Walking into danger

One of Ireland's leading paediatricians has called for a ban on baby walkers, but he reckons it could be 10-15 years before it happens. How many more babies will be injured by then, asks SHEILA WAYMAN

BABY WALKERS are potentially the most dangerous piece of nursery equipment a parent can buy, according to child safety advocates. What’s more – contrary to the belief that they help children to learn to walk – research suggests they may actually delay walking.

When one of Ireland’s leading paediatricians, Prof Alf Nicholson of the Children’s University Hospital, Temple Street in Dublin, last month called for a ban on baby walkers, his aim was to “signal the issue” in this country and the reaction, so far, has been all positive, he says.

A baby walker – a seat surrounded by a rigid frame which is set on wheels – is certainly a popular nursery item for children aged between five and 15 months. “But it does not have to stay that way,” he says.

“You can debate it endlessly, but if you can honestly say, although a very popular item, this is not going to improve your child’s chances of walking faster, it may actually delay it and is potentially dangerous, why are we persisting with it?”

In Canada, baby walkers have been banned since 2004, but Nicholson reckons it will probably be at least 10-15 years before such a move is made here – and then it would most likely be on the foot of a European directive, he suggests, rather than Ireland taking the initiative.

In the meantime, he encourages parents and caregivers to opt for safer alternatives, such as a play pen or stationary activity centre.

Most parents who use baby walkers believe they are a safe place to put a child and keep him or her entertained while they get on with doing things close by. They also think it will hasten that cherished milestone – the first step.

However, babies who used walkers are slower to crawl, stand alone and walk unaided than babies who did not use walkers, according to a UCD study referred to by Nicholson and colleague Dr Adrian Murphy in an article they co-authored for the current edition of the Irish Medical Journal, outlining the case against baby walkers.

But it is the “highly increased risk” of head injury, burns, scalds and poisoning while using a baby walker that most concerns paediatricians. In his work at Temple Street, Nicholson sees the results of accidents that have happened when babies were in a walker.

Data on child injuries from nine European countries collected from 2002-2007 showed that more than 90 per cent of baby walker injuries are to the head, with 31 per cent of them causing brain injury and 35 per cent causing skull injury.

Research in Wales showed that a quarter of babies hospitalised with burns and scalds had been in a baby walker.

As chairman of the European Academy of Paediatrics Accident Prevention Group, Nicholson sees gathering momentum against baby walkers among his European colleagues. The American Academy of Paediatrics has also called for a ban; it described them as “dangerous” and urged people to throw them out.

Undoubtedly some parents in Ireland have been aware of the questions being raised internationally over the wisdom of using walkers. Yet many others swear by them.

Earlier this year, a “poster” on the magicmum.com discussion forum said she was getting split advice on baby walkers – half saying they were brilliant and the other half advising against – and she asked what other people thought.

The majority of the replies came from mothers who were enthusiastic about them, with comments ranging from “amazing little invention” to “I would be lost without it”. “They really are great fun for babies and give them a great sense of freedom,” said one.

Only one contributor advised strongly against getting one: “No, no and some more from the NO camp,” she wrote, adding that there was no need to give a baby an “aid” that was also a potential hazard.

Babies do enjoy walkers – up to a point, agrees Nicholson. “It does keep them entertained; they can see a bit more and move around a bit more, that is attractive.” The thrill – and the danger – is their new-found fast mobility. (Indeed, I can remember the look of glee on my first child’s face as he whizzed around in one.)

It is estimated that a baby can travel a metre a second in a walker, so even when an adult is watching, accidents happen – a mug of hot tea is pulled down off a table in a blink of an eye or the walker topples over something.

As a parent supervising a child, it is impossible to give 100 per cent concentration all of the time, says Nicholson. Your phone goes off, the doorbell rings, you are distracted for that moment or two . . .

A new European standard for baby walkers was introduced in 2009, stipulating that they must be too wide to fit through a standard doorway and have a mechanism to stop at the edge of a step.

It remains to be seen what effect this will have, but it will not prevent injuries caused by pulling down dangerous items or colliding with objects

In response to the paediatrician’s call for a ban, the National Consumer Agency says: “As far as product safety legislation is concerned, baby walkers which comply with the relevant standard, which is EN 1273:2005, are considered to comply with the General Product Safety Directive and therefore are not an unsafe product.”

Some sellers of nursery equipment report a steady demand for baby walkers, while others have noticed a drop-off and at least one, Tony Kealys, refuses to stock them.

Its managing director, Paul Kealy, explains how some years ago a nurse from one of the children’s hospitals told them they were a dangerous piece of equipment, and they did their own research and saw that child safety advocates were advising against them.

He does not accept the argument put forward by the manufacturer of baby walkers, that it is not the piece of equipment that is dangerous but the lack of parental supervision. And safety standards are not necessarily best practice, he points out.

Kealys has lost “thousands of sales” of baby walkers, as an estimated 20,000 are sold here every year, he says. There are always people coming into their shops asking for them, but they offer a stationary child entertainer instead – similar in looks and style but without the wheels.

“We try to educate people and let them know that some products are not the best thing,” he says. “Unfortunately, some people don’t want to know; they think you are preaching to them.”

He recalls one customer protesting that he had been in a baby walker as a child and he was fine. Then a customer behind him said: “Well, I was also in a baby walker and if you want I can show you my chest where I have a scar from where I pulled a deep-fat fryer down on myself!”

The first customer retorted that obviously the man’s parents had not looked after him properly and left the store in a huff.

A significant drop-off in demand for walkers has been noticed by Martin Murphy, co-owner of the family business that used to run a pram shop on High Street in Dublin, and now operates in Rathcoole, Co Dublin, with another shop due to open in Gorey, Co Wexford, shortly.

“Some people like the idea of them – it really depends on the parents. People do buy them, but they are definitely not as popular as they used to be.” He estimates they are selling nearly three times as many stationary activity centres as walkers now.

Evelyn Garvey, who started Bellababy in Galway three years ago and recently opened another outlet in Dundrum Town Centre, sees a steady demand for baby walkers.

She believes there has been awareness for some time among customers about question marks over walkers and her attitude is, “If you don’t want one, don’t get one”.

As a mother of two children, now aged two and four, she has used walkers herself.

“It was useful when they were at a stage when they couldn’t walk and wanted to be upright,” she says, adding: “I did not have door saddles they could trip over.”

DANGER: NURSERY EQUIPMENT AHEAD

Reducing unnecessary risks of serious injuries to children in day-to-day living is a continuous process.

For instance, years ago nobody had fireguards and children ran about in flammable clothing – resulting in terrible cases of burns, points out Prof Alf Nicholson, consultant paediatrician and RCSI Professor of Paediatrics at Children’s University Hospital, Temple Street.

Likewise, using car seats for babies and young children has helped to save up to 15 young lives a year in Ireland and greatly reduce injuries.

However, more children over one year of age die of injuries than of all illnesses combined.

Some 85 children died in the Republic due to injury or poisoning in 2009, of whom 18 were aged one to four, according to the State of the Nation’s Children report published last December.

When child safety report cards on 24 European countries were published for 2009, Ireland’s overall performance was rated as “fair”. We failed to make it into the top 10 whose performance was rated as “good”.

“Road safety is all about enforcement, home safety is all about education and reducing hazards,” says Nicholson. “You can childproof your home without too much expense and the wise people do.”

The use of stair gates, window locks, socket covers, door slam stoppers, corner cushions and cupboard catches where dangerous items are stored, all help to make the home a place where children can explore without getting into serious trouble.

Parents should not be so paranoid that they restrain children from enjoying vital, physical play.

Minor injuries are a normal part of growing up, stresses Nicholson. “What you want to avoid is the significant head injuries, the poisonings, the drownings and the car-related injuries.

“It is more than just baby walkers,” he adds. “It is a bit more thought to how we want to mind, but not cosset too much, our precious children.”

While the European Child Safety Alliance recommends that parents do not use baby walkers at all, it also alerts people to the hidden hazards of other items of nursery equipment that are widely used but have been shown to cause either frequent or severe injuries. These include:

BATH SEATS/RINGS:Babies can slip out of a seat or the suction cups that attach to the bottom of the tub may suddenly release, allowing it to tip over. The main danger is that they can lull parents into a false sense of security, making them believe it is okay to leave the child alone for a minute.

These items are bath aids, not safety devices, and it is essential to be at arm’s distance from your baby at all times.

CHANGING TABLES: Most injuries occur when children fall from the changing table to the floor – although the alliance's Child Product Safety Guide recounts the case of a 10-month-old boy who fell out an adjoining window when left standing on a changing table for a moment. Again, it is essential to keep within arm's reach at all times. The safer alternative is to change the child on the floor.

STAIR GATES:Avoid accordion-style safety gates as children's heads can become entrapped if they try to crawl through or over them.

A gate which operates by using an expanding pressure bar, and is not bolted to the wall, should only be used at the bottom of the stairs as it is more likely to tip over if a child pushes against it, causing a fall down the stairs.

For more information, see childsafetyeurope.org

CAR SEATS: GETTING IT RIGHT

Car seats have been compulsory for babies and young children in the Republic since 2006, but the Road Safety Authority (RSA) estimates that in nearly three out of four cases, the seat is being misused: either it is not right for the child or wrong for the car, or it is not fitted properly.

When buying a car seat, says RSA communications manager Brian Farrell, parents should only go to a retailer who is prepared to check that the car seat fits your car and that the child is compatible with the seat.

The Isofix system, whereby metal rods on a child seat click into the chassis of the vehicle, is safest and eliminates the possibility of misrouting the seatbelt when trying to secure the seat. However, only newer cars have Isofix fittings and the compatible seats are more expensive.

As well as finding a high level of incorrect use of car seats at its “check it fits” road shows, the RSA also reports that, based on annual observational surveys, in three out of 10 cars, children are not strapped in – they may be in a car seat, but they are not belted.

There is also a tendency for parents to upgrade their babies from rearward-facing to forward-facing seats too early. “Keep your kids in rearward-facing seats as long as you possibly can – in line with the recommendations of the seat manufacturer,” says Farrell and, likewise, keep young children in a booster seat as long as you can before moving to just a booster cushion.

The American Academy of Pediatrics issued guidelines in March advising parents to keep babies and toddlers in rearward-facing seats until they are two. In Sweden, it is normal practice to keep children rearward facing in cars up to the age of five.