The Hidden Dangers of Baby Bottles, Pacifiers and Sippy Cups

Toddlers, don't drink and run (or walk): most falls while sucking on a bottle occur around age 1, when children often tend to be taking their first steps.

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They’re synonymous with infancy, but baby bottles, pacifiers and sippy cups may not be as baby-friendly as parents would like.

Between 1991 and 2010, about 45,000 children under age 3 were treated in emergency rooms for injuries due to these products, according to a report in the journal Pediatrics. Most of the injuries were caused by toddlers falling while using them, with 71% of the injuries, including lacerations, mouth-related. Most of these accidents occurred among 1-year-olds, who were more likely to be just taking their first unsteady steps, says Sarah Keim, a principal investigator at the Nationwide Children’s Hospital in Columbus, Ohio and the study’s lead author. Compared to infants under 1 year, these toddlers were 7.6 times more likely to take a tumble and be harmed by something they had in their mouths.

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Perhaps more reassuring was the fact that other sources of injury, including defects in the products, were far less common, especially after manufacturers changed the design of pacifiers to include ventilating holes to prevent choking and asphyxiation.

The study is the first to take a nationwide look at the incidence of injuries related to these commonly used products and show that during the nearly two decades of the trial, the rate of injuries has dropped by nearly 30%. That’s good news, but Keim says parents could be paying more attention to how their toddlers are using bottles and sippy cups to lower the incidence even further. “When parents go to baby-proof homes, especially when infants are more mobile, closer to age 1, they should consider other aspects of the environment in addition to the usual things like putting up baby gates,” she says, “These include things like the products their children are using, and they should think about habits they might want to start with their children, like eating and drinking at the table in order to help reduce injuries.”

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Being aware of children’s changing mobility and physical skills is also important to make sure that infants are moving from bottles and pacifiers to sippy cups or even lidless cups when they are ready. The American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommends that infants transition from bottles to cups without lids after 12 months, and following that advice may also help to reduce some of these injuries, says Keim. In the study, over half of injuries among 2-year-olds involved a bottle, suggesting that a good proportion of toddlers aren’t learning to drink from lidless cups yet. Using cups — because they’re harder to hold — could also help youngsters get in the habit of sitting down or remaining still while drinking rather than moving around, which can increase their risk of falling.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.