Consumer rights for child safety products- European Child Safety Alliance European Consumer Safety Association Final Report

Transcription

1 Consumer rights for child safety products- European Child Safety Alliance European Consumer Safety Association Final Report Project Leader: Joanne Vincenten

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3 Consumer rights for child safety products- European Child Safety Alliance European Consumer Safety Association Final Report The project Consumer rights for child safety products was co-ordinated by the European Child Safety Alliance of ECOSA, Amsterdam, the Netherlands, with financial support of the European Commission, Agreement nº: B5-1000/02/ September

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5 Contents MAIN REPORT Page Summary 6 1 Adult beds 12 2 Baby walkers 14 3 Bath seats or rings 16 4 Bunk beds 17 5 Changing tables 19 6 Child car seats 20 7 Child gates/ safety barriers 23 8 Child sleep wear 24 9 Cots Fireworks Goals for soccer or handball High chairs Lighters non-child-resistant Pacifiers Plastic bags Playground equipment Playpens: mesh-sided Rattles Small parts (marbles, small balls, strings, toys sold in food etc.) Strings, cords and necklaces Strollers Toy chests Toys Trampolines Window blind or drapery cords 56 References 58 FINANCIAL REPORT ANNEXES Annex A Annex B Annex C Annex D Annex E Literature review Product safety organisations Data tables EU and related reports Expert groups 5

6 Summary Project title: Consumer rights for child safety products Project duration: November 2002 till June 30, 2004 Introduction All Europeans consumers and especially our most vulnerable in society, children, have the right to safety as outlined in the United Nations charter of rights for children. This particularly needs to include products available on the market place that are promoted as safety devices giving consumers the expectation that it meets a safety standard and will provide protection to their children. Consumers need education to increase their awareness and knowledge of being informed shoppers and their rights to attain safe products for children. Consumers also need to be aware of hazards that can occur while specific products are in use. Currently consumers make the assumption that if a product is available for purchase that it is safe to buy and use. Many consumers as reported by ANEC (European Association for the Co-ordination of Consumer Representation in Standardisation) assume the CE mark is a safety seal, yet at this time there is no universal European mark that approves a product for safe use. Therefore the need for consumer product safety information that is consistent across the European market is essential and products are available at a global level. Deaths and serious injuries related to various children s childcare products have been reported in many Member States national data systems and through the European Home and Leisure Accident Surveillance System (EHLASS) data registry in Europe. This has also been reinforced with detailed data reports from the Consumer Product Safety Council (CPSC) in the United States with products for children. Deaths and serious injuries related to childcare products and toys do not need to occur. Raising the awareness of the potential risks before purchasing and using products with children is one strategy to reduce unnecessary accidents from happening by enhancing the knowledge of consumers to buy products wisely and use them safely. Project purpose and objectives Purpose: To increase awareness and knowledge of European Consumers of their rights to safe childcare articles and toys as well as their ability to purchase and use safe equipment for their children. Objectives: To research and prepare a recommended list of consumer products that pose injury risks to children. To launch a communications plan to inform consumers of the researched risks and recommended actions to take to reduce child injury risks from specific products. 6

7 Project partners This project was conducted by the European Child Safety Alliance of the European Consumer Safety Association (ECOSA). The Alliance has an active and established network of 22 countries and 3 international associations that work co-operatively to advance child safety in Europe. A complete list of Alliance Members can be located on our website under the contact section and annex E of this report. The project leader was Joanne Vincenten, Director of the European Child Safety Alliance and research support provided by Mathilde Sector, research associate for the Alliance. Justin Cooper of the European Consumer Safety Association and Henk Zantvoord of the Consumer Safety Institute of the Netherlands completed Website development and design. Expert review and technical support was also provided by the following individuals: Dirk van Aken Yvonne Lievens Morag Mackay Joe Sibert Perry Chan Lotten Strindberg Wanda Geisendorf Helena Menezes Fernanda Polacon Robert Bell Ian Scott Wim Rogmans Consumer Safety Institute Consumer Safety Institute European Consumer Safety Association Cardiff University Wales Ram Consulting Konsumentverket Konsumentverket Portuguese Association for Child Safety and Injury Control Portuguese Association for Child Safety and Injury Control Nursery Group Sweden World Health Organisation European Consumer Safety Association Target group and geographical coverage The audience for this project are European Consumers in the EU Member States. In particularly the information and communication pieces focus on parent consumers of young children whom are the most vulnerable in our society and deals with their leading cause of death, injury. Approach and methods A series of steps were undertaken to conduct the work on this project. First a review of relevant literature was conducted to determine what has already been studied and reported in a formal method regarding hazards and child related products. This information provided indications world wide of products that have been reported as potentially dangerous for children and the specific problems encounter with these products. The literature in this area is not large and therefore reinforced the need in this project to not only rely on published journal articles regarding potentially dangerous products, but other forms of information and evidence that certain childcare products or toys could be a problem for families. Samples of the most relevant articles are available in annex A of this report. A comprehensive listing of related literature is available on the new Alliance website ( 7

8 Second a review of key organisations in Europe that are involved with product safety were reviewed for scope of work and information provided for background and information for this project as well as the European population in general. Summaries of these organisations can be found in annex B. Limited information was provided by these organisations for both this project as well as consumer information in general. No one organisation provides a complete overview of products that can be viewed as dangerous to families, agencies tended to focus on only one or two categories. No one agency also existed that provided consumers with information on recalled products (the Rapid Alert System for Non-Food Products (RAPEX system) of the European Commission is for the exchange between Member States and the Commission, but not targeted to alert consumers, only the authorities). As well, no reports are produced from RAPEX stating product recalls or safety alerts. It is not transparent, who and how the Commission deals with the products reported to RAPEX. Therefore further inquires were made to organisations based outside Europe, including the Consumer Product Safety Commission (CPSC) in the United States, which currently provides the most specific information by product. Yet it still was not possible in this organisation to get statistics on which products were the most dangerous, or a ranking of dangerous products. Available data was then reviewed to determine which child related products were involved in accidents with children in the previous 15 Member States of the EU. Data available was very limited in Europe and currently does not provide a complete or accurate account of the relationship of deaths or injury hospitalisations that are product related for children or adults. No information was found concerning the number of deaths, injuries and or property damage resulting from consumer product incidents in the EU annually. Also no toll free hotline exists for consumers to report product related injuries or potentially hazardous products to use as a data source. Through the current European Home and Leisure Accident Surveillance System (EHLASS) an inquiry of hospitalisations to children due to product related incidents was investigated. This data provides only a sample of hospitals in some EU Member States that participate and is not representative data at a national level or for Europe, but this is the currently available data. The injury hospitalisations provided by this sample of hospitals is detailed in annex C and are used in each of the product summary sheets that follow in this report. To supplement this data sample, National data was sought where available to provide a more concrete example of the level of deaths and injuries some products have caused. These have been also included on the product summary sheets that follow and are referenced. It should be noted that the CPSC offices in the United States receives product-related injuries within 24 hours from the hospital via electronic transmission while the EHLASS data takes 1.5 years in some countries and longer in others, to clean and make available to the public. A series of EU and related reports were also collected and reviewed to assist in determining a list of potentially dangerous child related products along with the previous information described in this section. The Consumer Product Safety Commission (CPSC), a leader in international product safety, identified for example the following products as child hazardous products: - Adult Bed/Water Bed Hazards for Children - Age Labeling Issues - Baby Bath Seats/Rings - Baby Back Carriers/Carrier Seats - Baby Gates/Enclosures - Balloons - Booster Seats - Chest Freezers - Children's Toys - High Chairs 8

9 - Infant Suffocation Issues - Juvenile Furniture - Pacifiers - Rattles - School/Day Care Safety Issues - Shopping Carts - Storage Chests - Strollers/Carriages - Teethers - Walkers - Water Toys In Europe, home and leisure data was examined concerning injuries caused by falls to a lower level among 0-4-year-olds from Austria, Denmark, Greece, the Netherlands and Sweden. It was found that children s use of several product categories was closely related to age. Children s furniture account for between 21 percent (Netherlands) and 34 percent (Sweden) of the injuries from falls to a lower level in the first living year, but decreased with increasing age in all countries. The same pattern applied to strollers. In contrast, injuries due to falls involving playground equipment increased with age to reach between 13 (Greece) and 34 (Netherlands) percent of injuries following falls to a lower level among 4-year-olds. Bicycles also increase with age, reaching between 4 (Netherlands) and 17 (Denmark) percent among 4-year-olds. Stairs, chairs and sofas were most frequently involved in falls to a lower level at ages 1 to 3 in all countries. Type of injury: Contusions and concussions were the result of injuries involving children s furniture, in particular changing tables, high chairs and baby walkers. Fractures were strongly associated with injuries involving playground equipment. Wounds were frequent in connection with bicycles and chairs. The researcher concluded that the majority of the furniture causing injuries were of low height, such as ordinary beds, chairs and sofas, and products intended especially for children (such as playground equipment, children s furniture incl. high chairs, changing tables, baby walkers and strollers) continue to account for several thousand injuries each year in the five European countries. (Reference: Falls among Young Children in Five European Countries -Injuries requiring medical attention following falls to a lower level among 0-4-year-olds - A study of EHLASS data from Austria, Denmark, Greece, the Netherlands and Sweden. Henrik Nordin, Swedish Consumer Agency, June 6, 2004 World Conference, available in annex D). Research in Sweden examined the safety of childcare products from 1998 to The researcher analyzed the causes of mild brain injuries at home and during leisure time and the relation to childcare products, defined as child and baby furniture, nursing tables, baby walkers, toys, baby carriages, sport equipment for children, playground equipment and security equipment for children. In % of mild brain injuries were due to childcare products, and 48% in Nursery furniture caused the most accidents, and baby walkers were the most dangerous childcare products, followed by playground equipment. (Reference: Emanuelson, I. How safe are childcare products, toys and playground equipment? A Swedish analysis of mild brain injuries at home and during leisure time Injury Control and Safety Promotion, 2003, 10(3): ) 9

10 These reports also contributed to information for the product summary sheets that follow on 25 child related products. The sections of the most relevant reports have been placed in annex D. With the assistance of all the information describe above, Alliance members made the opportunity available during their biannual meetings and online communication to discuss the issues of product safety and those potentially dangerous to children and the outputs to be developed. Meeting minutes that include references to product safety discussions for this work are enclosed in annex E. Members provided input into planning the project work, providing research and evidence for developing the list of products and contents for the product summary sheets, national data examples, review of technical and promotional materials which includes 25 product summary sheets, a TV and radio spot (which focuses on one product to be targeted to parents and caregivers of young children as a starting pointbaby walkers, which was viewed by the Alliance as potentially the most dangerous for children) and new website to make all this information available. A final large group discussion on potentially dangerous products occurred in Stockholm on September 20, Discussions regarding dangerous products and child safety concluded with the drafting of a manifesto representing 21 countries that participated in the discussions and can also be found in annex E. Project results The completion of this project has resulted in the following outputs: 1 A broad listing of 25 potentially dangerous child related products in Europe (this does not include fad toy items that appear for short timeframes such as yo yo balls). Standard communication pieces that can be adapted for use by Member States available for use in various mediums (electronic- television, radio, video, websites and printed-newspapers, magazines, journals, flyers, poster and press releases) with 25 product summary sheets, a 30-second TV and radio spot and new Alliance website to launch these materials. 2 A position statement in the form of the Stockholm Manifesto that addresses product risks and prevention actions to take at the level of the World Health Organisation, European Commission, Member States, Business and Non Governmental Organisations. These outputs are available to the Member States to use for communication with parents to alert them of potential dangers of child related products currently available in the market place. This completes the communication plan outlined in the project objectives. The 22 Member States of the Alliance have made a commitment to launch their next European level campaign on home injuries for children that will include potentially dangerous products. The Alliance has prepared a new website for these materials that allows for easy access by all interested parties and professionals in the field of child safety as well as parents and caregivers. Conclusions A wide variety of child related products have been implicated in deaths and serious injuries for children in the European Union. Consumers and in particular, parent consumers of young children who are the most vulnerable to injuries have the right to be well informed about potential risks of child related products when deciding to purchase a product and before it is used. Awareness and knowledge based materials providing consistent information across Europe for child related products that are readily available on the European market place is a valuable tool and one method to assist in the reduction of child deaths and injuries. 10

11 Through the support of the European Commission a small start has begun with this project by identifying 25 child-related products that pose potential danger to children and making educational information available for parents across Europe in a consistent manner. As well as creating initial promotion material to begin to address these potentially dangerous products, such as for baby walkers. The formal statement of the Stockholm Manifesto will serve as an advocacy tool over the next year as a call to action for Member States, Business, NGO s, WHO and the European Commission to reduce chid injuries including those related to products. Further work is needed to enhance the level of communication to parents to make them aware of product related risks. Some recommendations to consider for this area of work include: - Make transparent at the EU Consumer Affairs how dangerous products are recalled. - Establish a hotline for consumers to call in unsafe products and have follow-up to the concern. - Establish a clearing house of product safety information for consumers - Establish a Fast Track Recall system similar to that of the CPSC in the USA - Make available injury records due to products on a population level. - Conduct an annual child safety campaign to increase the parents awareness and knowledge of actions to reduce child accidents. The European Child Safety Alliance will continue its work to make Europe safer for children and build from the information and resources gained through the work in this project. As the Alliance is an established and ongoing platform for child safety work in Europe this issue of child-related product safety will continue to be addressed in the agenda of work and will work cooperatively with all partners to achieve gains in this area. 11

12 1 Adult beds Why are adult beds a problem? In Austria for example there were an estimated 935 injuries involving adult beds in children 0-18 years of age in In a sample of hospitals in the 15 Member States of Europe in 1998 (latest standardised data available) there were 4321 hospitalisations of children 0-18 years of age due to an injury involving an adult bed 2. The United States Consumer Product Safety Commission has reports of more than 100 deaths of children under age 2, most from suffocation, associated with adult beds. In 2001 these deaths involved an entrapment, a fall, or a situation in which bedding or the position of the child was related to the death. Nearly all of the children, 98%, were babies under 1 year old 3. How are adult beds dangerous? Many parents and caregivers are unaware that there are hidden hazards when placing babies on adult beds. Consumers often think that if an adult bed is pushed against a wall, or pillows are placed along the sides of the bed, small babies will be safe as they sleep. However, data shows hidden hazards for babies on adult beds: - Entrapment between the bed and the wall, or between the bed and another object. - Entrapment involving the bed frame, headboard or footboard. - Falls from adult beds onto piles of clothing, plastic bags, or other soft materials resulting in suffocation. - Suffocation in soft bedding (such as pillows or thick quilts and comforters). Figure 1: Adult bed and child 1 Austrian EHLASS 2003 data, Institute Sicher Leben. 2 Fifteen Member States EHLASS 1998 data, European Commission. 3 Consumer Product Safety Commission, The United States Consumer Product Safety Commission Cautions Caregivers about Hidden Hazards for Babies on Adult Beds, # 5091, statesconsumerproductsafetycommissionpub/pubs/5091.htm. 12

13 When buying/ prior to using, what to look for: - Check that the bed has a firm tight-fitting mattress. - Buy a bed with the head and footboards as one solid piece rather than ones with gaps/spaces or bars. - Buy a bed with one mattress rather than a bed with two separate mattresses. How to use adult beds safely: - Never let a child sleep alone in an adult bed and always place the baby to sleep on his or her back, not on the stomach. - Remove soft blankets and pillows as they may cause suffocation. - Place a mattress on each side of the bed in case the child falls off. Alternative: Place your baby to sleep in a cot next to the adult bed. 13

14 2 Baby walkers Why are baby walkers a problem? The Child Accident Prevention Trust in the United Kingdom estimates that more children are injured in baby walkers than with any other nursery product. The accidents happen even when a caregiver is nearby. Baby walker accidents typically happen very quickly and there may be little that parents can do to prevent them. An American study has shown that in nearly 70 per cent of baby walker injuries the child was being supervised at the time 4. In 2002 in the United Kingdom over 2,350 babies were taken to hospital after being injured while in a baby walker, almost 70% of them aged less than 1 year. Research has shown that at least a third of babies using baby walkers will be injured 5. Many parents believe that baby walkers help to teach children to walk. Paediatricians have repeatedly stressed that this is not true. In fact there is increasing evidence to suggest that baby walkers may delay normal child development 6. How are baby walkers dangerous? Some parents believe that a baby walker is a safe place for their child. But data shows hazards 7 : Baby walkers are a fall hazard. In a baby walker a child has increased speed, mobility, and reach. This can lead to a fall down a flight of stairs, a crash into a hot stove, against a table edge or into a glass door. They offer limited balance to a child not yet completely able to stand or walk. If unstable, walkers can easily tip over. Most of the injuries are caused by: Falling down stairs: children in baby walkers can quickly move to the edge of the stairs and fall. This kind of accident frequently happens when someone forgets to close a basement door or safety gate. Tipping over: baby walkers can tip over when children try to cross uneven surfaces such as door thresholds or carpet edges. Burns: children in baby walkers can be burned when they touch hot surfaces such as oven doors, radiators, heaters, and fireplaces. Children can also be burned when they reach and spill hot liquids such as soup, coffee, or cooking oil. Research in Welsh burns unit revealed that a quarter of babies aged 6-12 months who were in the hospital with burns and scalds had been in a baby walker when the injury occurred 8. The baby s upright position in the walker also means that many of these scalds are on the face and head. 4 Smith, G. et al (1997) Baby walker related injuries continue despite warning labels and public education. Pediatrics, 100 (2), E1. 5 NSW Health (1998) Baby walkers, stairs and nursery furniture as potential factors for head injuries in infants. A case control study. State Health Publication (HP) , North Sydney. 6 Petridou, E. et al (1996) Hazards of baby walkers in a European context. Injury Prevention, 2(2), ). 7 Child Accident Prevention Trust Fact Sheets Baby Walkers, January 2004, 8 Cassells, O. C. S. et al (1997) Baby walkers still a major cause of infant burns. Burns, 23:

15 When buying/ prior to using, what to look for: The European Child Safety Alliance does not recommend buying or using a baby walker due to the high risk. If you decide to still buy a baby walker, it is important to buy one that has safety features to help prevent falls down stairs: - Check that the baby walker is too wide to fit through a standard doorway, or - Check that it has a gripping mechanism to stop the walker at the edge of a step. - Look for standard EN1273: 2001 to ensure that it meets European standards. How to use safely: Voluntary standards have been introduced as well as injury prevention strategies including parent education and warning labels. In many countries design modifications have been introduced to try to make baby walkers safer. There is however no evidence so far that British and European Standards, education, warning labels or design modifications have led to any reduction in the number or severity of baby walker injuries. - Buy a gate and make certain it is in use at the top of the stairs. Close all doors. - Keep children away from hot surfaces and containers. Keep hot containers away from the edge. - Beware of dangling appliance cords. - Keep your child in a walker away from toilets, swimming pools and other sources of water. - Stay with the child when he or she is in the walker, and use a walker only on smooth surfaces. Assist the child over thresholds or carpeting. Figure 2: Baby walkers 15

16 3 Bath seats or rings Why are baths seats/rings a problem? In the United Kingdom for example it is reported that at least six fatal drownings involved the use of bath seats for children one year and under 9. How are baths seats/rings dangerous to children? The bath seats/rings usually contain three or four legs with suction cups that attach to the bottom of the tub. However, the suction cups may suddenly release allowing the bath ring and baby to tip over. A baby may also slip between the legs of the bath ring and become trapped under it or submerged below the water. There are numerous cases of the caretaker turning away for a moment or leaving the child unsupervised to answer the doorbell or telephone that has resulted in the drowning and death of children 10. When buying/ prior to using, what to look for: Make sure the suction cups grip well. How to use baths seats/rings safely: - NEVER, even for a moment, leave your child alone or under another child s supervision in the bathtub, even when the child is in a bath ring or seat. Always be at arm s distance from your baby at all times. If you must leave the room to answer the phone or the door, take your baby with you. - Check periodically that the suction cups are gripping well as suction cups will NOT stick to textured, ridged, appliquéd, or factory designed non-skid bathtub surfaces. Suction cups will not stick to scratched, chipped, or repainted tub surfaces. After repeated use, the suction cups can become ineffective. - Bath rings are intended for use as bath aids while washing your child, they are NOT SAFETY DEVICES! Figure 3: Supervision of child in bathseat 9 Jenkins, David. Product safety: Bath seats for babies can give a false sense of security with fatal outcomes, The Royal Society for the Prevention of Accidents (RoSPA), 2003, 10 The United States Consumer Product Safety Commission, Report Bath Seats, CPSC-R , 2002, KB. 16

17 4 Bunk beds Why are bunk beds a problem? In a sample of hospitals in the 15 Member States of Europe in 1998 (latest standardised data available) there were 379 hospitalisations of children due to an injury involving a bunk bed 2. Each year in the United States thousands of children under age 15 receive hospital emergency room treatment for injuries associated with bunk beds. Most of these injuries are minor and occur when children fall from the beds. Play wrestling frequently contributes to these accidents. There are other less obvious yet potentially very serious hazards associated with bunk bed structures that have entrapped children and resulted in suffocation or strangulation deaths 11. How are bunk beds dangerous? Bunk beds are a strangulation/suffocation/collapse hazard. Children have died from strangulation when entrapped in the guard-rail and from collapse of the mattress foundation. Guard-rails that are attached to the bed by hooks and remain in place by their own weight can dislodge, allowing a child to become entrapped under the guard-rail or fall. Deaths have occurred when very young children rolled off the bed and became entrapped between the wall and the side of the bed not having a guard-rail. This hazard is not unique to bunk beds. Regular beds can present the same hazard. Suffocation deaths have occurred when mattress foundations fell on children playing on the floor or occupying the lowerbunk. Also, children have been hung when playing with ropes on the upperbunk. When buying/ prior to using, what to look for: - Look for the standard EN 747:1993 to ensure that it meets European standards. - Guard-rails: Make sure guard-rails are on both sides of the top bunk. Most bunk beds are used with one side located against a wall and are sold with only one guard-rail for the upper bunk to prevent falls from the side away from the wall. - Mattress foundation - The mattress foundation on some bunk beds merely rests on small ledges attached to the bedframe. They can dislodge, particularly if a child, underneath the bunk, pushes or kicks upwards on the mattress. Check that the mattress foundation is secure. - Wrong size mattress - Make sure there is no opening between the mattress and headboard or footboard. Strangulation deaths have occurred when children fell through openings created between the mattress and headboard or footboard when a regular length mattress was used in an extra long bed frame. 11 Consumer Product Safety Commission, Just The Facts, The United States Consumer Product Safety Commission Document #071, bs/071.html. 17

18 Choose bunk beds that have: Guard-rails on all sides that are screwed, bolted or otherwise firmly attached to the bed structure to prevent falls. Spacing between bed frame and bottom of guard-rails that is no greater than 75 mm. Guard-rails that extend at least 160 mm above the mattress surface to prevent a child from rolling off. Cross ties under the mattress foundation that can be securely attached. A ladder that is secured to the bed frame and will not slip when a child climbs on it. A feature which permits the beds to be separated to form two single beds if you have children too young to sleep safely on the upper bunk. Choose a mattress that correctly fits your bed so no space exists between the mattress and the head- or footboard. How to use bunk beds safely: Use - Always use two side guardrails on the upper bunk. Keep guardrails securely in place at all times no matter what the age of the child. Children move about during sleep and may roll out of bed. - Do not permit children less than 6 years of age to sleep in the upper bunk. This is because the safety standards for bunk beds are based on average measurements of children of this age. The spaces between the bars and around the mattress have been tested to make sure that a six-year-old could not get trapped in any part of the bed. - Be sure cross ties are under the mattress foundation of each bed and that they are secured in place even if bunks are used as twin beds. - Emphasise to children to use the ladder and not chairs or other pieces of furniture to climb into or out of the top bunk. - Teach children that rough play is unsafe around and on beds and other furniture. - Consider using a night-light so that children will be able to see the ladder if they get up during the night. Maintenance or Safety Repair - If spacing between guard-rails and bed frames is more than 75 mm, nail or screw another rail to close the space to prevent head entrapment. - Keep guard-rails in good repair and securely in place. - Replace loose or missing ladder rungs immediately. - Repair or replace loose or missing hardware, including cross ties immediately. 18

19 5 Changing tables Why are changing tables a problem? In Austria for example there were an estimated 715 injuries involving changing tables in children in In a sample of hospitals in the 15 Member States of Europe in 1998 (latest standardised data available) there were 249 hospitalisations of children due to an injury involving a changing table 2. How are changing tables dangerous for children? Most injuries associated with changing tables occur when children fall from the changing table to the floor. This occurs when a child is not strapped on the changing table and when a child is unattended because the caregiver has turned away for a brief moment, or is answering the telephone or the doorbell. When buying/ prior to using, what to look for: - Look for standard EN12221: 1999 to ensure the changing table has met European safety standards. - Look for a table with a wide base for stability and one that has safety straps that are easy to use. - Check that the changing table will allow you to have all needed supplies nearby. How to use changing tables safely: - Always use safety straps on a changing table. But know that children in secured straps can wiggle out of the straps over time. So have all supplies within arm s reach prior to changing your baby. - Be an arm s length away from your baby on the changing table. - Take your baby with you when having to leave the room, even for a phone call or to answer the door. - Never leave your child strapped to the table unattended. 19

20 6 Child car seats Why are child car seats a problem? Data from the Royal Society for the Prevention of Accidents (RoSPA) show that every year in the United Kingdom around 40 children between the ages of 0 and 11 years are killed while travelling in cars, about 500 are seriously injured and up to 9,000 slightly injured. The Royal Society for the Prevention of Accidents (RoSPA) states that the proper use of child car restraints would prevent many of these deaths and injuries 12. Road safety officers in Scotland found that in 52% of vehicles checked, 28% of children were secured incorrectly. The commonest errors were loose seat belts and restraint devices not adequately secured to the seat. Rates of incorrect use were highest in child seat restraints, reaching 60% with two-way seats and 44% with rear facing infant seats 13. How can child car seats be dangerous? In a 50-km/h crash, a child who is not properly restrained would be thrown forward with a force 30 to 60 times their body weight. They would be thrown about inside the vehicle, injuring themselves and quite possibly seriously injuring (or even killing) anyone else inside the vehicle. They are also likely to be ejected from the car through one of the windows. When buying/ prior to using, what to look for: - Look for standard ECE/R44/03 to ensure the car seats meets European safety standards. - Choose a seat that is suitable for your child's weight and height. Try to find a retailer who will let you (or even better, help you) try the seat in your car before you buy it. If this is not possible, make sure that you can return the seat if it is not suitable, and replace it or get a refund. - Avoid buying a child seat by mail order, unless you are sure that it will fit your car. Do not buy a second-hand seat, you cannot be certain of its history (it may have been involved in an accident and been seriously weakened - the damage may not be visible) and often the instructions are missing. Second-hand seats are likely to be older and not designed to current standards. - Only accept a child seat from a family member or friend, if you are absolutely certain that you know its history, it comes with the original instructions and it is not too old. - It's safer to fit child seats in the rear of the car, but if necessary they can be fitted in the front. But, NEVER fit a rearward-facing baby seat in the front if there is an airbag on the passenger side of the car. If the airbag went off it would strike the seat with considerable force, and could severely injure or kill your baby. 12 Choosing and Using Child Seats, 2003, 13 Campbell H, Macdonald S, Richardson P. High levels of incorrect use of car seat belts and child restraints in Fife--an important and under-recognised road safety issue. Inj Prev Mar; 3(1):

21 How to use child car seats safely: Rearward facing seats: Babies should be in rearward facing baby seats as the injury-reducing effect of these seats was found to be superior to all other child restraints in cars 14. Do not move your child to a forward-facing seat until they weigh at least 9 KGs and can sit up unaided, but keep them in a rearward-facing seat for as long as possible. Once your child is above the maximum weight of 13 kilos for a rearward-facing seat or the top of their head is above the top of the seat, they should be moved into a forward-facing seat. It is not important if their knees are bent in the seat, provided they are still within the seats weight range. National regulations in some member states, Sweden for example, require children as old as three years to travel rearward facing in the back seat 15. Also: Make sure the seatbelt passes through all the correct guides on the child seat. Some seats have an alternative routing if the seat belt is too short to go around the main route. Push your weight into the child seat as you tighten the seat belt to make sure the child seat is securely held. There should be no slack in the seat belt. The child seat should rest firmly on the car seat, with hardly any forwards or sideways movement. Never modify the seat or adult seatbelt to make it fit. The seat belt buckle should not rest on the frame of the child seat. Do not place the child in a car seat on top of a table or couch as the child may rock in the car seat and cause it to fall over, causing a head injury, or tip on the couch, causing the child to suffocate. You can also obtain information about the safety performance of some seats from the European New Car Assessment Programme (EURO NCAP, When possible choose a child seat that has scored well in their tests. Use the checklist below from RoSPA to select the child seat that is most suitable for your child and your vehicle 16. Is the Child Seat suitable for my car(s)? The shape of car seats, the length of seat belts and the position of seat belt anchor points differ between cars. So, not all child seats fit all cars. For instance, the seat belt in a particular car may be too short to go around a certain child seat. It is essential to check that the child seat you purchase will fit in your car and that it will fit in all the seat positions you intend to use it. The manufacturer and retailer should advise you. Does the child seat fit on the rear side seats? Yes Does the child seat fit on the rear middle seat? Yes No No 14 Carlsson G, Norin H, Ysander L. Rearward-facing child seats--the safest car restraint for children? Accid Anal Prev Apr-Jun; 23(2-3): A Guide to Child Safety Regulations and Standards in Europe, European Child Safety Alliance, March RoSPA. Buying a Child Seat: Checklist, 21

22 How helpful is the Retailer? Some retailers are very knowledgeable about child restraints, others are not. Try to find a retailer who will let you try the seat in your car first and who will demonstrate how it should be fitted. If this is not possible, make sure you can return the seat, if it is not suitable. Will the retailer help me fit the seat? Yes No Will the retailer let me try the seat before I buy it? Yes No Will the retailer let me return seat if it is not suitable? Yes No Does the retailer provide good advice? Yes No Does the seat meet the latest safety Standard? Check that the seat you are buying meets the latest European safety standard: ECE R44.03 Does the seat conform to the European safety standard R44.03? Yes No Does my car have airbags? If your car has an airbag in the front on the passenger's side, you must not use a rearward-facing seat in the front seat. So make sure, the seat will fit in the rear of your car. Does my car have a passenger airbag? Yes No If so, will the rearward-facing seat fit in the rear of my car? Yes No Are the instructions easy to understand and follow? Many people find fitting child seats difficult. The most important thing is to read and follow the manufacturer's instructions. Some instruction booklets are clearly written and well illustrated. Others are difficult to understand and use. Ask to see the instruction booklet before you buy. Are the instructions easy to read and follow? Yes No ISOFIX A child restraint system called ISOFIX is being introduced. ISOFIX points are fixed connectors in a car's structure into which an ISOFIX child seat can simply be attached. Many new vehicles have ISOFIX points built in when they are manufactured, and child seat manufacturers are beginning to produce ISOFIX child seats which have been approved for use in specific car models. Does my car have ISOFIX Points? Yes No Has the ISOFIX child seat been approved for my specific car model? Yes No 22

23 7 Child gates / safety barriers Why are child gates a problem? Baby gates are used at the top and bottom of stairs or in open doorways to prevent toddlers from falling or entering unsafe areas. But some baby gates themselves are dangerous, or can be misused. In a sample of hospitals in the 15 Member States of Europe in 1998 (latest standardised data available) there were five hospitalisations of children due to an injury involving entrapment in the gate 2. How are child gates dangerous for children? An entrapment and strangulation hazard exists with accordion-style baby gates that have large V- shaped openings along the top edge and diamond-shaped openings between the slats. There are deaths that occurred when children's heads were entrapped in the V-shaped or diamond-shaped openings when they attempted to crawl through or over the gates. There are also a number of incidents where pressure gates have popped out of openings at the top of stairs resulting in children falling down stairs 17. When buying/ prior to using, what to look for: - Look for standard EN 1930:2000 to ensure that the baby gate meets European standards. - Do not buy accordion-style child safety gates. Choose a gate with a straight top edge and rigid bars or mesh screen. - Do not buy a pressure gate to use at the top of the stairs. This type of gate is not bolted to the wall so it has a higher risk of popping loose and tipping over when a child pushes against it, causing the child to fall down the stairs. - Be sure the child safety gate is securely anchored in the doorway or stairway it is blocking. Children have pushed gates over and fallen down stairs. - Follow installation instructions carefully to ensure proper fit. If installed too high from the floor a child can get trapped in the space underneath. How to use child gates safely? - Check to make sure that gates are closed when the child is in the home. - Each time you use the gate, check that it is securely anchored in the doorway or stairway it is blocking. Children have pushed gates over and fallen down stairs. 17 The United States Consumer Product Safety Commission, Report 5085, 2001, 23

24 8 Child sleepwear Why is children s sleepwear a problem? The Department of Trade and Industry reported that 28% of clothing flammability accidents in the United Kingdom are due to nightwear. Nightdresses and dressing gowns, followed by pyjamas are the three nightwear garments most frequently involved. Above average levels of minor accidents occur among all children under 18, the highest being boys aged Above average numbers of severe accidents is highest amongst girls under 18. Overall, burns account for 99% of all injuries. That is why since 1984 the United Kingdom has set a national safety standard for children's sleepwear flammability designed to protect children from burn injuries if they come in contact with an open flame, such as a match or stove burner. A flame resistant garment does not continue burning when removed from an ignition source in the Netherlands, legislation has been proposed, but recently it has been decided to maintain voluntary labelling (Convenant between the ministry and the industry), and to take action against very flammable clothing on the basis of the GPSD only 18. In the Netherlands, about 10 children (0-9 years) are submitted to hospitals each year after their clothing caught fire. About the same number are treated at accident and emergency departments of hospitals (30 persons in the age group 0-24 years). The portion of sleepwear in these figures is unknown 19. A European standard is available for testing the flammability of clothing textiles (EN 1103). In addition, a standard has been proposed for classification of nightwear according to the burning behaviour (pren 14878). The latter standard, if adopted, will require children s nightwear to be relatively slowburning. However, it is important to realise that all consumer clothing will burn in the end if exposed to flames. How are children s sleepwear dangerous? Children are most at risk from burn injuries that result from playing with fire (matches, lighters, candles, burners on stoves) while in their sleepwear, just before bedtime and just after rising in the morning. One reason for the increased proportion of severe of accidents amongst children is that they are prone to panic rather than attempting to put the flames out. Instead they scream for help, and continue to burn until an adult (who is usually not too far away) comes to extinguish the fire. When buying/ prior to using, what to look for: - Buy children's sleepwear that is either flame-resistant or snugfitting. - Flame-resistant garments are made from inherently flame-resistant fabrics or are treated with flame retardants and do not continue to burn when removed from a small flame. However, there are health and environment issues with some flame retardant chemicals. - Snug-fitting sleepwear is made of stretchy cotton or cotton blends that fit closely against a child's body. Snug-fitting sleepwear is less likely than loose T-shirts to come into contact with a flame and does not ignite as easily or burn as rapidly because there is little air under the garment to feed a fire. 18 United Kingdom Department of Trade and Industry. Clothing flammability accidents study. June 1994 URN 94/ The Netherlands EHLASS data 2003, Consumer Safety Institute. 24

25 How to use children s sleepwear safely: - Loose-fitting T-shirts and other loose-fitting clothing made of cotton or cotton blends should not be used for children's sleepwear as they catch on fire easily. Only use child sleepwear that is flameresistant or snug fitting. - Supervise children carefully just before bedtime and just after rising in the morning as this is when children are at most risk from burn injuries that result from playing with a candle, a lighter, etc. while in sleepwear. 25

26 9 Cots Why are cots a problem? In Austria for example there were an estimated 165 injuries involving children in cots in The United States Consumer Product Safety Commission reports that in the United States more infants die every year in accidents involving cots than with any other nursery product. Thousands of infants are injured seriously enough to require treatment in hospital emergency rooms. Decorative knobs or cornerposts have been implicated in two cases of brain damage and 48 deaths due to strangulation 20. How are cots dangerous? Cot cornerposts: cot cornerposts are a strangulation hazard as children's clothing or other items can catch on cornerposts or knobs, especially if the child is trying to climb out. Cot design: cot design may be a strangulation/suffocation hazard as it can create openings that can entrap a child. If there is more than two fingers width between the mattress and the side of the cot, an infant s head could get caught in between and the infant could suffocate. If the slats are more than 4.5 cm to 6.5 cm apart, the baby s body can slide between the slats and the baby can suffocate. Cot Toys: cot toys are also a strangulation hazard. Remove all cot toys which are strung across cot or playpen area when your child is beginning to push up on hands or knees or is 5 months of age, whichever occurs first. Never hang toys with long strings, cords, loops or ribbons in cots or playpens. Pacifiers should never be attached by string or ribbon around a baby s neck. When buying/ prior to using, what to look for 21 : - Look for the standard EN 1130:1996. A crib with this standard will have been designed to make sure that your baby cannot easily fall out or get his or her head trapped between the bars. - If you buy a second-hand cot or are given one from a friend or family member, you can check the important measurements yourself: the cot should be at least 50 cm deep to make sure your baby cannot climb out and bars should be vertical with spacing of 4.5 cm to 6.5 cm between them. - Cots should be on a firm stand and any swinging mechanism should be lockable. - Look for a cot mattress that is smooth, firm and fits the cot there should not be a gap of more than 4 cm anywhere between the edge of the mattress and the bars of the cot. If the gap is bigger than this your baby s head may become trapped causing suffocation. - Remove cornerpost extensions and discard them to prevent suffocation by hanging. Some may be removed merely by unscrewing, while others may have to be sawed off and sanded smooth. 20 Consumer Product Safety Commission, Some Cot Cornerposts May Be Dangerous, Document #5027, 21 Child Accident Prevention Trust. Keep Your Baby Safe, 2003, information leaflet, 26