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Table 1.  Sample Characteristicsa
Sample Characteristicsa
Table 2.  Opinions on the Sale and Safety of Crib Bumpers Among Respondents Who Had Heard of Crib Bumpers
Opinions on the Sale and Safety of Crib Bumpers Among Respondents Who Had Heard of Crib Bumpers
1.
Scheers  NJ, Woodard  DW, Thach  BT.  Crib bumpers continue to cause infant deaths: a need for a new preventive approach.   J Pediatr. 2016;169:93.e1-97.e1. doi:10.1016/j.jpeds.2015.10.050PubMedGoogle ScholarCrossref
2.
Task Force on Sudden Infant Death Syndrome.  SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment.   Pediatrics. 2016;138(5):e20162938. doi:10.1542/peds.2016-2938PubMedGoogle Scholar
3.
Centers for Disease Control and Prevention. Sudden unexpected infant death and sudden infant death syndrome. Published December 9, 2019. Accessed February 1, 2020. https://www.cdc.gov/sids/parents-caregivers.htm
4.
US Consumer Product Safety Commission. Joint statement of Chairman Elliot F. Kaye, Commissioner Robert S. Adler, Commissioner Marietta S. Robinson, and Commissioner Joseph P. Mohorovic recommending parents and caregivers not use padded crib bumpers. Published November 3, 2016. Accessed February 1, 2020. https://www.cpsc.gov/s3fs-public/Joint%20Statement%20on%20Padded%20Crib%20Bumpers%20FINAL%2011.3.16_0.pdf
5.
Frankel  T. Regulators again struggle with response to crib bumper deaths. Published January 22, 2020. Accessed February 1, 2020. https://www.washingtonpost.com/business/2020/01/22/regulators-again-struggle-with-response-crib-bumper-deaths/
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    Research Letter
    Pediatrics
    June 18, 2020

    Public Opinion on the Sale of Crib Bumpers

    Author Affiliations
    • 1Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • 2Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    JAMA Netw Open. 2020;3(6):e208089. doi:10.1001/jamanetworkopen.2020.8089
    Introduction

    Crib bumpers have no meaningful health benefit and have been associated with the asphyxiation and suffocation deaths of more than 40 infants in the US.1 The American Academy of Pediatrics2 and Centers for Disease Control and Prevention3 advise against their use, and the states of Maryland, Ohio, and New York have prohibited their sale.

    The US Consumer Product Safety Commission (referred to hereafter as the Commission) is the federal regulatory agency with jurisdiction over crib bumpers. In November 2016, citing safety issues, a majority of the commissioners advised against their use.4 However, in January 2020, the Commission held a hearing to consider adopting a manufacturing standard to increase the product’s stiffness and a warning label on proper installation.5 We assessed the public’s opinions on banning the sale of unsafe products, their attention to warning labels, and their beliefs about crib bumpers.

    Methods

    This survey study was approved by the Johns Hopkins University institutional review board. We added questions to an omnibus survey of adults living in the US conducted online between January 14 and 16, 2020, by The Harris Poll, which uses a large network of online panels with millions of unique respondents worldwide recruited through more than 100 different sources. All panelists completed a confirmed or double opt-in process, which is an approved proxy for informed consent that includes introductory language describing the survey. There were 3568 survey entrants, of whom 2994 qualified and 2036 completed the survey.

    Single survey items assessed respondents’ use of warning labels and their opinions about the product. Respondents who reported having heard about crib bumpers were also asked 6 Likert-scale items measuring their beliefs about crib bumpers. All percentages reflect weighted data, with respondents weighted to targets from the US Census Bureau’s Current Population Survey for US adults aged 18 years and older; no statistical testing is presented. Data were analyzed using Quantum statistical software version 5.8 (Unicom). Data analysis was performed in January 2020.

    Results

    Table 1 shows the demographic characteristics of the full sample of 2038 adults who completed the survey (1059 women [51.40%]) and the 176 who were parents of children younger than 2 years (107 women [54.50%]). Among all respondents, nearly one-half (969 respondents [45.80%]) were aged 18 to 44 years, and most (1174 respondents [65.30%]) had an annual household income of $50 000 or higher. Among the 176 parents, most were aged 18 to 44 years (157 respondents [86.40%]), and most (107 respondents [69.1%]) had an annual household income $50 000 or higher.

    Among all respondents, 1372 (67.3%) said they had heard about crib bumpers and 851 (62.0%) reported ever having used them. Among parents, 133 (75.6%) said they had heard of crib bumpers, and 86 (64.7%) reported ever having used them (data not shown).

    Table 2 shows that among those who had heard of crib bumpers, 966 of all respondents (70.4%) and 88 parents (66.2%) thought they were safe, 529 respondents (38.6%) and 61 parents (45.9%) thought they were dangerous, 699 respondents (51.0%) and 86 parents (64.7%) knew that infants could suffocate because of bumpers, 592 respondents (43.2%) and 56 parents (42.1%) believed that crib bumpers helped the baby sleep, 926 respondents (67.5%) and 85 parents (63.9%) believed that bumpers made the crib look better, and 809 respondents (59.0%) and 66 parents (49.6%) agreed that “people wouldn’t be able to buy crib bumpers if they were dangerous.” All respondents were asked about buying infant products, and 801 of all respondents (39.3%) and 73 parents (44.2%) said they always read all the safety information when buying infant products (Table 2). When asked whether it would be a good idea for the government to stop the selling of crib bumpers if experts determined that they have been linked to infant deaths, 1275 of all respondents (62.6%) and 113 parents (68.5%) agreed; 209 respondents (10.3%) and 23 parents (13.9%) thought it would be a bad idea.

    Discussion

    There is consensus among pediatric and public health authorities that crib bumper pads have been linked to infant deaths and do not offer a meaningful health benefit. The findings of this national survey suggest that many parents may still purchase these products because they perceive them to increase the attractiveness of the crib, falsely perceive them to be safe, or mistakenly believe that they would have been removed from the market if they were dangerous.

    The study results are limited in the extent to which we could assess parents’ actual practices of buying or using crib bumpers or other dangerous crib products, such as mesh liners, as well as the association of parents’ opinions with these practices. Nevertheless, this is the first study, to our knowledge, to assess the public’s opinion on crib bumpers, a widely used yet dangerous infant product. By an almost 5:1 margin, parents believe that if they were linked to infant deaths, crib bumpers should not be sold. Despite previously advising against crib bumper use, the Commission is considering establishing a standard far short of a ban. Our results cannot only guide public information efforts to correct misperceptions, but should also inform regulatory, legislative, and other actions on crib bumper pads, which could be undertaken by the Commission, the Juvenile Products Manufacturers Association, and product manufacturers.

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    Article Information

    Accepted for Publication: April 10, 2020.

    Published: June 18, 2020. doi:10.1001/jamanetworkopen.2020.8089

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Gielen AC et al. JAMA Network Open.

    Corresponding Author: Andrea C. Gielen, ScD, ScM, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205 (agielen1@jhu.edu).

    Author Contributions: Dr Gielen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Both authors.

    Acquisition, analysis, or interpretation of data: Gielen.

    Drafting of the manuscript: Both authors.

    Critical revision of the manuscript for important intellectual content: Gielen.

    Statistical analysis: Gielen.

    Supervision: Gielen.

    Conflict of Interest Disclosures: Dr. Gielen reported providing written comments to the Maryland Department of Health and Mental Hygiene regarding the safety of crib bumpers during a regulatory effort to ban the sale of crib bumper pads. Dr Sharfstein reported serving as Secretary of the Maryland Department of Health and Mental Hygiene from 2011 to 2014 and leading a regulatory effort that banned the sale of crib bumper pads in the state of Maryland. No other disclosures were reported.

    Additional Contributions: Aimee Vella Ripley (Harris Insights and Analytics) and other colleagues at Harris Insights and Analytics provided data collection efforts that made this work possible. They were not compensated beyond their salaries.

    References
    1.
    Scheers  NJ, Woodard  DW, Thach  BT.  Crib bumpers continue to cause infant deaths: a need for a new preventive approach.   J Pediatr. 2016;169:93.e1-97.e1. doi:10.1016/j.jpeds.2015.10.050PubMedGoogle ScholarCrossref
    2.
    Task Force on Sudden Infant Death Syndrome.  SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment.   Pediatrics. 2016;138(5):e20162938. doi:10.1542/peds.2016-2938PubMedGoogle Scholar
    3.
    Centers for Disease Control and Prevention. Sudden unexpected infant death and sudden infant death syndrome. Published December 9, 2019. Accessed February 1, 2020. https://www.cdc.gov/sids/parents-caregivers.htm
    4.
    US Consumer Product Safety Commission. Joint statement of Chairman Elliot F. Kaye, Commissioner Robert S. Adler, Commissioner Marietta S. Robinson, and Commissioner Joseph P. Mohorovic recommending parents and caregivers not use padded crib bumpers. Published November 3, 2016. Accessed February 1, 2020. https://www.cpsc.gov/s3fs-public/Joint%20Statement%20on%20Padded%20Crib%20Bumpers%20FINAL%2011.3.16_0.pdf
    5.
    Frankel  T. Regulators again struggle with response to crib bumper deaths. Published January 22, 2020. Accessed February 1, 2020. https://www.washingtonpost.com/business/2020/01/22/regulators-again-struggle-with-response-crib-bumper-deaths/
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