This article is part of “Death by Delay,” a series on how consumer product hazards have cost lives.
The Consumer Product Safety Commission staff on Wednesday recommended the first federal requirements to make nursing pillows safer and discourage caregivers from setting babies down on the pillows to sleep, citing dozens of deaths associated with the popular infant product.
The staff recommended requiring nursing pillows to be “sufficiently firm that the product is unlikely to conform to an infant’s face,” to reduce the likelihood of babies’ suffocating. The staff also recommended that the U-shaped pillows have openings wide enough to avoid restricting infants’ head movements, which could cut off airflow.
“Because infants frequently fall asleep during or after feeding, nursing pillows are foreseeably misused for infant sleep, which creates a potential hazard for the infant,” according to the staff’s draft proposal.
The CPSC staff also proposed requiring prominent labels warning caregivers about the product’s hazards. Most nursing pillows already have warning tags that caution against using the products for sleep or leaving infants unsupervised on them, but they should be more visible and more difficult to remove, unlike the hanging warning tags currently attached to many nursing pillows, the draft proposal said.
In addition, the staff recommended that nursing pillows not include straps to secure babies, which could lead parents to believe it’s safe to leave infants alone in the products.
The recommendations come just over two weeks after an NBC News investigation found that at least 162 babies have died in incidents involving nursing pillows since 2007. Most of the infants died after they were placed to sleep on or with the pillows.
The CPSC staff cited 154 deaths involving nursing pillows from 2010 to 2022, including deaths caused by suffocation, asphyxia and sudden infant death syndrome. In 2020, the most recent year for which the agency had complete data, 38 deaths were associated with nursing pillows, the CPSC said.
The CPSC’s four commissioners are expected to decide whether to adopt the recommendations next month. If the commission moves forward with the proposal, the public will have the opportunity to provide feedback before it is finalized and goes into effect.
"Thousands of infants die each year in their sleep, and it’s a myth that all of those deaths are inexplicable," CPSC Commissioner Richard Trumka Jr. said in a statement to NBC News. "When products contribute to infant deaths, I believe it’s CPSC’s duty to eliminate that risk."
The safety recommendations were welcomed by Taylor Wells, a Mississippi mother whose 4-month-old daughter, Autumn, died in March 2022 while she was napping on a nursing pillow at day care, police said. Wells urged CPSC commissioners to advance the staff's proposal.
“This is an opportunity to do something to actually help children and save their lives,” she said. “If they say anything other than we should actually do this, I would be very disappointed.”
Wells said she was particularly encouraged by the idea of a more prominent, permanent warning label cautioning against letting babies sleep on nursing pillows.
“If it’s in an obvious place where you’re forced to look at it, then I think it’s going to make a huge difference,” she said.
Nursing pillows are ubiquitous on baby registries, with 1.34 million sold annually in the U.S., according to industry estimates. The horseshoe-shaped pillows can help position infants so they get the correct latch as they nurse — and they are marketed as essential tools for reducing parents’ neck and shoulder strain as they breastfeed or bottle-feed their babies.
The CPSC staff proposal is likely to face opposition from an industry that has defended the safety of its products, arguing that nursing pillows pose no risk when they are used as intended: while babies are awake and supervised. Manufacturers have advocated for voluntary safety standards that are currently under development, rather than mandatory requirements, and they have funded a lobbying and public relations campaign against federal regulation.
Most nursing pillows on the market would have to be redesigned to meet the recommended standards, the CPSC staff said. The total cost to the industry could reach $13.5 million in the first year, it added. It estimated that raising the retail price less than $5 per pillow could cover the cost of the newly required tests and a significant part of the redesign costs.
The CPSC has long recognized the danger nursing pillows can pose, but it was not until 2020 that it warned consumers that nursing pillows and other similar products “are not designed for sleep and are not safe for sleep.”
Experts say exhausted parents often set their babies down to sleep on nursing pillows or other infant cushions against manufacturers’ warnings — which can lead to deadly situations within minutes. The American Academy of Pediatrics’ safe sleep guidelines recommend that babies sleep alone and on their backs without any loose bedding on flat surfaces, such as in bassinets or cribs.
NBC News’ analysis of 162 deaths was based on law enforcement and medical examiners’ reports, federal data obtained through a Freedom of Information Act request and reports by consumers and local officials that had been reviewed by federal authorities.
The count includes deaths caused by suffocation when babies turned their faces into the plush surface of the pillows or by restricted airways when babies arched backward or slumped down on the pillows. In some cases, the cause of death was undetermined, unexplained or unlisted, but a nursing pillow was mentioned as a potential contributor. In other cases, there was another cause of death, such as respiratory illness, but the nursing pillow was cited as playing a role in the overall unsafe sleep environment. Three incidents involved mothers who fell asleep while they were feeding their baby with nursing pillows and awoke to find their children unresponsive.
Most of the babies in NBC News’ count were less than 4 months old, with the youngest only 3 days old.
The tally of 162 deaths is almost certainly an undercount, as autopsy reports do not always include product details and often are not made public.
