Young children depend on their parents to keep them safe. While careful supervision is the mainstay of protection, many of us underestimate the importance (and effectiveness) of providing a safe, child-friendly environment. Nowhere is this more important than in one’s own home, the place where the majority of injuries to young children occur, and therefore the place where the most injuries can be prevented.
Injuries to children are common. Three out of every 10 children is seen by a doctor each year for an injury, and one out of every 200 children is hospitalized for an injury each year. While it was once common for people to believe that injuries — even serious ones — were mostly inevitable, most people now realize that the circumstances that lead to falls, burns, drownings, choking, and other common home injuries are both foreseeable and preventable. Here, we present a room-by-room tour of injury prevention. The idea is not to be all-inclusive, but rather to give parents some things that they can do to make their homes safer and more child-friendly. Again, none of this takes the place of adequate supervision. Yet, “childproofing” combined with supervision can go a long way toward reducing the chances that your child will sustain or suffer from a preventable injury.
THE KITCHEN
Small appliances:
Small appliances, such as toasters and coffeepots are enticing yet hazardous. Make sure that they are far back on the kitchen counters out of reach. Unplug appliances when they are not in use and keep the cords well out of reach so that children do not pull the appliances down onto themselves.
The stove and oven are the large appliances of greatest concern. Children must be taught early that the stove is off limits, whether it is in use or not. Even newer, well-insulated ovens can become quite warm on the outside when in use. And newer stove tops become very hot in less than a minute. Always use the back burners whenever possible. Turn all pot handles inward. If the controls are accessible, consider using knob covers to prevent your child from operating the burners.
Parents can install appliance latches for oven, refrigerator, and dishwasher doors if necessary. And talking about refrigerators, inspect the door for small refrigerator magnets that might be within reach of a toddler and be a choking hazard.
Scald burns:
Not all scald burns come from the tap. Hot coffee and soup are often worse than hot tap water, because they are hotter! And hot liquids spilled on clothed skin will soak the clothing and stay in contact long enough to turn what would be a minor burn into something more serious.
In addition to turning pot handles inward, remember never to tend to your child while you are holding a hot beverage. Also, consider not using tablecloths, as young children will pull at the ends and spill whatever is on the table down onto themselves. We discourage parents from using infant walker with wheels not only because they can cause injuries by going down the steps, but also because they allow children to get very quickly to places (such as the stove) where they can burn themselves.
Parents should be aware, that even if a child should be accidentally scalded with hot liquid, using the proper immediate first aid can greatly reduce the seriousness of the burn. Parents should know to quickly remove any clothing covering the scalded skin and immediately to run cold tap water over the burn for at least five minutes or until the pain subsides. Doing so will result in a burn that is less deep.
Like the bathroom, the kitchen has cabinets are full of things that can harm young children. The drawers have knives and other sharp utensils and the cabinets have cleaning supplies that are often poisonous. Use child resistant latches and consider choosing high, out-of-reach cabinets for products that are hazardous. Also, never store household chemicals in food or beverage containers; this practice is dangerously confusing to young children. Never store non-food items in the same cabinets or pantries that are used to store foods — for the same reason.
Smoke detectors and carbon monoxide detectors:
Smoke detectors should be on every level of your home. The most important location is in the bedroom area. A working smoke detector can cut in half the chance of your child dying in a house fire. Batteries should be checked monthly and replaced yearly.
The Consumer Product Safety Commission recommends at least one carbon monoxide detector in each home, located near the sleeping area. Better yet, consider one on each level of your home. Carbon monoxide is produced when any type of burning fuel is incompletely burned or exposed to heat. Most homes have several potential sources of this odorless, colorless, and extremely poisonous gas: furnace, fireplace, water heater, stove, gas dryer, or the automobile in the attached garage. (Electric appliances do not produce carbon monoxide.) All family members should know the signs of carbon monoxide poisoning: headache, nausea, vomiting, drowsiness, confusion, and rapid heart rate.
THE BEDROOM
Windows/Window coverings:
Windows present two major risks to young children: falling out, and strangling on drapery and blind cords. The typical child who strangles is a one-year-old who stands in the crib, reaches for a drapery or blind cord, and becomes entangled in it. Older children will climb on furniture that is beneath a window and fall out as they are attempting to see what is outside.
Move cribs and all furniture that can be climbed on away from windows. Consider using window safety latches that limit how far windows can be opened. Open double-hung windows from the top when possible. Window guards to prevent falls can be installed inside the window frame of all windows above ground level that are accessible to children. Such guards are required in New York City and elsewhere. Never use any window latches or guards that cannot be easily and quickly released on windows that may be needed to escape a fire.
All drapery and blind cords with loops deserve your attention; they could strangle a child. For horizontal blinds and draperies, cut the loops and install individual tassels on each of the cords. For vertical blinds, install a permanent tie-down device on the floor. Alternatively, tie drapery and blind cords high out of reach.
Cribs and beds:
Cribs manufactured within the past ten years are best; older ones are likely to be less safe. If you are using a previously used crib, inspect it to make sure that the hardware is secure and that the mattress is tight-fitting. The vertical slats should be closely spaced and corner posts, no matter how short, are a strangulation hazard: they can catch clothing or neckwear.
When a child becomes able to climb out of a crib, it is time to move to a bed. At about 35” tall is the right time; or when the crib rail is less than 3/4 the child’s height. Children under 35 inches tall should usually be in a crib. A few children can climb out of a crib at 18 months; most can at 2 years.
Some bunk beds have been associated with serious injuries and deaths. The common problems are falling mattresses and strangulations in the gap between mattress and guardrails. These two problems can occur even if the bunk beds are being used as twin beds. Parents should therefore check two things: Make sure that the mattress supports (the cross boards underneath the mattress) are securely attached with screws or bolts. Also make sure that there are no large gaps (greater than 1 inch) between the top of the mattress and bottom of the guardrails. If a larger gap exists, some modification is necessary; perhaps use a thicker mattress. Children under six years old should not be in a top bunk. Children should understand that bunk beds are not playthings.
Never leave infants unattended on adult beds. They can roll off, they can become trapped between the bed and the wall, and they can suffocate in the soft bedding or pillows. Particularly hazardous to infants are adult waterbeds. Waterbeds are sufficiently soft that an infant rolling over onto her stomach can suffocate.
Toy chest, small parts:
Toy chests with heavy hinged lids can fall on a child’s head or neck causing strangulation or serious injury. Make sure that all such toy chest have a lid support that will keep the lid opened in any position. Better yet, remove the lid.
Children under the age of three are particularly prone to choking by putting small objects in their mouths. Keep any toy or part of a toy that can fit in a child’s mouth away from the youngest children. Use a “no-choke” tube or an empty toilet paper roll as a “toy tester” to determine of a toy is too small for a child under three years.
BATHROOM
The bathtub:
Never leave infants or toddlers unattended in the bathtub; they can drown, or they can turn the hot water on themselves. In fact, unattended bathing should be delayed until your child is at least five years old. Older children can take baths or showers, as they wish, but children and adults who have a seizure disorder are safer taking showers — they might fall, but they can’t drown.
To prevent hot water scald burns, run the water before you put your child in the bathtub. As a general rule, get into the habit of turning on the cold water first and turning off the hot water first. Set the thermostat at your home’s water heater to 120 degrees or less. That should provide your family with plenty of hot water, but it will prevent the very severe scald burns that can be caused by water temperatures of 140 or 150 degrees. If you do not have access to the water heater (such as in a multi-family dwelling) and you are unable to get the hot water temperature lowered to a safe temperature, then you may have to have a plumber install a temperature-limiting valve on the water supply to your bathroom
Hair dryers, curling irons, and other electrical appliances that might be used in the bathroom present a burn hazard as well as an electrical hazard. Keep electric appliances unplugged when not in use, and store them safely out of the reach of young children. Bathroom electrical outlets should have “GFCIs” — ground fault circuit interrupters. Those are the outlets with the two small buttons; they automatically interrupt the electrical supply if an appliance should short out or come in contact with water. Such outlets can help prevent electrical shocks.
Poisoning:
The average bathroom is filled with household poisons, most of them enticing to young, curious, and resourceful children. The medicine cabinet contains prescription medicines for a variety of adult ills, and oftentimes as few as two or three pills can make a small child very ill. Even the “over-the-counter” medicines such as cough and cold remedies and pain-relievers can be highly poisonous. Cosmetics, toiletries, and even mouthwash often contain enough alcohol that several swallows will make a young child quite ill. And finally, under the counter, families often store cleaning supplies and chemicals that are usually at least mildly poisonous if ingested. Items such as toilet-bowel cleaners and drain cleaners can be highly toxic.
For poison protection, parents should rely on several safety strategies working together. Store all medicines in their original containers with child-resistant caps. Household chemicals that are sold with child-resistant caps are done so for a reason; make sure that you use this safety feature. When medicines are out of date or no longer needed, dispose of them safely, usually by flushing the contents down the toilet, rinsing the bottle and disposing of it in a trash can that the child does not have access to. Store medicine in a cabinet that is either out of reach or that has a safety latch or lock or both. Put safety latches on all cabinets that contain chemical products that could harm a child. Teach children never to taste anything that is not food or drink. Have the telephone number of the regional poison control center conveniently posted so that you can rapidly get advice should there be an accidental ingestion.
FAMILY ROOM
Unstable furniture:
While children can pull furniture down onto themselves in any room of the home, the family room is the room that often has tall free-standing bookshelves and televisions atop cabinets. Sometimes, bookshelves that extend down to the floor can even be used as ladders, and parents may need to rearrange furniture if there young children are prone to trying such maneuvers. Unstable and top-heavy pieces of furniture that can be climbed upon should be secured to the wall in some fashion so that it will not tip over.
Coffee tables are a favorite piece of furniture for infants and toddlers to pull to a stand against and to cruise around. Unfortunately, the tables’ sharp edges and corners often lead to lacerations as children take their inevitable falls. Parents can purchase special edging and corner guards to protect children from coffee tables and other similar furniture. A better strategy may be to move the coffee table out from the center of the family room for a year or two, from the time children are pulling to a stand until the time they become skilled navigators or their own two feet.
Electrical cords and outlets:
Electrical cords and electric outlets are enticing to young children. Avoid using extension cords whenever possible and direct electric cords behind furniture where they are less accessible. Do not run extension cords under rugs as they may heat up and become a fire hazard. There are a variety of electrical outlet guards and covers to prevent children from plugging and unplugging appliance cords (and other objects) into the electrical outlets.
House plants:
Several varieties of common decorative house plants are poisonous if ingested. Keep house plants out of reach of children until they are old enough to know not to “sample” them. Also, label your house plants with their proper botanical names so that if you need ever to call the poison information center, they will be able to give you accurate advice.
HALLWAYS AND STAIRS:
There are several strategies that can make the halls and stairways in your home safer. First, keep these areas clear of clutter. Shoes, backpacks, boxes and books are not only obstacles at night, but during the day as well. People of all ages, trying to negotiate the stairs in a hurry, can trip and fall if the steps are used for storage!
Strategically place night-lights in outlets in hallways in the bedroom area of your home. If you can position a light so that the stairs are illuminated as well, all the better.
Carpeting is always a good idea on stairs, both for traction, and to cushion falls. This is particularly true where there are young children with developing motor skills. Check the height of the railing on the stairs, It may be perfect for adults but virtually unreachable for preschoolers. It may or may not be practical to reposition the railing several inches lower, but kids should have something to hold onto when climbing or descending stairs.
From the time a child is crawling or scooting (shortly after six months old) until he is skilled getting up and down the stairs safely, you should put gates at the top and bottom of staircases. There are two styles of stair gates: those that must be installed into the wall and “pressure gates” that expand between the walls and/or railing posts on each side of the stairway. At the bottom of the stairs, either style is fine, but the pressure gates are often more convenient. At the top of the stairs, however, do not depend on the less stable pressure gates. Install latching gates that are secured to the wall with screws and anchors.
Gates should be high enough that toddlers cannot climb over them: most are about three feet high. The latch should be child resistant, but remember that almost nothing is childproof. Gates that have only vertical slats are good as are those that are a fine mesh or Plexiglas, because they are difficult to climb.
By the time a child is two years old, the gates should come down, because you don’t want a child to climb over. When a toddler is learning to climb steps, some parents like to position the bottom gate on the third or fourth carpeted step to allow the child some supervised climbing experience without putting him in a position where he would fall down more than a couple steps.
Copyright 2003 Mark D. Widome, M.D. Dr. Widome is a general pediatrician and professor of pediatrics at the Penn State Children’s Hospital. He writes frequently on topics of interest to parents and is a regular contributor to the “Today” show. His book, “Ask Dr. Mark: Answers for Parents,” was published this month by NSC Press and the National Safety Council (www.nsc.org).