Shopping carts seem sturdy, but they’re deceptively unstable, especially when you’ve got a baby in an infant carrier perched on top, or a squirmy toddler who won’t stay in his seat. It’s no wonder shopping carts are among the leading causes of head injuries to young children.

The latest emergency-room data underscore the fact that shopping carts can be hazardous to children younger than five. In each of the three years from 2003 through 2005, there were 19,500 shopping cart-related injuries treated in U.S. hospital emergency rooms. More than 80 percent of the injuries were caused by falls from the carts, according to data prepared for the voluntary standard-setting organization ASTM International, and more than 40 percent of the injuries could be judged as potentially serious. Injuries to the head and neck, including concussions, internal injuries and fractures were the most common.

The number of injuries hasn't decreased since 1999, though the latest data are too recent to reflect the voluntary standards that were adopted in 2004. Those standards, designed to cover children between six months and 4 years old, and weighing up to 35 pounds, require adjustable child restraint straps in the child-seating area plus warnings about the dangers of falling out. The voluntary standards also call on retailers to regularly inspect and maintain their carts to make sure they are in compliance.

To prevent shopping cart injuries from falls and tip-overs, keep these cart precautions in mind:

DO:
--Have another adult come with you to watch your baby while you shop.
--Use a stroller, wagon, or soft carrier instead of a shopping cart.
--Shop online so you don’t have to trek to the store with your baby.
--Leave your kids home with another adult on your grocery shopping days, if you can.
--Have your child walk once he gets older.
--Always use seatbelts to restrain your child in the cart’s seat and keep an eye on her. That’s the best you can do if going shopping with your children can’t be avoided and you decide to use a shopping cart.

DON’T:
•    Leave your child alone in the shopping cart unsupervised.
•    Let your child stand up in a shopping cart.
•    Place an infant carrier on top of the shopping cart.
•    Let your child ride in the cart basket.
•    Let your child ride or climb on the sides or front of the cart.
•    Let older children push the cart when there’s another child in it.

See our report on shopping-cart covers for additional information.