June 2, 2008— -- Beth Slinger remembers her family's nightly ritual when her son, Reed, was almost 3 years old: story time on the top bunk of his bed. He slept on the bottom mattress, so he considered the top bunk his tree house.
One night, Reed climbed up the ladder quickly and stood up, pretending to be the red Power Ranger. The ceiling fan, which was turned on, struck the right side of his head. His parents caught him before he could fall to the floor.
Reed, who is now 14, didn't need stitches for the cut on his head, and he recovered from the incident without a scar.
"He doesn't remember much, except that the bed disappeared the day after," said Slinger, who lives in Columbus, Ohio.
The Slingers were fortunate. Other parents know all too well that what kids consider a treat or even a toy can be a hazard. Every year, bunk bed injuries require a trip to the emergency room for an estimated 36,000 Americans, ages 21 and younger, according to a study released Monday in the journal Pedatrics.
"Everybody at some point or another has probably slept in a bunk bed," said Lara McKenzie, assistant professor at Nationwide Children's Hospital in Ohio and one of the study's researchers.
McKenzie and her colleagues were not surprised to find that children under 6 suffered nearly half of the injuries, and boys were more likely than girls to get hurt.
But they did take note of the spike in injuries for college-age kids. The 18- to 21-year-olds had double the injuries of the 14- to 17-year-olds, resulting in part from dorm life combined with alcohol use.
Laura Jana, a pediatrician in Omaha, Neb., and spokesperson for the American Academy of Pediatrics, remembers witnessing a bunk bed injury in the 1980s when she was attending the University of Michigan.
"My college roommate freshman year was goofing around and fell off the top bunk," Jana said. On her way down, she hit her back on the corner of a desk, and she couldn't move, so paramedics had to carry her down five flights of stairs on a stretcher, she recalled.
Though bunk beds are a fixture in college dorms and summer camps, nearly 94 percent of injuries in the study happened at home. The most common cause? Falls, at more than 70 percent, including all bthose that were alcohol-related. The head, neck and face bore the brunt of injuries.
In addition, about three-quarters of children and young adults were treated for cuts, scrapes, bruises and fractures. Of these injuries, fractures were the most serious, requiring kids to be held for observation, hospitalized or transferred to another hospital.
In 2000, the U.S. Consumer Product Safety Commission addressed concerns about falls and entrapment by issuing a new set of requirements for bunk bed design, including guardrails around the entire top bunk. The CPSC also outlined specifics to ensure that mattresses properly fit the beds.
Furthermore, the instructions that come with bunk beds must include safety warnings directed at the upper bunk: only one person at a time, use a ladder to get on or off, and no one under 6 years old. "They just really don't have the judgment or the motor skills to get out of the bed at that age," said Nancy Nord, acting chairman of the CPSC.
Because these regulations were instituted somewhat recently, Nord said parents should be sure they know the age of the bunk bed they are buying, especially if it is secondhand.
"If it was manufactured before 2000," she said, "it probably does not meet the standards."
Twin-over-twin-mattress bunk beds are one of the top-selling items for Young America, a youth furniture manufacturer, and the company considers safety just as important as product design.
"It's fine to come out with a great-looking bunk bed, but if it's not safe and sturdy, then it's back to the drawing board," said Curtis Wenke, product manager for Young America.
Manufacturers are not the only ones responsible for making sure that design doesn't dictate decisions. Parents should not be swayed by either -- even if their 5 year old is begging for a race-car themed bunk bed.
"I have three elementary-aged kids, and they want bunk beds," Jana said. "To be honest, as an adult, I think they look pretty darn fun too. It's easy to forget the potential risks when you or your kids want them."
Jana encourages parents to follow safety guidelines and think twice about buying bunk beds for high-energy children who love to jump and climb.
As a mother of two boys who had a bunk bed, Ann Brunzell understands the attraction. They take up less space and are convenient for smaller bedrooms. But Brunzell, a registered nurse and coalition coordinator for Safe Kids Tri Cities in Grand Island, Neb., said she would not buy one again.
"The risk is just too great," she said. "Kids will be kids. ... It's their job to play."
Parents can do their best to explain the dangers to a child who has a bunk bed, but younger siblings, relatives and friends could be the ones who get hurt because they don't know or understand the rules.
While Brunzell said that two kids sleeping in a double bed is a better alternative, Jana offers another solution -- trundle beds. They have a built-in safety measure because the lower mattress can cushion a fall or serve as a step to the upper mattress.
For parents who decide on a bunk bed, McKenzie offers a few suggestions: discourage kids from playing on it, remove objects from around the bed, position it away from a ceiling fan or light fixture, and keep a nightlight on, so a child can see the ladder while getting down from the top bunk at night.
By following these tips and the instructions that come with bunk beds, McKenzie said they can be used safely, even with the high numbers of childhood injuries found in the study.
"I wouldn't advocate elimination entirely but certainly for the younger age group," she said. "We definitely don't want them sleeping in the top bunk."