Putting the cart before shopping safety

Anyone who has taken a small child to a grocery or big box store quickly discovers the challenges of safely negotiating the aisles with a shopping cart. Typically kids want to slip their restraints, sit or stand in the main part of the cart, hitch a ride on the outside or push their younger sibling through the store. Doing any of those things can lead to a fall and a visit to the emergency room.

The latest emergency-room data underscore the fact that shopping carts can be hazardous to children younger than five. In each of the three years from 2003 through 2005, there were 19,500 shopping cart-related injuries treated in U.S. hospital emergency rooms. More than 80 percent of the injuries were caused by falls from the carts, according to data prepared for the voluntary standard-setting organization ASTM International, and more than 40 percent of the injuries could be judged as potentially serious. Injuries to the head and neck, including concussions, internal injuries and fractures were the most common.

The number of injuries hasn't decreased since 1999, though the latest data are too recent to reflect the voluntary standards that were adopted in 2004. Those standards, designed to cover children between six months and 4 years old, and weighing up to 35 pounds, require adjustable child restraint straps in the child-seating area plus warnings about the dangers of falling out. The voluntary standards also call on retailers to regularly inspect and maintain their carts to make sure they are in compliance.

The American Academy of Pediatrics has called for even stricter standards, particularly to reduce the risk of cart tipovers.  Gary Smith, M.D., who is chairperson of the AAP committee on injury, violence, and poison prevention and director of the Center for Injury Research and Policy at Children's Hospital in Columbus, Ohio, believes carts should be redesigned to put children lower to the ground. That would make them less susceptible to falls as well as serious injuries if falls occur, he said.

But Paul Giampavolo, chairman of the ASTM subcommittee that wrote the standards, says that the data show that tipovers account for only six percent of the injuries, relatively small when compared to the falls that the voluntary standard seeks to address.

We're not here to take sides in this debate. But we are here to remind parents and caregivers to be careful when putting an infant or a small child in a shopping cart.

To reduce shopping cart injuries, AAP has called on  parents to leave their children at home with another adult or stay at home and shop online. That may not be realistic.  So here's our advice: If you do bring your child to the store, always use the cart's seatbelt and never leave a child alone in the cart. Heed the weight limit warning on the cart itself -- and don't allow children to ride in the basket or on the outside of the cart. Also, don't allow your children to reach for items as they pass by; that could make the cart tip.

For infants, some stores now feature carts with the infant seats built in. This is a better option than placing your own infant car seat/carrier into the smaller top compartment of shopping carts; most manufacturers warn against this practice.  It's better to place the car seat/carrier in the large compartment, but we realize that leaves little room for groceries.  A more practical solution for bringing an infant shopping is to wear a soft frontal infant carrier such as the Baby Bjorn Active, or a backpack such as the Snugli Cross Country by Evenflo.  For more on these options see our reports on soft infant carriers and backpack carriers.