Bathtub Seats No Substitute for Parental Supervision, Study Finds

National Institute of Child Health and Human DevelopmentFOR RELEASE, Monday, October 6, 1997, 5:00 PM Eastern Time, Robert Bock, NICHD, Kathleen Begala, USCPSC

According to an analysis of data collected by the United States Consumer Product Safety Commission (USCPSC), 32 infant drowning deaths involving a bathtub seat occurred from 1983 through 1995. In 29 of these deaths, the infant drowned after being left unattended in the bathtub seat--despite manufacturers' warnings never to leave a child unattended in a bathtub.

The study, published by the American Academy of Pediatrics on the PEDIATRICS electronic pages (http://www.pediatrics.org/cgi/content/full/100/4/el), was conducted by researchers at the Consumer Product Safety Commission, the National Institute of Child Health and Human Development (NICHD), and the Johns Hopkins School of Hygiene and Public Health. The study's first author was Renae Rauchschwalbe of the USCPSC. Co-authors were Ruth Brenner of the NICHD, and Gordon Smith, of Johns Hopkins.

"Over one million bath seats are sold in this country every year," said first author Renae Rauchschwalbe of the USCPC. "We want parents and caregivers to know that they are not a safety device. Never leave your child alone in the tub, whether or not you are using a bath seat."

Infant bath seats typically consist of a plastic ring and three or four attached legs. The infant sits inside the ring, and his or her legs straddle one of the plastic legs. The infant sits either directly on the tub surface or on a rubber mat attached to the legs. Without the need to hold the child up in the water, the caregiver's hands are free to wash and attend to the child. According to manufacturers' estimates obtained by the study's authors, about 1 million of the seats are sold in the U.S. each year.

"Never, ever, leave an infant alone in a tub--not even for a minute," Dr. Brenner of the NICHD said. "Get the towels, clothes and everything you need before you fill the tub. And don't worry about the phone or doorbell. Whoever it is can get in touch with you later."

For the study, the authors analyzed statistics collected by the USCPSC from 1983 to 1995. Initially, 33 drowning deaths, in which a bathtub seat was in use at the time of the submersion, were reported in the U.S. during that time. One death, of an infant who was scalded after turning on the hot water, was not included in the analysis. The age of the children involved ranged from 5 to 15 months, with an average age of 8 months. Most of the deaths (84 percent) occurred between 1991 and 1995, with 50 percent occurring in 1994 and 1995. The children were left alone in the tubanywhere from 1 to 35 minutes, and for an average time of 6 minutes. In all, 11 infants were left in the tub with an older brother or sister, 1 was left with a child the same age, and 17 were left alone. In addition, two children drowned while their caregiver was present. In the remaining case, not enough detail was provided in the investigative report to make a determination on whether the caregiver was present or not.

For the cases in which the caregiver was present, the caregivers reported difficulty removing the infant from the seat after the infant went under water. In one case, the seat tipped sideways with a 6-month old infant in it. In the other, a 15-month old infant became wedged between the legs after sliding down into the seat.

In all, 24 percent of the caregivers left a child alone in the tub so they could answer or make a phone call; 24 percent left a child alone to attend to other children; 17 percent left to get towels or clothes for the child in the tub; and another 17 percent left to attend to household chores.

A label that warned not to leave a child unattended in the tub was present on 28 of the seats; the researchers could not tell if a label was present in the remaining four cases. Based on data from focus groups of 25 caregivers--22 women and 3 men, caregivers are aware of such warning labels, but may ignore them, as similar warnings are present on many childhood products. In fact, focus group participants reported that they would feel more comfortable leaving a child alone in the tub if a child was seated in a bath seat, if the child was in viewing and hearing range, or if there was an older child present.

Dr. Brenner noted that in this study about a third of the infants were left alone in the tub with an older sibling. She emphasized the need for constant adult supervision.

The study authors noted that the youngest age at which an infant should be placed in a bathtub seat is 6 months--about the age when most infants can sit up unassisted. The upper age limit may be based on the age at which children can pull themselves to a standing position, about 8 to 9 months. "In most of the incidents involving infants more than 8 months old," the study authors wrote, "the victim was found separated from the seat, indicating that he/she probably climbed out of the product."

The authors added that a child's motor skills develop rapidly at this age, and parents may underestimate a child's ability to climb out of the seat. In some cases, the seat was reported to have tipped over and in others, the child became trapped under the ring.

"Educational efforts must reinforce the need for continuous adult supervision of infants and children around all bodies of water," the study's authors concluded. "If possible, the telephone should be brought into the bathroom, and all necessary bathing items (soap, washcloth, towels, etc.) should be assembled before placing the infant in the tub."

The authors also urged that all parents and caregivers be trained in basic cardiopulmonary resuscitation (CPR). They added that physicians should remind caregivers that bath tub seats are meant for convenience, not safety, and that they do not substitute for adult supervision.

For more information on this topic, consumers may call the U.S. Consumer Product Safety Commission hotline at 1-800-638-2772.