A 9-month-old male came to clinic for his health supervision visit. He was developing and growing well. His mother was concerned that as winter was coming on that his room temperature was too cold. “We were thinking about buying a space heater to keep it warmer in there. What do you think?” she asked. The past medical history showed a previously full-term infant with no health issues.
The pertinent physical exam revealed a smiley infant with growth parameters in the 50-90% and normal vital signs. He had some general dry skin on exam. The diagnosis of a healthy male with general dry skin was made. The pediatrician discussed a variety of winter safety and health issues with the family including the use of emollients for dry skin. The pediatrician told the mother that he was concerned about the space heater use because of the increased risk of fire and burns that space heaters could cause. He recommended that they use an infant sleep sack along with a sleeper for the child if they were concerned about the temperature. “Babies do just fine with one extra layer of clothing than adults. That is true when sleeping also,” he said. The pediatrician also reviewed back to sleep with the mother but acknowledged that the child by this age probably was finding his own comfortable sleep position after falling asleep.
Parents have many concerns about their children’s welfare. Recommendations for children’s and other products and how they are properly used change over time with new research and the development of new or products for families. Cultural practices and individual wishes also influence the products parents use.
Safe sleeping environment for infants are important because of the risk of sudden infant death syndrome and because infants spend an even larger proportion of the day asleep than older children and adults. Therefore sleep risks are increased. The American Academy of Pediatrics recommends that infants are always placed onto their backs when sleeping. They should be placed onto a firm surface without any additional soft materials and loose bedding such as additional bedding, bumpers, pillows etc. Room sharing of the infant with the parents is encouraged but bed sharing is not recommended. Overheating is not encouraged. One additional layer for a child than for an adult in the same environment suffices. Using sleep clothing designed to keep the infant warm without the possible hazard of head covering or entrapment is recommended. Parental smoking and drug use are discouraged and breastfeeding and use of a pacifier are encouraged.
Most infants can be kept warm enough using the recommendations above without the use of an additional space heater. Portable space heaters that use combustible fuel such as kerosene or gas have the potential problems of being flammable, producing carbon monoxide poisoning, and producing other indoor environmental air pollution. Venting must be used with combustible fuel heaters if space heaters are used. Stoves that use combustible fuel such as wood, pellets, corncobs etc. have the same problems as portable space heaters. Electric heaters are the only option for non-ventilated areas if they are used. However all types of portable space heaters and stores can cause fire and burns.
If used, space heaters should:
- Be safety-certified. This can be checked at the Occupational Safety and Health Administration here.
- Have an on-off switch that automatically turns the unit off at a certain temperature and if tipped over.
- Have at least 3 feet or more of clear space around the unit – this includes curtains, wallhangings, rugs, papers, bedding, etc.
- Placed on a non-combustible, level surface
- Placed away from any foot traffic
- The cord should be placed directly into the electrical socket with no extension cord used
- The cord should not be placed under objects such as rugs
- Never used in a bathroom
- Never used near a water source
- Never used while sleeping or otherwise unattended
- Use only when an adult is awake and can monitor the unit
- Regularly checked for any damage to the unit, cord and electrical outlet
- Regularly checking the space around the unit
Safety equipment should always be easily available such as fire and carbon monoxide detectors and fire extinguishers.
Questions for Further Discussion
1. When can older children have soft or loose items in their sleeping environment?
2. How often should smoke detectors and fire extinguishers be replaced?
3. What are some recommendations for winter safety for parents? See here for recommendations.
- Disease: Space Heater Safety | Winter Weather Emergencies | Sudden Infant Death Syndrome | Infant and Newborn Care
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Age: Infant
To Learn More
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National Environmental Education & Training Foundation (NEETF). Environmental management of pediatric asthma. Guidelines for health care providers. Washington (DC): National Environmental Education & Training Foundation (NEETF); 2005 Aug. 56 p. Available from the Internet at http://www.guideline.gov/content.aspx?id=10019&search=space+heaters (cited 10/28/14).
Consumer Product Safety Commission. Reducing Fire Hazards for Portable Electric Heaters Available from the Internet at http://www.cpsc.gov/Global/Safety%20Education/Home-Appliances-Maintenance-Structure/098.pdf (cited 10/28/14).
American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Policy Statement. Pediatrics. 2011, October 17. Available from the Internet at http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284.full.pdf+html (rev10/17/11, cited 10/28/12).
Korioth, T. Prevent burns, fires when using space heaters. American Academy of Pediatrics News. Available from the Internet at http://aapnews.aappublications.org/content/33/12/32.6.full
(rev. 2012, cited 10/28/14).
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
4. Patient management plans are developed and carried out.
5. Patients and their families are counseled and educated.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital