk to the kid from car travel is easily ten times that great.

This does not mean that the problems should be ignored.  But it was noted that most of the injuries, especially the most serious ones, consisted of toddlers pulling themselves up out of the crib and then falling to the ground.  This is another case of operator error rather than bad tech, since the mattress can and should be lowered, effectively raising the walls of the cage, as the kid gets bigger.  And, of course, there comes a combination of height and arm strength when the pen walls create rather than reduce falling risk.  In other words, a lot of the injuries were to newly motile kids whose parents had not figured out that they needed to climb-proof their space, so those kids faced some risk wherever they were left alone.  Strange how none of the articles I saw led off with or even clearly noted the message "parents can eliminate almost all of the small but nonzero risk from cribs by making sure the kid cannot climb out of them."

Many of the news articles about the topic mentioned that, despite the hazards, putting the kid to sleep in a crib is safer than any other option.  I find it rather difficult to understand how this can be asserted, given that it is probably quite difficult to get good statistics on how often kids are put to sleep in socially frowned-upon places like, say, their parents' bed (common in most of the world, but widely condemned in the U.S.).  I would guess that there are no good statistics on alternative sleeping arrangements like the parents' bed, dresser drawers, or mattresses on the floor (hmm, that one seems safer).  This is one of those claims that should cause a reporter to say "how do you know that"; they seldom do.

All that got me thinking.  We have a fairly low-risk activity and the risk is being further lowered by changing technology.  It is an alternative to a popular but officially socially-condemned activity.  That sounded really familiar.  So I had to wonder, why the "health promotion" types are not attacking cribs, like they do other harm reduction practices, screaming that cribs are not a safe alternative to other sleeping arrangements.  After all, the study was published in Pediatrics.

How can we accept actions that merely lower the risk from cribs when there are government sanctioned proven methods of quitting...er...sleeping.  As shown here, there are tested and proven safety gear approved by the U.S. National Highway Traffic Safety Administration, International Mountaineering and Climbing Federation, and U.S. Consumer Product Safety Commission.  Photographer's Note:  The latter is not shown in use (it is sitting in the back) since my model started crying every time I put the bike helmet on him, and for some reason his mom then decided the shoot was over.  Models can be such divas.  But, if we have learned anything from anti-tobacco extremists and their ilk, it is that a little needless emotional distress and intense discomfort is a small price to pay to eliminate every last trace of risk.

With that in mind, why is there no demand to do away with these jungle-animal-decorated death traps?  My personal theory is that all the health activists are secretly in the pocket of Big Crib.  This explains why they condemn the most popular alternative in the world (and that mattress on the floor idea) in favor of a slavish devotion to cribs, even as they desperately try to eliminate all crib features that could lead to faulty assembly or other operator error.  Coming soon will be cribs with a lid on top like a hamster cage,  which will be a bit dehumanizing, but will be good for getting kids ready for their role in our increasingly feudal society.  Actually I think it is more likely that the requirement will be cribs
where the mattress cannot be raised above the lowest level, to make it impossible for anyone to not properly lower it when the kid grows.  Yes it will cause all manner of orthopedic problems due to back bending lifting by a large portion of mothers as well as shorter fathers, but how dare you worry about that?  Think of the children!

Where does it end?  I will bet that more babies are injured when being carried than when they are in their cribs.  Shouldn't we do something about this needless risk, perhaps creating some kind of approved device that eliminates the danger of unassisted carrying.  Naturally U.S. government regulators will never endorse anything Swedish, even if it is the obvious natural and popular solution and has proven to be miraculously harm reducing.  But I am sure that Big Crib can come up with some convoluted solution to the problem that has not been contaminated by being an accepted lifestyle alternative for centuries.

[Disclaimers:  (1) No babies were harmed in the making of this blog post.  Not seriously anyway.  (2)  The journal Pediatrics is a go-to outlet for both utter crap junk-science that has a particular nanny-state bias and for legitimate research about children's health that the author thinks should be read by activists rather that just by medics and scientists.  The latter studies are not necessarily junk, they are merely written by authors who are willing to implicitly support the junk so that they can gain greater visibility among those who are not sufficiently expert to know that Pediatrics publishes junk.  Not high praise, I suppose, but it is only fair to concede the point.]

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