As 20-month-old Morgan Sherrill reached her arms out to be picked up, her mother Jackie, 26 was not expecting her to fall forward with her bottle still in her mouth.
"Her foot slipped off the couch, and the bottle chipped her tooth," said the Grove City, Ohio, mother. "She was in a lot of pain because she cut her lip as well and she was bleeding.
"It never occurred to me that this injury could happen from a bottle, it was hard to believe that this could happen. The chip was right in front and you can still see it."
Every four hours a child under the age of 3 is treated in the Emergency Department for an injury caused by a bottle, pacifier or sippy cup. Previous studies had focused on choking and burns caused by these products. But a new study published Monday in the journal Pediatrics has shown that a range of injuries can occur, especially injuries to the mouth.
"Our study team was interested in doing this study because we recognized that almost every child in the U.S. uses all of these products on a daily basis at some point during infancy or early childhood," said Sarah Keim, principal investigator in the Center for Biobehavioral Health at The Research Institute at Nationwide Children's Hospital in Columbus, Ohio, and a researcher on the study. "We noticed that there was really no research about injuries associated with these products, aside from a handful of case reports about severe burns from overheated bottles and asphyxiation or ingestion of pacifier parts."
Keim and her colleagues at Nationwide studied 20 years of data and found that around 2,000 children each year are treated in the emergency room for injuries from these products. Children younger than 3 were usually hurt when falling while these objects were in their mouths.
If there is a silver lining, Keim said, it is that the number of injuries has been on the decline in recent years compared to years past -- though it is hard to say exactly why.
"It could be [that] children are using the products less, the products are somehow safer, or the injuries are less severe and so don't arrive at emergency departments for care," she said.
Still, the idea that bottles and sippy cups could be leading to these injuries at all may be surprising to parents.
"Everybody uses them, so we automatically assume that they are safe -- but are they really?" said Dr. Deborah Lonzer, chair of the department of community pediatrics for the Cleveland Clinic Children's Hospital in Cleveland, Ohio. "This study shows that they may not be as safe as we think that they are."
Children around age 1 were most likely to be injured, probably because kids are learning to walk, climb and run around this time. Boys were most likely to suffer cuts to the face while girls were more likely to break or chip their teeth.
Lonzer said many of these injuries may be avoided if parents switch their kids over to regular cups sooner.
"The American Academy of Pediatrics has been saying, 'Get rid of bottles and go straight to regular cups at a year,' and the American Academy of Pediatric Dentistry agrees," she said. "That's always been really to avoid cavities, but now we know if you go straight to an un-lidded cup you can also prevent a significant number of injuries in these kids."
Parents should also pay particular attention to avoid using these products while walking or running to ensure safety as well as supervising children when using these products.
"I'm just glad that she didn't hurt herself worse," Jackie Sherrill said. Morgan, now 22 months, now only uses her bottle under her mother's watchful eye. And Jackie Sherrill encourages other parents to follow suit.
"Have the kids stay in the kitchen or wherever they eat their meal," she said. "That's what we do now."