Walking while bottle drinking causes injuries in toddlers

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On average 2,270 children require treatment each year after falling with a bottle, pacifier or sippy
On average 2,270 children require treatment each year after falling with a bottle, pacifier or sippy

HealthDay News -- During the past two decades, more than 45,000 U.S. children aged younger than 3 years required emergency treatment after falling with a bottle, pacifier or sippy cup in their mouth, study data reveal.

Most injuries resulted from falling (86.1% of injuries; 95% CI: 33,103-45,097), while drinking from a baby bottle, and consisted mainly of lacerations (70.4%) or contusions to the mouth or face, Sarah A. Keim, PhD, from Ohio State University College of Medicine in Columbus, and colleagues reported online in Pediatrics.

"Given the number of injuries, particularly those associated with falls while using the product, greater efforts are needed to promote proper usage,"  the researchers wrote.

This is the first retrospective analysis to examine incidence of injuries associated with these products in a  nationally representative cohort of children admitted emergency departments from 1991 to 2011. Data were extracted from the National Electronic Injury Surveillance System.

During the study period, an estimated 45,398 children were treated in emergency departments for injuries related to bottles, pacifiers or sippy cups, averaging out to approximately 2,270 cases per year. This equates to one child being treated every 4 hours, the researchers determined.

After stratifying the cohort according to gender and age, from younger than 1 year, 1 year, and ages 2 to 3 years, data indicated that 66.4% of injuries (95% CI: 25,538-34,740) occurred in children younger than 1 year because of falls while using a bottle (57.5%) or a pacifier (33.8%).

One-year olds were 7.62 times more likely to fall (95% CI 4.84 to 12.02) compared with younger children, and more boys (61.2%) were injured than girls. "Children who are just learning to walk and run are at the highest risk for these injuries," the researchers noted.

The body region injured most often was the mouth (71%), followed by the head, face or neck (19.6%). Bottles were the item most frequently implemented in injuries (65.8%; 95% CI: 25,245-34,525), followed by a pacifier (19.9%; 95% CI: 7,108-10,935) and a cup with a drinking spout lid (14.3%; 95% CI: 4,454-8,512). Product malfunctions were uncommon (4.4% of cases).

Although lacerations were the most common diagnosis across all products, pacifiers were associated with a higher likelihood of soft tissue injuries (OR=1.86; 95% CI: 1.12-3.10) and dental injuries (OR=3.25; 95% CI: 1.75-6.04) than bottles or sippy cups.

Based on these findings, the researchers advise that children not use these products beyond intended ages recommended by the AAP, and that parents help their children transition to lidless drinking cups around age 1 year.

They also recommended parents encourage children to sit while they drink or eat, rather than letting them walk around with a bottle or cup 'grazing' during the day.

The study may have underestimated the true number of injuries attributable to bottles, pacifiers and sippy cups, as many parents may treat minor injuries at home, the researchers noted, and because cases were limited to the minimal descriptive details contained in ED records.

Furthermore, the study did not examine which product characteristics were most involved in the injuries reported, and lacked comparison data for injuries that were unrelated to the products mentioned.

Keim S et al. Pediatrics. 2012. 129;doi:10.1542/peds.2011-3348. 

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