Babywalkers

Babywalkers (infant walkers, wheeled seats that allow infants to move around with their feet on the floor) are widely used, by 50% or more of infants.¹ A recent short report in the BMJ showed that babywalkers delayed acquisition of crawling, standing alone, and walking alone.² A brisk correspondence followed, with many respondents picking faults with the study, some supporting continued parental choice, and others welcoming this additional evidence that babywalkers are dangerous (see also p 657).³

JULIE FISHER/BUBBLES PICTURE LIBRARY

Previous reports have suggested that development is affected adversely by babywalkers.^{2 w1-w3} Along with that in the BMJ, these were observational or questionnaire based studies and not randomised control trials. Some inconsistencies exist regarding which milestones were affected, probably reflecting comparatively low numbers of children in the studies, but overall evidence shows significant developmental delays associated with babywalkers. Anecdotal reports note adverse effects from the use of babywalkers in a child with cerebral palsy⁴ and even the development of cerebral palsy-like symptoms in apparently normal children.⁵ No published data are available that imply that development may have benefited, although this is a common reason why parents choose to use babywalkers.¹ Against an effect on development is a small controlled study in 15 pairs of twins, with one twin allocated to a babywalker and the other not, which found no difference in age at walking.⁶ An earlier study from one of the same authors showed apparently adverse electrophysiological changes in six babies allocated to a babywalker compared with their twin controls.⁷

For injuries the evidence is even stronger. Injuries with babywalkers are common, if usually minor. However, deaths and serious injuries (skull fracture, concussion, intracranial haemorrhage, fractures of the cervical spine, and other fractures) occur. These are particularly associated with falls downstairs, which are the commonest cause of babywalker related injury.¹ Poisoning and burns are other risks.^{w4, w5} A rate of 8.9 injuries needing attendance in emergency departments per 1000 children less than 1 year of age and 1.7/1000 for serious injuries has been reported.⁸

Can preventive interventions help? Programmes to educate parents have proved disappointing.^{9 w6} Uncontrolled mobility—up to one metre per second—is the major hazard. Most accidents occur while the child is under supervision, often with an adult in the same room.¹ Recent voluntary standards introduced in the United States recommend that babywalkers be manufactured wide enough (more than 36 inches; 91 cm) not to pass through doors; it is hoped that this will prevent children tumbling down steps on to, for example, a concrete floor in the cellar. Braking systems designed to stop the walker toppling if one wheel loses contact with the ground (for example, over the edge of stairs) are also recommended, but evidence shows that they may not work.¹⁰

What else can be done? Babywalkers have been banned in Canada, although many families still import them.¹¹ The American Academy of Pediatrics recommends a ban on the manufacture and sale of the products.⁹ Stationary activity centres providing tilt, rotation, and bounce are suggested as an alternative to wheeled machines and are likely, if not confirmed, to be safer.⁹,¹² The shown risk for injuries, together with apparent adverse effects on development and lack of other benefit, makes a very strong case for a general ban on babywalkers.

Letters p 657