Safety Tips for Young Children

Editor’s note: This text-based course is an edited transcript of the webinar, Safety Tips for Young Children, presented by Tara Warwick, MS, OTR/L.

Learning Outcomes

After this course, participants will be able to:

• List three guidelines for car safety.
• Identify three safety precautions for home.
• Identify three safety precautions for play.
• Identify three strategies for children who wander.

Introduction 

The topic of child safety became near and dear to my heart a few years ago. I'm in Oklahoma, and we had a young boy with autism get out of his home in the middle of the night. After a lengthy search, they finally found him and he had drowned. After that horrible event, it became apparent that we need to start being more aware of safety for children. We need to provide education to parents, therapists, teachers, and communities so that they have strategies and information in order to prevent accidents and injuries. Today, we're going to talk about a lot of different safety strategies for children as they relate to automobile travel, the home environment, and safe play. Toward the end, we're going to focus more specifically on special accommodations for children with autism who wander. I obtained most of this information from the Safe Kids website (www.safekids.org). I highly recommend this website, as it has a lot of good resources for safety that you can share with families.

Why do we need to talk about safety? Each year, 8,000 families lose a child because of a preventable injury. In addition, 7.7 million children are injured every year. A family's life is forever changed when they lose a child or if their child sustains a debilitating injury. Looking at these statistics, it is clear that we need to work hard to prevent these accidents and injuries from happening. 

Car Safety

Let's begin our discussion with the topic of car safety. Road injuries are the leading cause of preventable injury and death in the United States. Alarmingly, three out of four car seats are not installed correctly or are not used properly. More than 500 children are killed every day as a result of a road traffic collision, and tens of thousands are injured, often suffering lifelong disabilities. Children who live in poorer nations are more at risk, with 90% of child road deaths occurring in low and middle-income countries. 

American Academy of Pediatrics (AAP) Guidelines for Car Seats

The American Academy of Pediatrics has set forth specific guidelines for car seats (Figure 1). Keep in mind that these may vary from state to state.

Figure 1. American Academy of Pediatrics car seat guidelines.

The main guideline that has changed recently is that for infants and toddlers, they recommend only rear-facing car seats until at least two years of age, or until the child has met the car seat manufacturer's height and weight requirement. For toddlers and preschoolers, after they have outgrown the rear-facing seat, they recommend forward facing convertible car seats with harnesses. For school-aged children, booster seats are recommended when their weight exceeds the forward-facing convertible car seat. Typically, they should be in a booster until they're around four feet, nine inches and around eight to 12 years of age. We need to make sure we're keeping kids in boosters as long as we need to. Additionally, all children under 13 should ride in the back seat. Older children (14 and over) can sit in the front with a properly fastened lap and shoulder seat belt.

Proper Car Seat Purchase, Installation, and Positioning

As early childcare professionals, we can assist families when they are purchasing a car seat to ensure they make the right choice. Be sure to have them review the AAP guidelines so that they're getting the proper car seat (either rear or forward facing) for their child's height, weight, and age. We can help families install their car sets, or we can guide them toward the appropriate resources. Here in Oklahoma, you can go by the fire department and they will make sure that your car seat is installed correctly. Also, families need to know when to change the car seat based on the child's height and weight, and to which type of seat they need to transition. The American Academy of Pediatrics offers handouts and information that you can give to families about car seat safety. 

Booster Seats

Booster seats should only be used if the child has outgrown the height and weight limits of their car seat, as the car seat is safer. When the child is sitting in the booster seat, the seat belt should be flat against the chest, on the bony part of the shoulders and low on the hips or upper thighs. If it's not, then it's probably too soon for the child to be in a booster seat. If it's up on the stomach, it's not the right place. Do not place the shoulder belt under the child's arms or behind the back. We need to make sure that the belt is across the chest and over the hips. 

Home Safety

Next, we're going to review various types of home safety recommendations. These recommendations are good to share with families, especially those who may be first-time parents or families who have extremely active kids that are into everything. These ideas will help them childproof their house, as they might not be aware of the risks. Even as I was preparing for this safety presentation, I learned about some things that I would never have thought would be considered risks. Helping families go through this list can be beneficial in preventing injuries.

Burns and Scalds 

More than 126,000 children across the country (including more than 67,000 children under the age of four) were injured due to a fire or burn and treated in an emergency room. We can play a role in helping families understand how they can prevent burns and scalds. First of all, the stove can be a high-risk area. Avoid holding the child while cooking or using the oven. If steam comes up out of a pot, or if you drop a pan, the likelihood is high that the child could get burned from the pan directly or the liquid/food in the pan. In addition, direct pot and pan handles away from the edge of the stove. That way, a child can't walk by and hit or grab the handle. Keep hot foods away from counter edges where a child can easily reach up and pull it down. Another simple tip is to set your water heater so that it can't get any hotter than 120 degrees. Also, be careful to place lighters, matches, and gasoline out of reach of children. It's important to put those items out of reach where the child can't even see it because they might think it is something they want to play with.

Carbon Monoxide and Smoke

Carbon monoxide is a gas that you cannot see or smell. In 2009, poison control centers reported more than 3,500 cases of carbon monoxide exposure in children 19 and under. There is a distinct difference between a carbon monoxide detector and a smoke detector. We need to educate families on the difference and help them to get both kinds if they can. There are a lot of different resources out there that can help with this. For example, here in Oklahoma, the fire department will install smoke alarms for families if cost is an issue. Check and see if there are any local resources for families in your area that can assist with fire prevention and/or carbon monoxide poisoning prevention.

Another tip is to avoid using grills, generators or any kind of camping stove inside your home because that can cause carbon monoxide poisoning. All of those items need to be used outside. If you need to warm up a vehicle, make sure you drive the car out of the garage first. Never leave a car running inside the garage with the door closed. Keep gasoline or any gasoline-powered devices outside, stored in a locked area where children cannot access them. Children are curious. If they can see it, they play with it. Also, keep gasoline and other flammable materials away from any source of heat or spark.

Choking and Strangulation

As early childhood providers, we know that toddlers and young children put everything into their mouth. They always need to teethe, to suck, and to drool on different items. Among children treated in emergency rooms for non-fatal choking, almost 60% of choking incidents were food related. In addition, 13% of choking cases involved swallowing coins, and 19% involved candy or gum.

As it relates to food, one way to prevent choking is to be sure that you're cutting food into tiny pieces. Children under five should not eat small, round, or hard foods. In my experience, the biggest mistake I see is families serving hot dogs to children who are too young. If you are going to serve any kind of hot dog, make sure that you first cut it lengthwise and then into small pieces from there. Hot dogs, cheese sticks, hard candies, marshmallows, and popcorn are all big "no-nos" for children under five. Those are all just big enough to get into their airway and cause choking.

Also, be cautious with certain games or toys, such as Legos. A family may have older children in the house who play with games that have tiny pieces -- toys that a small child could easily put in their mouth and choke on. Put those up and away from very young children so they can't access them. Another concern is swallowing magnets. Are there shiny or colorful magnets that children can get off the fridge and easily put into their mouth? Take care to place magnets out of reach. Finally, keep an eye on cords and strings, such as those that are attached to window blinds and curtains. This is something that a new parent might not think about. Be sure to twist those cords up and away around a cord cleat to prevent strangulation. 

Falls

When young children are moving and crawling, they see everything as something they can crawl on (e.g., tables, chairs, pillows). It is important to help parents (especially first-time parents) be aware of those things that are fall risks, and to help them problem-solve how to prevent falls from happening.

Unintentional falls are the leading cause of non-fatal injuries for children in the US. In 2013, unintentional falls resulted in almost three million injuries requiring treatment in an emergency room. Some of those fall injuries involved climbing on furniture, playing by an unsecured window, falling down stairs, and playing on playgrounds. Many of these fall injuries are easily preventable if we follow some simple tips.

Window screens are meant to keep bugs out, not to keep children in. Window screens themselves are not a good measure to prevent falling out of windows. Are there any window guards that you can put in place in addition to the window screen? If you do install any window guards and if you're on the second floor, make sure that they have some type of emergency release in case there is a fire. In the springtime, many families will keep their windows open without the screens because it's nice weather. We need to make sure that families are educated on the risks of falling out of windows. 

Another thing to consider is using the appropriate safety straps on high chairs, infants' swings, strollers, and things of that nature. If you're in a child care setting, be sure that you are using the appropriate straps and seat belts that come with the device. We should never put children in any device without the appropriate straps and seat belts that are needed to prevent falls. Furthermore, infant carriers should never be placed on a table; only on the floor. In addition, safety gates should be placed at the top and the bottom of the stairs and if possible, attached to the wall. That's the most secure. 

Lately, we have heard a lot of stories of children getting injured from pulling over the TV and furniture, such as dressers and bookcases. Are children climbing on tall furniture that is not mounted to the wall? Is the television mounted to the wall or securely inside of an entertainment center that is affixed to the wall? We need to make sure that there's no way they can crawl on it or climb on it and that they are secure and mount systems are in place.

When children are at the age where they regularly play on the playground, consider the playground's surface. There are playgrounds with more shock absorbent areas, where they have synthetic turf, rubber, or mulch. If children fall on the concrete, grass, or dirt, it's a lot more dangerous and hurtful. We can help families locate safer playgrounds, especially when their children are just learning to climb and are unsteady with their balance. Climbing is an important motor activity for children, but we also have to try to make it a safe activity.

Guns

It is estimated that about one-third of households with children 18 and under have a gun in the home. It is vital to help families understand what it means to be safe with guns. Store guns in a locked location that is out of reach and out of sight of children. Also, be sure that guns are stored unloaded, and that ammunition is kept in a separate location from the gun. If a child sees a gun, they're going to be curious and interested in it. When the gun is not in the locked box, make sure that the gun is in your line of sight. Employ the use of effective child-resistant gun locks. As more and more people own guns, we need to make sure that we're keeping our children safe.

Liquid Laundry Packs

Another potential cause of accidental poisoning that has been in the news recently is liquid laundry packs/pods. If you use these in your laundry room, be sure to store them well out of reach of children and keep them in the original container. That way we know what they are, the children know what they are, and it doesn't get confused with anything else. These detergent pods can be very colorful, and if a young child sees them, they might mistake them for a toy or candy. It is also vital that families have access to the poison control line and that they keep it posted in the house in an easily accessible location. That phone number is 1-800-222-1222. If a child eats or swallows anything that they're not supposed to, call this poison helpline immediately. 

Medications

Parents of young children should make sure to put all medications out of sight, preferably in a locked container where the child cannot easily access it. Consider places where children can get into medicine. Sometimes people store it in their bathroom. Can the child easily get into that area? A lot of times when we think about medicine, we only think about our prescription pills or liquids. There are many other products that can be dangerous and cause harm to children, such as creams, ointments, vitamins, eye drops, and nail polish. We need to take care that all these products are out of reach of young children. If you're not sure if a product is poisonous, research it online or call poison control and ask them. Another bit of advice regarding medicine is to only use the application device that comes with the medicine to deliver it. For example, if there is a measuring cup, or a syringe or dropper, be sure to use that to deliver the medicine. Write clear instructions for everyone. If you are leaving children with child care, or with their grandparents or babysitters, make sure the instructions are clear and that they know what kind of medications the child can have. Again, remind families to post the poison control number in an easily accessible place. It's also a good idea to save the number in their phone contacts. 

Poison

There are many household products and cleaning supplies to consider that can cause poisoning. Store those items in a place high up and away from young children, rather than under the kitchen sink or in the laundry room where they can easily access them. Some of those household products are bright colors and they look very appealing. For example, to a child, Pine-Sol might look like some kind of juice or lemonade. Are there child safety locks on the cabinets? It is important to know what is hazardous. Have families open up their kitchen cabinets and take inventory of what is and what is not hazardous, making sure that anything hazardous is stored away from children. Also, check for any type of lead-based paint, which can cause lead poisoning in young children.

Sleep

It is especially important for families of young babies to understand that babies should always sleep in a safe crib, bassinet, or pack-and-play. If a family is co-sleeping, make sure they have a co-sleeping device for the baby to sleep in a separate, defined area of the shared bed. Or, rather than the baby sleeping in the same bed with the parents, they could room share and have the crib or bassinet in the parents' bedroom. Always lay baby on their back. Avoid stuffed animals, pillows, and soft bedding. Have a firm mattress with a tight-fitting crib sheet.

Toys

As early childhood professionals, you are in a great position to help educate families on toy safety. In 2011, 188,000 children under the age of 15 were seen in emergency departments for toy-related injuries. That's 516 kids every day. More than one-third of those were children under the age of five. Make sure to look at the age recommendations on toys and games. The manufacturer is not going to recommend a game or toy with small parts for children under five. Remind families to observe those age limits and to check for any small parts that may cause choking. This is probably a bigger issue for families who have a mix of older and younger children, as they are likely to own a wider range of games and toys with smaller parts. Use a bin or container to store toys after use. When choosing a bin or container, be sure that there are no holes which might allow children to still access those toys or games. Also, avoid toy boxes or cabinets with hinges or latches that children can pinch children's fingers. There are toy boxes with soft-closing safety hinges that allow the lid to close softly.  

Play Safety

There are several areas related to play that we need to consider when thinking about child safety. These include:

• Playing on the playground
• Skating and skateboarding
• Bicycling
• Boating
• Swimming

Playground

A playground is a wonderful place for kids to actively explore and learn motor skills and social skills. However, the playground can be a source of injury. Falls are the most common type of playground injury, accounting for more than 75% of playground-related injuries. Lack of supervision or improper supervision is associated with almost 45% of the playground-related injuries. Make sure that families are aware that they need to be actively supervising their children during playground time. This also applies to teachers and teachers' assistants. Playground time is not break time for teachers. We have to be actively supervising to observe when children are engaging in at-risk behaviors that may result in falls and other injuries.

As stated earlier when we discussed falls, there are playgrounds that have shock-absorbing surfaces that are less likely to be associated with major injuries. Have children dress appropriately for active play. For little girls, remove necklaces, purses, scarves, drawstrings, and anything can get caught up in playground equipment. Even helmets pose a danger because of the straps and should be saved for activities like biking or skateboarding. Teach lessons to the children about the dangers of pushing, shoving, and crowding. I was in a preschool classroom yesterday, and one of the girls there was getting upset over having to wait her turn for the swing. As a result of her impatience, she was hitting and pushing other children. I talked with the teacher and they're going to work on teaching the child how to wait her turn at the swing. Each day, they're going to take a couple of children outside and practice waiting in line for the swing. Providing education and awareness to children can help prevent them from pushing each other down the slide or off the swing, etc.

Skating and Skateboarding

Skating and skateboarding are good for coordination, core strength, balance, agility, and aerobic activity. However, they can be dangerous activities. More than 80,000 people are treated in hospital emergency rooms for skateboard-relating injuries every year. The injuries can range from mild to life-threatening. Skateboarders have been killed by head injuries and collisions with cars.

When skating, skateboarding, and even using a hoverboard, everyone should wear a helmet to protect their head. The other recommendation would be to wear wrist guards, knee pads, and elbow pads, but at a minimum, a helmet should be worn. When engaging in these activities, make sure that children are riding on smooth, dry surfaces. Teach children to check their skates and skateboards before use, to see that there isn't anything stuck in the wheels that might cause them to fall, and to make sure all of the components are working, and not cracked, loose, or broken.

Another idea to help prevent injury is to teach children the proper way to fall. If a fall is inevitable, teach them how to curl up and roll off instead of falling right onto their joints. Encourage them to crouch down as they lose balance versus going from a straight, standing posture directly down to the ground. If they can practice falling the right way, that might help prevent some of those injuries as well.

Bicycling

Biking is another great activity for children that teaches core strength and coordination. It's also a great sensory activity, providing a lot of freedom and exercise. That being said, bicycling can also be dangerous, like anything else. Proper fitting helmets can reduce head injuries by at least 45%. However, less than half of children 14 and under regularly wear a bike helmet. Encourage children to ride on the sidewalk whenever possible, instead of in the road. If their only choice is to ride on a road, teach them the basic laws of the road. For example, instruct them to ride on the right-hand side of the road. When turning a corner, make sure they can see what's coming. When there's a stop sign, they need to stop. Teach them how to use some different hand signals for if they're going to turn right or left, or if they are stopping. Wearing bright colors and reflectors is a good idea for greater visibility. You can also ride along with your children, so you can see where they're having trouble and if they're following the rules of the road, or if they need a little bit more guidance in proper biking.

Boating

Boating a great family activity. However, in 2013, 77% of all fatal boating accident victims drowned. Of those who drowned, 84% were not wearing a life jacket. Children should always wear life jackets when boating. Make sure that those life jackets fit properly. One tip to ensure a proper fit is to do the touchdown signal. By raising both arms straight up in the air, if the life jacket hits the child's chin or their ears, it might be too big or the straps might be too loose. Be sure to educate families to limit alcohol consumption on boats. Prevent hypothermia by bringing blankets and warm clothes for younger children.

If a family does a lot of boating, they should learn CPR. In fact, every family should learn how to perform CPR, regardless of they go boating or not. Another way to help prevent drowning is to teach children to swim at a young age. Also, teach them the difference between swimming in open water versus in the pool. They should know that in open water, there might be uneven surfaces. In a lake, there could be a drop-off point. In an ocean or a river, there might be currents or an undertow. There are tidal changes at different times of day that change the level of the water, and inclement weather can have an effect on waves. Those are all different things to take into consideration when swimming in open water versus swimming in a pool.

Swimming

Children need to be closely watched and attended to when swimming. Keep children within arm's length. Teach them how to swim. I would highly recommend that you work with families on getting kids to learn how to swim. Water is everywhere. Among preventable injuries, drowning is the leading cause of death for children ages one to four. Children one to four years old are more likely to drown in a pool. Children five years and older are more likely to drown in natural water (e.g., ponds, lakes and rivers). The older children who drown are perhaps the kids that we thought were good swimmers, but they didn't know how to swim in open water situations.

It is important to instruct children that when entering water that is over their heads, to step or jump into the water feet first. Teach them how to float for one minute and how to tread water for one minute. Teach them how to turn around in a full circle, so that way if they are in open water and they need to go somewhere different to get out of the water, they can. Children should know how to swim 25 yards and how to exit in different ways from the water. Once again, explain the difference between open water and swimming pools, and encourage families to learn CPR and water rescue. It is especially important to know CPR if they have a swimming pool or they go to the lake a lot, or they have a neighbor with a pool or frequent the community pool.

Special Accommodations: Autism and Wandering

Roughly half of the children with autism attempt to elope from a safe environment. It is very common for children with autism to wander. In addition to the child I mentioned earlier, I worked with another boy whose mom dropped him off at school in the morning, and by the time she got home, he was back on the front porch. When the teachers weren't looking, he found a way out. The second they weren't watching, he knew exactly how he could get out and get home because he had something on his mind he wanted to do. You can put some of the most preventative strategies in place, and for children who have it on their mind they want to get out, they're going to find a way. It's not just about prevention, it's also about community awareness. More than one-third of children with autism who elope are rarely able to communicate their name, address, or phone number. As a teacher, an educator, or a therapist, it is critical that we help children with autism know how to say their name, their address, and their phone number, so they are able to tell people who are familiar to them as well as strangers.

Among parents of children with autism, over 58% of them ranked wandering as the most stressful autism behavior. In addition, 40% of parents suffered sleep disruption due to fear of elopement. The family of the Oklahoma boy who drowned had security alarms in place, but the child knew how to get out of the door without the alarm going off. However, he couldn't tell you his name and number. He was determined to escape, and he was able to pay attention to the details of what he needed to do to get out. Alarmingly, half of the families reported that they never received any guidance on elopement from a professional. Early childhood educators, educators at schools, and therapists are in contact with these families. Clearly, wandering is a topic that we should address because the families might not know who they should talk to. Giving them resources on wandering can be instrumental in preventing their children with autism from eloping.

Why Do Children Wander?

Why do children wander? Often, it is goal-directed. It seemed as if the little boy in Oklahoma had something in his mind that he wanted. Also, the other boy that left his school, his purpose was goal-directed. There was something he didn't do at home that he wanted to do. He had a goal in mind. Those are the kids that will find any way they can and be very cunning and savvy to meet that goal.

Another reason children wander is more of a bolting or fleeing from something. Another family I work with has two young boys with autism. When their younger son elopes, it is more like he is fleeing. If they have a neighborhood get-together, he becomes overwhelmed and he'll just take off running. It doesn't matter where he's going, but he will simply run off.

Other causes of wandering include things like nighttime wandering. Children may wake up and be disoriented and not know where they are. They may elope due to boredom or curiosity. I have a friend who has a young boy with autism, and I think his wandering is because he is curious. It's as if he is thinking, "I don't know what to do here, so I'm just going to go out and look to see what's going on down the street." Another reason for wandering could be due to transition confusion, where the child simply doesn't know where he's supposed to be or what he's supposed to be doing.

Dangers Associated with Wandering 

There are many different dangers associated with wandering. These dangers include:

1. Drowning
2. Being struck by a vehicle
3. Falling
4. Dehydration
5. Hypothermia
6. Abduction
7. Victimization
8. Assault

Drowning is the number one cause of death due to wandering in children with autism. In addition, a child could be hit by a vehicle because these children aren't particularly aware of their surroundings. In general, they're not stopping at the street and looking left, right, left. They've got something on their mind and they're going to go. 

Prevent/Educate/Respond

This Big Red Safety Box is a great resource from the National Autism Association. They have a "Prevent-Educate-Respond" campaign with regard to wandering. On their website, they have some helpful videos as well as different printables and resources that you can provide to families.

Prevention. Preventing a child from wandering is a key component, however, as stated earlier, if a child wants to get out, he's going to find a way no matter what. Parents can install home safeguards, such as locks and alarms or door chimes that alert people if the door is open. Are there secure personal safeguards? I have some families that will use temporary tattoos or GPS monitors. One family I know uses the Angel Sense monitor which has GPS on it. They have to keep it securely on the child and it will let the family know where he is located. It can also help them talk to the child when they're out. Another family uses an Apple watch with the location services on it. The trick is getting the child to keep it on. Another branch of prevention is creating community awareness. Let the neighbors know that a child with autism lives in the area, and inform them what to do if they see their child out and about. Remain hyper-vigilant, especially during transition times such as changes in the seasons, or a big gathering with lots of people around. Those can be times that children are more likely to wander. 

Education. Think about some of the skills that we need to target to children with autism. Identify triggers that cause a child to wander and teach them self-help skills. Teach them how to ask for a break versus just bolting. If the child is able to understand, teach them some safety skills, such as why you don't run away and what you should do instead. Teach them to memorize and be able to recite their name, phone number, and address. For older children, you might have to instruct them about what to do if a police officer approaches you, or how to find a safe person if you're lost and you've wandered. There are a lot of examples in the Big Red Safety Box of different things to teach and target. If you have a child with autism in your classroom, incorporate safety skills into their IEP.

What could be triggering their wandering? Could it be bright lights or loud noises? For those kids that are bolting or fleeing, can we use noise canceling headphones? Can we teach them other ways to ask for a break or how to go to a safe area when they're overwhelmed? Can we teach them self-help and calming techniques? Put them in swim lessons, since 91% of wandering-related deaths were due to drowning. If you go on the National Autism website, they list places in your local community with people who specialize in teaching children with autism to swim. Use social stories to teach them about the importance of safety. Practice their personal identification questions, and instruct them on how to dial 911 and how to identify a safe person.

Response. Always call 911 immediately. Law enforcement should treat each case as critical. Provide families with autism elopement forms. The Big Red Toolbox has forms for families that they can complete before the elopement occurs. On the form, they can indicate things like who to call in case of emergency, where the child usually goes when they wander, and what to do when the child is found. That way in an emergency, you automatically have that form filled out. Always search areas of water first. Drowning is a high risk, as many children with autism enjoy the water. If you go to www.missingkids.org/aware, they have a helpful video of what to do if you find a child who may have autism wandering out in the community. Watching that video, and following the tips and suggestions can be helpful from a community perspective. 

Summary and Conclusion

In summary, safety is critical in young children. Today, we covered a lot of different safety measures. Think about the families that you work with to determine in which areas their children might be at risk. Help families go through their homes using a checklist to identify potential dangers in order to prevent as much as possible. Remind families that road injuries are the leading cause of preventable deaths, and to make sure they have their car seats installed properly and that the child's weight and height is appropriate for their car seat or booster seat. Think about those safety tips for the car, home, and play. Finally, keep in mind the special accommodations for children with autism. Use the Big Red Safety Box and print off forms to give to parents. Also, inform parents of the Big Red Safety Box so they can use those resources to prepare in the event that their child with autism wanders. 

Resources

• www.safekids.org
• http://nationalautismassociation.org/big-red-safety-box/