A recent national study of ER visits raises a red flag on the rates of cuts and bruises for infants and toddlers and what is causing them…pacifiers, bottles and sippy cups.

Previous research on injuries related to bottle, pacifier, and sippy cup use has largely focused on case reports of infant injuries or fatalities attributed to pacifiers or pacifier parts causing asphyxiation or to bottle warming causing burns.

This study, published online May 14 and appearing in the June issue of Pediatrics. is the first to use a nationally representative sample to investigate the range of injuries requiring emergency department visits associated with bottles, pacifiers, and sippy cups among children aged 0-3 years.

Using a nationwide survey, researchers estimated that more than 45,000 visits to the emergency room between 1991 and 2010 in children under 3 years old were because of injuries related to using bottles, pacifiers and sippy cups.

Most injuries involved children aged between 1 and 2 years who had a bottle and fell and cut their mouth.

“A lot of parents baby-proof their house but don’t ever think about the possibility of an injury related to these products,” said Sarah Keim, a researcher at Nationwide Children’s Hospital in Columbus, Ohio, and lead author of the study.

The American Academy of Pediatrics recommends that parents transition their children from a bottle to a cup between 12 and 15 months of age to avoid problems such as tooth decay. The AAP also recommends weaning babies off pacifiers between 6 and 12 months.

For the study, Keim and her colleagues collected data from the U.S. National Electronic Injury Surveillance System, a network of about 100 hospitals nationwide that record injuries in their emergency departments related to consumer products.

Two-thirds of the injuries were in children between 1 and 2 years. “This is right around the time that kids start to walk and run and aren’t very good at it yet,” Keim said.

About 66 percent of the injuries were related to a bottle, and 86 percent involved a fall.

It is not clear why more injuries were associated with bottles than the other products, Keim said. “There could be something about the products themselves that are potentially more dangerous or that children are using them more.”

Injuries related to pacifiers made up about 20 percent of cases. They occurred most often in children under 1 year old and led to bruising and dental damage. Sippy-cup injuries, which were most common in children older than 2 years, were more likely to affect the head, neck and face.

Keim said it was reassuring to see that choking injuries made up a small portion of overall injuries.

Having children stay seated while drinking may help protect them, the authors said.

To learn more about child product safety, visit Keeping Babies Safe.

(SOURCES: Sarah Keim, Ph.D., principal investigator, Center for Biobehavioral Health, Research Institute at Nationwide Children’s Hospital, Columbus, Ohio; Mark Zonfrillo, M.D., pediatric emergency medicine physician, injury epidemiologist, Children’s Hospital of Philadelphia Center for Injury Research and Prevention, and assistant professor, pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; May 14, 2012, Pediatrics