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Am Fam Physician. 2002;65(5):959-960

Preambulatory children are often placed in an infant (or baby) walker. The device generally consists of a rigid frame on wheels with an attached soft seat. It allows the child to walk and sit before he or she is able to remain upright. The Committee on Injury and Poison Prevention of the American Academy of Pediatrics studied such walkers and the injuries that can be attributed to them.

In 1999, approximately 8,800 children were seen and treated in U.S. emergency departments for injuries related to infant walkers. There may be many more injuries that did not require emergency care. The most severe injuries described (other than the 34 deaths caused by use of walkers between 1973 and 1998) are usually fractures and closed head injuries. Most injuries (75 to 96 percent) related to infant walkers also involve stairs.

The walkers are used as a means of promoting ambulatory ability, but research shows that children who use walkers demonstrate later sitting, crawling, and walking ability than children who do not use walkers. These effects do not appear to be long lasting, however. The only benefit of walkers seems to be that parents think their children are happier in walkers.

The AAP committee's approach to prevention of walker-related injury has five aspects: (1) education, (2) improved supervision of the child in the walker, (3) environmental modifications (such as stair gates), (4) design changes to the walkers, and (5) a ban on mobile walkers. Even when a child has been injured previously in a walker, 32 percent of parents continue to use the walker; 59 percent of parents reported being aware of the dangers of walker use even before the injury occurred. Since 1997, some changes in walker design have been implemented voluntarily. For example, the walker must be more than 36 inches wide (the width of a standard door) or have a brake that activates if one or more wheels lose contact with the riding surface. Industry compliance with these standards is not known. Many walkers are made by companies that do not belong to organizations mandating compliance with safety standards.

The AAP committee recommends that walker manufacture and sale be banned. If walkers are used, the AAP committee recommends that they meet performance standards, that the risks of walker use be emphasized to parents, and that walkers not be allowed in day care centers or hospitals.

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Copyright © 2002 by the American Academy of Family Physicians.

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