They are just so irresistible to new parents: those cute, fluffy bumper pads lining the inside of the crib, creating a little cocoon of softness to protect their newborn baby.1 No bumper pad? What if my baby moves during sleep and bumps his head on the crib bars?

The real question should be, what if my baby moves and presses his face into the nice, soft bumper pad and stops breathing? The answer: possible death by asphyxiation. A recent review of the Child Protection Safety Commission (CPSP) database found that bumper pads or similarly padded bassinets were associated with 27 infant deaths during a 10-year period from 1995 to 2005. Three types of infant death occurred with bumper pads: face against the bumper, infant wedged between the bumper and another object, and bumper tie around the infant's neck.2

Asphyxiation, resulting from rebreathing expired air or by nasal and oral compression, was judged to be the cause of death in cases where infants were found in the corners of their cribs, with their faces up against the bumper pads, or when infants had moved or rolled to the sides of their cribs and their faces were found against the bumper pads. Asphyxiation was also the likely cause of death when infants were found wedged between mattresses and bumper pads; it was thought the infants lacked the motor development required to extricate themselves.2 Because of the potential for head entrapment, firmer bumper pads are just as hazardous as softer pads. Bumper pad ties, used to attach the pad to the crib, led to 2 deaths by strangulation.

However, getting parents to choose safety over style is another matter. The message nothing in the bed but baby must be delivered consistently by all healthcare providers. During discharge teaching with new parents, nurses can also point out the advantages of going bumperless. In addition to saving money, the lack of a bumper pad will allow parents to visualize their infant more easily during room-sharing.1 Parents who plan to use a bumper pad despite the potential risks may believe they will be able to remove the bumper pad from the sleep environment before their baby begins moving around in the crib or rolling over. The data reviewed by Thach et al2 suggest that this is not a safe plan. One of the infants in their series was only 6 days old.

Crib bumper pads first came into use when the slats on most cribs were wide enough apart to allow an infant's head to fit between the slats. Safety regulations now require that crib slats be no more than 2 3/8 inches apart, obviating the need for bumper pads. However, many parents still worry that their infant will be injured by bumping against the crib slats or sliding an arm or leg through the opening. The minor bruises and contusions that could result from unpadded crib slats are far outweighed by the risk of death from padded ones.

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