The safety of children is potentially at risk from accidents and injuries, as well as crime. Providing a safe environment, putting prevention measures into practice, and teaching children methods of self-protection are all ways to reduce the potential for harm to children.
Accidents are the leading cause of death for children aged 14 and under in the United States, claiming more than 5600 lives each year, or an average of 15 children per day. More than 16 percent of all hospitalizations for accidental injuries among children lead to permanent disability. Although the accidental injury death rate declined among children ages 14 and under by almost 40 percent from 1987 to 2000, accidental injury remained in the early 2000s the number one killer of this age group. In 2000, the leading cause of fatal accidental injury among children was motor vehicle occupant injury (28%), followed by drowning (16%) and airway obstruction injury (14%). Falls (36%) were the leading cause of nonfatal, hospital emergency room-treated childhood injury in 2001. Other frequent causes of accidental injuries and deaths are fire and burn injury, accidental firearm injury, and poisoning .
Another way children may have their safety jeopardized is by becoming victims of crime. Child abductions are often publicized widely and cause parents to experience a great deal of anxiety and fear regarding this possibility. Another relatively new place children face potential dangers is on the "information highway." Though the Internet opens a world of possibilities to children, there are individuals who may attempt to exploit and harm children through this technology.
Though the idea of the number of potential risks children face may seem overwhelming to parents, there are a variety of measures parents can take to reduce those risks.
Motor vehicle occupant injury
In 2001, motor vehicle accidents resulted in 36 percent of accidental deaths in children ages one to four. In the early 2000s an estimated 14 percent of children ages 14 and under continued to ride unrestrained, however, and 55 percent of those children killed in motor vehicle accidents were not restrained. Also, at that time, nearly one-third of children rode in the wrong restraint for their zage and size, and an estimated 82 percent of child safety seats were installed or used incorrectly. The following measures will help parents keep their children safe:
- Car seats need to meet federal safety standards. A car seat with a five-point harness will provide the best protection. In addition, the car seat needs to be the correct size for the child and needs to fits properly into the vehicle.
- The Lower Anchors and Tethers for Children (LATCH) system in cars manufactured after September 1, 2002, should be used. Some car seats require that parents attach additional hardware for maximum protection.
- The child must face in the right direction. Infants should ride in a car seat that faces the rear of the car until they are one year of age and weigh approximately 20 lbs (9 kg). Infants who weigh 20 lbs (9 kg) before they are one need a restraint approved for the higher weight and should also be rear-facing.
- Car seats should be installed correctly. The car seat should be held tightly against the car's back seat. After installing the car seat, parents need to make certain they cannot move it more than one inch from side to side or front to back. Police departments and community organizations frequently hold child restraint inspections, during which parents can discover if they have installed their car seats properly.
- Rear-facing car seats should not be placed in the front seat of a car that has air bags. Children 12 and under should ride in the back seat in order to avoid being hurt by inflating airbags. Generally, the back seat of the car is the safest place in a crash.
- Children need to stay in a safety seat with a full harness for as long as possible, at least until they weigh 40 lbs (18 kg). Afterwards, they can use a belt-positioning booster seat, which provides a taller sitting height so that the adult lap and shoulder belts fit correctly.
- When older children are 57 inches (1.45 m) tall and weigh 80 lbs (36 kg), they may use adult lap belts.
- Children need to be restrained every time they ride in a car.
- Children should never be left alone in or around a vehicle. Unattended children can quickly die from heat stroke or carbon monoxide poisoning.
Drowning remains the second leading cause of accidental injury-related deaths among children ages 14 and under, claiming 943 children in 2000. An estimated 4700 children required treatment in hospital emergency departments for drowning-related incidents in 2001. As many as 20 percent of children who survive near-drowning suffer severe, permanent neurological disability. Children ages one to four are at the highest risk of drowning. The following measures may significantly reduce the drowning risk for your child:
- Parents and caregivers should never, even for a moment, leave children alone or in the care of another young child while in bathtubs, pools, spas, or wading pools or near any other open standing water. Infant bath seats are not a substitute for adult supervision. Parents should remove all water from containers, such as pails and buckets, immediately after use.
- If the home has a swimming pool, it should be surrounded by a fence that prevents children from having direct access to the pool from the house. Remove toys from in and around the pool, as toys can attract children to the pool.
- Parents should enroll their child in swimming lessons when they are old enough (usually not before age four), but should remember that these lessons do not provide protection against drowning for children of any age.
- Children should be taught to always swim with a buddy. In addition, they should be instructed never to dive into an unknown body of water, but instead jump in feet first to avoid hitting their heads.
- When boating, every person must wear a U.S. Coast Guard approved life jacket.
- Air-filled swimming aids (such as water wings) cannot take the place of life preservers.
- Parents need to teach their children about the risks of drowning in the cold weather months. Children should not walk, skate, or ride on thawing ice on any body of water.
- Parents should learn CPR and keep a telephone close to the area where their children are swimming.
Poisoning is a common cause of home accidents, with toddlers being the ones most vulnerable. Children are at risk of poisoning from household and personal care products, medicines, vitamins , indoor plants, lead, and carbon monoxide. In 2000, 91 children ages 14 and under died as a result of accidental poisoning. Approximately 114,000 children in this age group were treated in the emergency room for accidental poisonings in 2001. People can keep children safe by being aware of the potential hazards in the home and by following these guidelines:
- Medications and cleaning solutions need to be stored in locked cabinets.
- Medication lids need to be tightly closed with child-resistant caps.
- Parents should avoid taking medicine in front of children and never refer to pills as candy, as children often mimic the behavior of adults.
- Parents should check the garage for any toxic chemicals and gasoline containers. Items such as windshield washer fluid, antifreeze, and pesticides are poisonous and should be placed where children cannot reach them. In addition, these kinds of items should never be kept in juice or milk bottles.
- Poisonous plants in the home need to be identified and either removed or placed where children cannot reach them.
- Carbon monoxide detectors/alarms should be installed in homes and recreational vehicles. These should be placed in the hallway near every separate sleeping area of the home.
- Insect sprays should not be used around food.
- All painted furniture and toys should be checked for non-toxic finishes.
- The Poison Control Center phone number should be posted in a prominent place, where family members and other caregivers can find it quickly. Caregivers should call the Poison Control Center (1–800–222–1222) immediately when a poisoning incident is suspected. The experts at the Poison Center provide directions on the appropriate actions to take.
Fire and burn injuries
Fire and burn injury is the fifth leading cause of child accidental injury-related death. Children make up 20 percent of all fire deaths, and over 30 percent of all fires that kill children are set by children playing with fire. Children of all ages set over 100,000 fires each year, and approximately 20,000 of these are set in homes. Children aged four and under are at the greatest risk, with a fire- and burn-related death rate nearly twice that of all children. This circumstance occurs for several reasons. Young children have a less acute perception of danger and a limited ability to properly respond to a life-threatening burn or fire situation. They are also more susceptible to fire-related asphyxiation, as well as more prone to burns than adults. The United States Fire Administration (USFA) encourages parents to teach children at an early age about the dangers of playing with fire in order to help prevent child injuries, fire deaths, and the number of fires set in homes. The following suggestions will aid in keeping children safe from fires:
- Young children need to be supervised closely. They should not be left alone even for short periods of time.
- Lighters and matches should be kept in a secured area and children taught to tell an adult if they find lighters or matches.
- Parents should look for indications that children may be playing with fire, for burnt matches under beds or in closets.
- Families need a home fire escape plan and to practice it with the children. A meeting place outdoors should be designated.
- Children should be taught that if a fire occurs, they should crawl low on the floor, below the smoke, and get out of the house according to the escape plan. They should not attempt to get back in the house.
- Children need to know how to stop, drop to the ground, and roll if their clothes catch on fire.
- Parents should install smoke alarms on every level in the home, and familiarize children with the sound of the smoke alarm. They should test the alarm monthly and replace the battery at least yearly. Having a working smoke alarm dramatically increases residents' chances of surviving a fire.
- The thermostat on the hot water heater should be set to 120°F (49°C) or lower. The water temperature should be checked when bathing or showering children.
- Do not drink or carry very hot beverages or soup when holding a child.
- Access to the stove should be blocked if possible. Foods should be cooked on the back burners with pot handles turned away from the front of the stove. Parents and caregivers should avoid holding a baby or small child while they are cooking.
Each year, nearly 3 million children in the United States are injured in falls. For those under five, falls cause more than half of all injuries. Even close supervision is not adequate, as falls can happen very quickly. They can occur at home as well as away from home. Although most falls result in only mild bumps and bruises , many cause serious injuries that require immediate medical attention. Following these guidelines may help to prevent children from becoming injured in a fall:
- Playgrounds should have soft surfaces to cushion children if they should fall. Examples of soft surfaces are those made of items like bark mulch, wood chips, sand, pea gravel, or shredded tires. Avoid concrete, asphalt, and dirt surfaces. Even sod can be too hard under certain weather conditions.
- Chairs and other pieces of furniture in the home should be kept away from windows. Windows should be closed and locked when children are around. Residential windows in tall buildings should have bars or window guards. Window screens may not prevent children from falling out a window.
- Stairways must be clear to prevent children from tripping over clutter.
- Throw rugs should be secured to the floor with a rubber pad, double-sided tape, or a piece of foam carpet backing.
- Safety gates can keep toddlers away from stairs. Gates should be attached to the wall if they are used at the top of a staircase.
- Safety belts keep children from falling from shopping carts.
- As children get older and start riding a bike, a scooter, or using skates, they should always wear a correctly fitting helmet. If a child falls from one of these while wearing a helmet, the risk of a brain injury is reduced by 88 percent. A properly fitting helmet sits evenly on top of the head (low on the forehead, no more than two finger widths above the eyebrows), should be comfortable but snug, and have straps firm enough so that the helmet will not rock forward, backward, or side to side.
Airway obstruction injury
Children, especially those under the age of three, are quite vulnerable to airway obstruction injury because they have small upper airways and have relative inexperience with chewing. They also have a tendency to place objects in their mouths. On average, infants account for approximately 64 percent of choking deaths among children ages 14 and under. Causes of choking or airway obstruction-injury deaths include suffocation by things such as pillows, choking on food or small objects, and strangulation from window blind and clothing strings. Anything children can place in their mouths can be dangerous. Taking the following steps will help protect children:
- Parents should avoid giving children under age four any hard, smooth foods that may block or partially block their airway. These include all nuts, sunflower seeds, watermelon with seeds, cherries with pits, popcorn, hard candy, raw carrots, raw peas, and raw celery.
- Certain soft foods, such as hot dogs, grapes, and link sausages, should be chopped into small pieces. These foods can cause choking because they are the right shape to block the windpipe.
- When babies start to eat solid food, parents need to beware of foods such as raw apples or pears. Raw fruit is difficult for babies to chew properly because their teeth are just developing.
- Children should sit still while eating and chew food thoroughly.
- Children should not run, ride in the car, or play sports with gum, lollipops, or candy in their mouths.
- Buttons, beads, and other small objects need to be stored safely out of children's reach.
- Drawstrings should be removed from children's coats and sweatshirts. Also window blind cords that pose a risk for strangulation should be removed.
- Parents should follow manufacturer's recommendations regarding toys and check toys frequently for loose or broken parts.
- Older children should not to leave toys with small pieces or loose game parts where younger children can reach them.
- A latex balloon should not be given to a child younger than age eight. Children can choke by inhaling the balloon or a portion of it into their windpipes.
- Parents should obtain and use a "small parts tester," an inexpensive child safety device that shows if an object is small enough to fit in a child's mouth.
Accidental firearm injury
In the year 2000, 193 children in the United States ages new infant to 19 died from accidental injuries involving firearms. A child as young as three has the finger strength to pull a trigger. Some studies show that by age eight, 90 percent of children are capable of firing a gun. Whether people are gun collectors, hunters, or fierce gun control advocates, they need to ensure their families' safety by talking with their children about the potential dangers of guns and what to do if one is found. Parents should assume that their children may come across a gun at some point in their youth and proactively teach them about gun safety. There are a number of programs available that instruct children, including the very popular "Eddie Eagle," a program of the National Rifle Association (NRA). This program offers a four-step approach to gun safety: stop, don't touch, leave the area, and tell an adult. People who own firearms should follow these guidelines to prevent accidental shootings:
- Guns need to be stored unloaded in a securely locked case and out of children's reach.
- Trigger locks and other safety features should be used.
- Ammunition should be stored in a separate place from the firearms, locked in a container that is out of children's reach.
- Gun owners should take a firearms safety course to learn the correct and safe way to use the firearm, and they should practice firearm safety. Children need to be taught that guns are not toys. They need to be taught to always tell an adult about any gun they happen to find.
While online computer exploration opens a world of possibilities to children, it also may expose them to a variety of dangers. Teenagers are particularly at risk because they are more likely to go online unsupervised and are more likely than younger children to participate in online discussions. Risks posed by the Internet include the following:
- Exposure to inappropriate material that is sexual, violent, hateful, or that encourages activities that are dangerous or illegal.
- Exposure to information or arrangements for an encounter that could risk children's safety or the safety of other family members. In some cases child molesters have used chat rooms, email, and instant messaging to gain a child's trust and then to arrange a face-to-face meeting.
There are several signs that children may be at risk online. These include their spending large amounts of time online, especially in the evenings; the presence of pornography on their computers; their making or receiving calls from men parents do not know; their receiving mail, gifts, or packages from people parents do not know; their turning off the monitor or quickly changing the screen on the monitor when parents enter the room; their becoming withdrawn from the family; and their using an online account that belongs to someone else.
Parents should not feel powerless in the face of these online risks. There are a variety of measures they can take to minimize the chances of an online exploiter victimizing their child. These include the following:
- Children need to be warned about the potential dangers online and about sexual victimization.
- Parents should spend time online with children.
- Computer should be kept in a common room in the house, not in the child's bedroom. It is more difficult for a predator to communicate with a child when the computer screen is visible to other members of the household.
- Parental controls and/or blocking software should be used.
- Parents should maintain access to the child's online account and randomly check his or her email. They should be open with children about parental access and state the reasons for it.
- Children should be instructed never to arrange a face-to-face meeting with someone they meet online; never to upload pictures of themselves onto the Internet to people they do not know; never to give out identifying information such as their name, address, school name, or telephone number; never to download pictures from an unknown source; and never to respond to messages that are suggestive, obscene, or harassing.
Publicized crimes involving childhood abductions, although rare occurrences, frighten many parents and make them unsure about how best to protect their children. According to one study, in 57 percent of the cases, the victims of child-abduction murder were victims of opportunity. The tips noted below will help parents lessen the opportunity for abduction and kidnapping and better safeguard their children:
- Parents should teach children to run away from danger, never towards it. Danger is defined as anything or anyone that invades their personal space. Children should be taught to yell loudly, as their safety is more important than being polite.
- Children should not be allowed to go places alone, and they should always be supervised directly by parents or by another trusted adult. Older children should always take a friend along when they go somewhere.
- Parents should know where and with whom children are at all times. They should know children's friends and be clear about the places and homes they may visit. Children should habitually contact their parents when they arrive and leave a destination and if their plans change.
- Parents should talk openly with children about safety and encourage them to report to trusted adults anything or anyone makes them feel uncomfortable or frightened. Children should know they have the right to say no to any unwelcome, confusing, or uncomfortable attention by others and that they should tell parents immediately whenever such an experience occurs.
- Babysitters and caregivers should be screened and their references checked.
- Instead of confusing children with messages about avoiding strangers, Parents should identify adults to whom children may talk. Parents should list the people by name whom they permit their children to visit.
- Parents should avoid using code words but instead use the "check first" method. Children should be taught not to talk to anyone, go with anyone, or accept gifts or candy from anyone without first checking with their parents or trusted adults in charge.
In spite of taking precautions and putting safety measures into place, accidents, injuries, and crime may still take place. All children should be taught how to call for help in an emergency. Instruct them to dial 911 when emergency assistance is needed and to remain on the phone as long as they are directed to do so.
Children can injure themselves in the blink of an eye. Parents can turn their heads away for a moment, and a child could pull down a boiling pot of food or swallow something and choke on it. It is impossible for new parents to anticipate all the potential dangers or safety problems around babies and children. The trick to keeping an environment safe for children is to stay one step ahead of them at all times. By spotting dangers before an injury happens, parents can protect their children from harm and protect themselves from stress and heartache. As children develop, some of the potential dangers may change. What does not change is the responsibility parents have to provide a safe, trusting environment in which their children can thrive.
|Know where your children are at all times.|
|Be sensitive to changes in your child's behavior.|
|Talk with your child about their schoolwork and activities regularly.|
|Get to know your child's teachers, friends, and friends' families.|
|Listen sincerely to your children.|
|Be alert to a teenager or adult who is paying an unusual amount of attention to your child.|
|Make sure your children know what to do when approached by a stranger.|
|Don't put your child's name on clothing in a way that is visible to others.|
|Be aware of your child's time and activities online.|
Airway obstruction injury —An injury that obstructs the airway and prevents proper breathing, either through strangulation, suffocation, or choking.
See also Childproofing .
Benson, Allen C. Connecting Kids and the Web: A Handbook for Teaching Internet Use and Safety. New York: Neal-Schuman, 2003.
Joyce, Julie. What Should You Do?: Safety Tips for Kids. Calumet, IL: Dynamic Publishing, 2004.
O'Neill, Heather. "How to Protect Your Child From Falls." Parenting (August 1, 2003): 45+.
"Prevention of Drowning in Infants, Children, and Adolescents." Journal of Pediatrics (August 2003): 437–40.
Consumer Product Safety Commission. Washington, DC 20207–0001. Web site: http://www.cpsc.gov.
National Center for Injury Prevention and Control. Mailstop K65, 4770 Buford Highway NE, Atlanta, GA 30341–3724. Web site: http://www.cdc.gov/ncipc/ncipchm.htm.
National Center for Missing & Exploited Children. Charles B. Wang International Children's Building, 699 Prince Street, Alexandria, VA 22314–3175. Web site: http://www.missingkids.org
National Highway Traffic Safety Administration (NHTSA). 400 7th Street, SW, Washington, DC 20590. Web site: http://www.nhtsa.gov.
National SAFE KIDS Campaign. 1301 Pennsylvania Ave., NW, Suite 1000, Washington, DC 20004. Web site: http://www.safekids.org.
"Buying a Safer Car for Child Passengers 2004." National Highway Traffic Safety Administration. Available online at http://www.nhtsa.dot.gov/CPS/BASCKids2004/index.htm (accessed August 14, 2004).
"Report to the Nation: Trends in Unintentional Childhood Injury Mortality, 1987–2000." National Safe Kids Campaign , May 2003. Available online at http://www.safekids.org/content_documents/nskw03_report.pdf (accessed August 14, 2004).
Deanna M. Swartout-Corbeil, RN