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 November 2007

Jamie Schaefer-Wilson is a consultant and campaign organizer for Consumers Union. She serves on several juvenile products committees for ASTM International. Schaefer-Wilson works with the nonprofit Kids and Cars and is a certified child passenger safety technician. She is also author of The Baby Rules: the Insiders Guide to Raising Your Parents and has been featured in newspapers and magazines including American Baby, Pregnancy, Consumer Digest, Woman's World, Working Mother and Parent Guide.

Joan Muratore is a program leader in the baby and child products department of Consumers Union, publisher of Consumer Reports magazine and ConsumerReports.org. She serves on several juvenile products subcommittees for ASTM International. Muratore has been testing and rating products of all kinds, from baby products to personal care and more, for more than 20 years.


2007 ASTM International Advantage Award Second Place

The Effectiveness of the ASTM International Standard for Infant Walkers in Reducing Injuries and Fatalities

by Jamie Schaefer-Wilson and Joan Muratore

Baby walkers have been used for decades by parents and caregivers who hope to help babies learn to walk, and to keep the child entertained while safely contained. The problem: babies in walkers can move very quickly, often so quickly that they can come to harm before a caregiver, even one in the same room, can get to the child.

Since 1973, baby walkers have been associated with 34 deaths. There were a large number of injuries; for example, U.S. Consumer Product Safety Commission data collection shows that in the United States between 1990 and 2001, there were an estimated 197,000 walker-related injuries to babies aged 15 months or younger (the recommended age group for walker usage) who were treated in hospital emergency rooms. About 79 percent of the incidents involved children who fell down stairs or between levels in a baby walker.

After a period of fairly steady annual increases, the average number of walker-related injuries remained fairly constant from 1990 to 1994, at about 23,000 per year.

By 1991, baby walkers were responsible for more injuries annually than any other type of nursery product, with more than double (in fact, nearly triple) the injury rate for strollers, the next most injurious nursery product. According to CPSC data, in 1991 there were an estimated 27,000 emergency room treated injuries for baby-walker related incidents, compared to 10,400 injuries related to strollers. The majority of these injuries were due to stairway incidents. By contrast, in 2004, seven years since stationary activity centers (SACs) were introduced to the marketplace and 10 years after the revised, tougher ASTM International walker standard was implemented, the number of annual injuries for walkers and jumpers was 3,900. There were more injuries involving several other groups of "nursery equipment" products, such as carriers and car seats, strollers, cribs and high chairs.

Attempted Solutions
Over the years, safety organizations and manufacturers attached warning labels to products and informed parents to install gates, keep walkers away from stairs and keep doors leading to stairways closed, but this educational campaign did not lead to a dramatic decrease in incidents. The injury data remained virtually unchanged from year to year and deaths increased. The baby walker was facing possible demise as an infant product and it became very clear that in order for this product to remain on the market, it would need to be manufactured in a way where even misuse or a potentially dangerous environment would not lead to serious injuries and a deleterious outcome.
In 1992, safety organizations decided to take matters into their own hands and the Consumer Product Safety Commission was petitioned to ban baby walkers by the American Academy of Pediatrics, Consumer Federation of America, Consumers Union and the National Safe Kids Campaign. However, approximately eight months later the petition was denied by CPSC.

The November 1992 issue of the American Academy of Pediatrics News noted that the Juvenile Products Manufacturers Association was against the ban: "JPMA believes that if a person purchases a ˜JPMA Certified' baby walker (one that has passed the tests for compliance with the voluntary standards) the fall hazard is greatly reduced or eliminated. And if the baby walker meets the standard, it also will have obvious warning labels ˜do not use near stairs,' etc."
This view would later change when the JPMA, CPSC and ASTM International worked together to create revised standards, but for now, parents were again told to install gates, read warning labels, and to keep walkers away from stairways and doors closed to prevent stairway falls, but it would soon become apparent that this was not enough. Unfortunately, once a walker begins its tumble down a flight of stairs, there is no way for the child to stop its descent and often times their body strikes the stairs or railing two and three times and they suffer multiple bruises and abrasions.

The Danger
The following incidents illustrate the danger, deaths and severe injuries that were being sustained in baby walkers:

  • 1988: A 10-month-old boy died after falling down an unprotected stairwell while using his baby walker. Cause of death: severe head injuries.

  • 1989: An 11-month-old boy died from injuries sustained during a fall down "some steps" in a baby walker.

  • 1990: A 1-year-old girl died when her walker fell down five steps.

  • 1991: A 6-month-old boy died after getting through a fence and falling into a swimming pool while in a baby walker.

  • 1992: A 9-month old boy fell down a flight of stairs in his home, repeatedly hitting his head on the wood supports of the hand railing. This resulted in a growing blood clot on the brain and emergency surgery.

  • 1993: A 10-month-old girl suffered a skull fracture and an epidural hematoma while using her baby walker and falling down concrete steps in her parent's backyard. The walker tipped over, causing her to hit her head on the concrete. The injury required a craniotomy with blood transfusions.

In 1994, the industry began to offer a new, safer alternative to baby walkers: the stationary activity center. SACs are similar to walkers, but without the wheels. They allow a child to swivel, bounce and rock, and many have elaborate toy bars and other attachments to keep the child busy and entertained. The lack of mobility adds to the safety of SACs.

The ASTM International Standard
The first version of the ASTM International standard for infant walkers - F 977, Consumer Safety Specification for Infant Walkers - was adopted in 1986; its main concerns were tip-overs and structural failures. In 1994, the CPSC deemed there to be an "unreasonable risk of injury and death associated with baby walkers." This same year, the government began steps toward rulemaking under the authority of the Federal Hazardous Substances Act and initiated the first steps toward creating a mandatory standard. The CPSC even commented that if "no feasible performance or design requirement will adequately reduce the risks associated with baby walkers, the Commission can consider other alternatives." It was clear that action needed to be taken or the product that had seen so many injuries and deaths could be pulled from the marketplace, but the question remained: would such action actually be taken and, if so, would it be enough to change the incident data and the injury trends that were being seen?

ASTM International Committee F15 on Consumer Products spent the next two years strengthening the already existing voluntary standard for infant walkers; the additions and revisions addressed ways to ensure that walkers would no longer be so prone to tip-overs and stairway falls. This reflected the injury data: stairway falls were responsible for the largest numbers of serious injuries, while tip-overs were another significant injury mechanism. Another problem and mechanism of injury was that a child in a walker would have increased mobility and speed, allowing access, in some cases, to hazards like oven doors, hot and/or heavy objects that he could pull down on himself, and poisonous substances that he could ingest.

The revised, tougher version of F 977, issued in 1997, covered all walkers manufactured after June 30, 1997. In sum, baby walkers must either be too wide to fit through a standard (36-inch [0.91-m]) doorway, with the 36-inch rationale being that the majority of the incidents involving doorways were with doorways 36-inches [metric] or less in width, or the walker must incorporate gripping features to stop the walker at the edge of a step, thus preventing falls down stairs.

Incorporated in this standard is a test to simulate a child walking across the floor, through a doorway and to a stairway. While conducting this test, the walker, when tested in forward, backward and sideways orientations, must stop at the edge of the test table, or fail the test. If the walker extends over the edge of the table, a tip-over test is performed, which it must pass to meet the requirements in the standard.

It appeared that the standard could now prevent the most common mechanism of baby walker injuries. Now it was up to the data to prove whether or not the standard was effective. Would walkers continue to lead the marketplace as the juvenile product with the largest number of injuries?

Improved Safety
In 2001, CPSC received its first two reports of baby walker related deaths since 1997. After further investigation, it was determined that both children were using walkers that were manufactured before the effective date of the revised ASTM walker standard. The use of "old" walkers or walkers that did not meet the new standard would continue to be a problem.

In 2002, CPSC found that there was no longer "an unreasonable risk of personal injury" due to stair falls and that "currently available information demonstrates that the existing voluntary standard adequately reduces the risk of injury associated with the use of baby walkers: Testing had demonstrated that walkers complying with the voluntary standard are unlikely to fall down stairs."

Due to the fact that the market share for this particular juvenile product was largely controlled by five large manufacturers and all were complying with the new voluntary standard, the CPSC felt there would be "substantial compliance with the voluntary standard in the future." As a result of the success of the voluntary standard and the fact that there was compliance within the industry, the CPSC ended the proceeding for regulatory action for baby walkers. Now the task of policing these manufacturers and others would become the next phase in ensuring the safety of children through compliance with the voluntary standard.

While U.S. manufacturers and importers have found the standard effective, the Canadian government has banned the sale of baby walkers. The belief in this standard is supported by the JPMA in forms of certification only for baby walkers that pass compliance tests for the revised voluntary standard. In 2003, the JPMA filed opposition to the ban and even requested Canadian officials to defer to the voluntary standards. The request was denied and the Canadian ban is still in place, while the U.S. has stepped up its commitment to ensure only walkers that meet the new standards are in the marketplace. The JPMA currently certifies only walkers that meet the new revised standard and currently these five manufacturers receive JPMA certification for their baby walkers: Baby Trend Inc., Delta Enterprise Corporation, Dorel Juvenile Group, Graco Children's Products Inc. and Kolcraft Enterprises Inc.

The CPSC has not endorsed such a ban in the United States, although organizations such as the American Academy of Pediatrics continue to push for one. In December 2005, however, CPSC implemented a policy that effectively makes the voluntary walker standard mandatory. It told importers, manufacturers, distributors and retailers that any baby walker that failed to have the stair fall protection would be considered a "substantial product hazard" and subject to a recall. Taking a bold step, in an effort to ensure that the new safer walkers reach the marketplace, CPSC reached out to manufacturers to meet the standard.

In December 2005, the Director of the CPSC Office of Compliance, John Gibson Mullan, wrote a letter urging them "to make certain that all baby walkers (they) import, manufacture, distribute or sell in the United States comply with all applicable federal requirements and voluntary safety standards." Mullan quantified this reasoning citing the statistics. He explained the drop in injuries from 25,700 in 1992 to 3,200 injuries in 2003 - "an 88 percent reduction" - and states that "the CPSC compliance staff considers baby walkers without stair-fall protection to be defective and to present a substantial risk of injury to young children."

Mullan's letter was an important milestone in the business of safety standards because in effect he stated that CPSC will recall any product that does not meet this voluntary standard. He is very clear about the action that will be taken: "Should the staff encounter such products, it will seek a recall of these products from the marketplace. There is no persuasive reason for baby walkers to be manufactured without stair-fall protection since products with stair-fall protection have been on the market for many years. In view of the foregoing, I urge you to review your product line and assure that you manufacture, import, distribute and sell only baby walkers with stair-fall protection. The CPSC staff will continue to follow up as appropriate to assure that firms are meeting their obligations in this area."

As an example of the CPSC's diligence and the acceptance of the revised standard, they have recalled several walkers that did not meet the new requirements. In each case, the recalled walkers would fit through a standard doorway and/or were not designed to stop at the edge of a step. The CPSC made it very clear with each recall that babies using these walkers could be seriously injured or killed if they were to fall down a flight of stairs. The table illustrates the recalls due to this hazard since the inception of the new, tougher ASTM standard F 977 in 1997.

The Statistics
Since the implementation of the revised standard incorporating stair fall protection, there have been a total of eight baby walkers recalled by eight different manufacturers by CPSC because the walkers did not meet this voluntary standard. This resulted in over 94,000 baby walkers recalled, due to their posing potential hazards of significant injury or even death. This constitutes evidence that this ASTM standard, F 977, has been shown to be so effective that it is treated as mandatory.

After the inception of the revised standard, the CPSC sent out a press release speculating that walker-related injuries would have risen to "as many as 32,000 in 2002." CPSC then projected that walker-related injuries would decrease to less than 10,000 by 2002. In actuality, according to NEISS data, there were approximately 5,000 walker-related injuries in 2002. These injuries continued to decline fairly steadily over the next few years to a low of approximately 3,300 in 2005.

Figure 1 illustrates the significant decline in the number of injuries per year since the adoption of the revised ASTM F 977 standard, which addressed the problem of stairway falls.

Figure 2, which shows the number of injuries sustained by children in baby walkers when they suffered a stair-related fall, gives further indication of the effectiveness of the revised ASTM F 977 standard in reducing such incidents. The numbers decreased dramatically from a high of approximately 19,000 injuries in 1991, to a low of about 2,000 in 2001.

These drops in injuries and deaths can be attributed to both the revised ASTM baby walker standard and to the fact that many consumers are choosing stationary activity centers over walkers. The use of SACs has effectively decreased the exposure of babies to infant walkers, while the implementation of the revised, tougher ASTM standard for walkers has been associated with a noticeable decline in the number of stairway fall injuries compared to other injury mechanisms associated with walkers. It is due to both of these developments that we have seen a dramatic decline in deaths and injuries.

Although CPSC's choice to enforce the voluntary standard as a mandatory one has proven very effective in reducing injuries, and though SACs provide a safer alternative to baby walkers, there is no way to prevent a parent or caregiver from keeping and using an older, unsafe walker. CPSC has issued bulletins on the dangers of walkers, and the AAP continues to press the U.S. government to ban them altogether, as Canada did in 1994, but there is no way to force parents and others to throw out existing older walkers that don't meet the revised walker standard, and potentially pose such hazards.

Walkers and SACs continue to see revisions and new product design that allow a child some independence and mobility yet safety at the same time. Recently, Kids II introduced the "Bright Starts Around We Go," which has an activity center in the center of the product, and a walker attached to the outside of the product. Since both products are attached, when the child is placed in the movable seat he can only walk the perimeter around the activity center, thus combining the usefulness and resourcefulness of both a walker and the SAC.

Educational announcements should emphasize that parents cannot use a baby walker as a baby sitter. The parent must always be there in the room with their child and, as many stairways have wider than average openings, they need to take every precaution to prevent walkers from getting near a stairway or edge of a step. Additionally, children can still find themselves in harm's way if they wheel the walker up to an appliance such as a stove or a hot iron, or to other hidden hazards such as a curtain, tablecloth or light fixture.

A standard can only go so far to reduce the number of accidents and injuries; the rest is up to those who use the product: parents and caregivers. A child should not be left to his own devices in any juvenile product, and not merely because there could be a danger of a product failure or an unforeseen hazard. Even when a product meets standards, whether voluntary or mandatory, environmental factors can come into play and it only takes a few seconds for a child to find themselves in harm's way.

In order to ensure that children are safe, we need safe products, tough standards and close parental supervision. A tough standard, such as ASTM F 977, can and does go a long way to protect our children, and to give consumers confidence that if they put their child in a product, it will not fail, tip, collapse or cause injury in some other way. //