JEFFERSON CITY, Mo. - Shopping cart safety needs a closer look, according to a new study from Nationwide Children's Hospital. Researchers found that, from 1990 to 2011, more than 500,000 children were treated in the nation's emergency rooms for injuries associated with shopping carts - including falls, entrapment and carts that tipped over on them. 
Dr. Gary Smith, director of Nationwide's Center for Injury Research and Policy, says parents' and children's behavior play a factor, but there also are flaws in shopping cart design. 
"The current shopping cart standard simply is not adequate. It does not have a component that addresses the stability of the cart to help prevent the tip-overs, despite the fact that other countries have such tip-over prevention standards," Smith said.
The study recommends several design changes, such as placing the seating area of the cart near the floor. Dr. Smith says that change would improve safety by lowering the cart's center of gravity, which reduces the risk of a tip-over. Falls would also be less serious if the child is sitting closer to the floor.
He describes the variety of injuries children can suffer from a shopping cart-related accident. 
"We've seen everything from bruises and cuts, all the way up to major fractures and concussions. In this study, we did not have any deaths, but I'm aware of deaths that have occurred from falls from shopping carts," he said.
Whenever possible, Dr. Smith says parents should look for alternatives to putting kids in a shopping cart - whether it's leaving children with another adult or in a supervised play area in the store. For very little ones, he suggests using an infant carrier. If you must use a cart, he recommends choosing one with the child seat low to the ground, following the safety instructions, and ensuring the child is secure. 
"Parents should use the restraint systems that are there and, as best they can, watch their children as close as they can while they shop. But even that is tough to do. These injuries can and do occur in just the time it takes to reach for something on the shelf as you turn your head," he warned.
The study was published in the January 2014 print issue of "Clinical Pediatrics." Its findings are summarized at www.nationwidechildrens.org.