Alarmed by rising injuries and deaths, pediatricians are recommending that parents avoid placing their children in shopping carts until safer models are available.

In 2005, more than 24,000 children were treated in U.S. hospital emergency rooms for shopping cart-related injuries. Most of these injuries occurred when a child fell from a shopping cart, the cart tipped over, the child became entrapped in the cart, or the child fell while riding on the outside of the cart, according to the new policy statement issued by the American Academy of Pediatrics (AAP).

Injuries to the head and neck accounted for 74 percent of shopping cart-related injuries among children younger than 15. Of the 4 percent of children treated in an emergency room for a shopping cart injury, more than 93 percent were under age 5.

With the potential instability of some existing shopping cart designs, and because it is difficult for a parent to easily ascertain a cart's safety simply by looking at it, parents should carefully consider the potential for injury before placing a child in a shopping cart, according to the policy.

Instead of putting children in shopping carts, parents can try one of the following alternatives:
• Get another adult to come with them to watch the children while shopping.
• Put children in strollers, wagons, or frontpacks instead of in shopping carts.
• Ask older children to walk and praise them for behaving and staying nearby.
• Leave children at home with another adult.
• Shop online if local stores offer shopping on the Internet.

If a parent chooses to place a child in a shopping cart, he or she should ensure that the child is properly secured in an effective and age- and size-appropriate belt or harness.

Parents and caregivers should never:
• Leave a child alone in a shopping cart.
• Allow a child to stand up in a shopping cart.
• Place an infant carrier on top of the shopping cart.
• Allow a child to ride in the basket.
• Allow a child to ride on the outside of a cart.
• Allow an older child to climb on the cart or push the cart with another child inside.

To help parents, the AAP recommends that businesses adopt shopping cart safety strategies and offer other assistance to help prevent injury.

This may include providing a supervised in-store child-play area; a pick-up area or assistance in bringing purchases to a vehicle; cart modifications to improve child restraint and cart stability; strollers or wagons for in-store use; education and warnings about cart dangers; and/or customer incentives, such as stickers or other give-aways, to reward safe shopping cart behavior.

In addition, the AAP recommends that the current U.S. safety standards for shopping carts be revised to include "clear and effective performance criteria" for child-restraint systems and cart stability to prevent falls and injuries due to cart tip-overs.

The U.S. Consumer Product Safety Commission should monitor and enforce manufacturer compliance closely, and regularly review child shopping cart-related injuries, according to the new policy.

The AAP recommends that child health and advocacy professionals support revised manufacturer standards, and educate parents, families, the public, and the media on shopping cart risks.