Paediatric Pearls’ “from the literature” series is written by Luton paediatric registrar, Tom Waterfield.  Always inciteful, sometimes wry and eminently readable, this month he shares with us his self-diagnosed neuroses about his new baby son’s sling:

I recently became a first time father and since then my son (Alexander) has turned my life upside down! In the space of two weeks I have morphed from a calm paediatrician into a neurotic and over anxious parent. I often ask myself “is he breathing too fast”, “is he breathing too slowly”, “what was that funny noise” and like all parents I worry about cot death (Sudden Infantile Death Syndrome – SIDS). In the UK the Back to sleep campaign has significantly reduced the risk of SIDS and most parents are now aware of the risks and how to avoid them¹.

Link to Back To Sleep Article & Guidelines (www.medscape.com/viewarticle/781979_2)

Like many parents we own a baby sling and Alex loves it. I was happy with the sling until I read an article from the Telegraph on a recent high profile case of SIDS attributed to suffocation secondary to the use of a baby sling². The case was horrific and triggered the neurotic parent in me. Had I been placing Alex at risk by using a baby sling?

The calm paediatrician in me decided that a quick literature search was required. During that search I found:

1)      In the United States the Consumer Product Safety Commission reported a total of 14 deaths attributed to baby slings spanning a period of 20 years³

• 12 of these deaths occurred in children under 4 months of age
• “many” of the deaths occurred in babies with additional risk factors for SIDS
• 3 deaths occurred in 2010 following use of Infantino baby slings

2)      A Medline search identified three papers (all case reports/case series)^4-6.

• Two articles were only available in Spanish ^5,6
• The third was a case report of two babies (both under 4 months of age) who reportedly died from suffocation after being carried in a baby sling⁶

Summary

From what little literature there is available it would appear that death secondary to use of a baby sling is exceptionally rare. In most cases death has occurred in infants aged less than 4 months who have poor head control and are at risk of suffocation either by direct contact with sling fabric or with extreme neck flexion resulting in airway obstruction. If parents choose to use a sling then they should be encouraged to use them in children over 4 months of age and to be careful to ensure that manufacturer’s guidelines have been followed. Parents may choose not to use slings in children with additional risk factors for SIDS (Prematurity, low birth weight, intercurrent respiratory illness).

References

1)      Hendrie JM, Meadows-Oliver M, Expanded Back to Sleep Guidelines. PediatrNurs. 2013;39(1):40-42.

2)      http://www.telegraph.co.uk/health/10744051/Warning-over-baby-slings-after-five-week-old-suffocates.html (Last accessed 17/05/2014)

3)      http://www.cpsc.gov/en/Newsroom/News-Releases/2010/Infant-Deaths-Prompt-CPSC-Warning-About-Sling-Carriers-for-Babies/ (Last accessed 17/05/2014)

4)      Madre C, Rambaud C, Avran D et al. Infant deaths in slings.Eur J Pediatr. 2013 Dec 18.

5)      Martin-Fumadó C, Barbería E, Galtés I et al. Death by incorrect use of baby sling: multidisciplinary approach to infant injuries.AnPediatr (Barc). 2013 Apr;78(4):271-2.

6)      MaquedaCastellote E, GiliBigatà T, Sánchez Pérez S et al. Infant suffocation associated with the incorrect use of a baby sling.AnPediatr (Barc). 2012 Dec;77(6):416-7.