Child safety is a major concern for any parent. Injuries are the leading cause of death in children from age one to 14, according to the American Academy of Family Physicians. Nearly 70 percent of these fatalities occur in children under age four.

Most of these deaths could be prevented with proper precautions. Parents can begin to provide a safe environment for their child even before birth. Doorknob covers should be installed, cabinets secured and safety locks placed on toilets, dishwashers, ovens and stoves. Window guards should be installed on all windows above the first floor.

Parents should exercise care in selecting toys, cribs, changing tables, playpens and strollers. By the time babies are between three months and five months old, they begin to wave their fists and grab at things. They also begin to put many things into their mouths. As a result, parents need to take several additional steps to ensure that the child does not accidentally choke or become burned, poisoned, cut or strangled.

After children turn six months old, their pace of activity picks up dramatically as they begin to roll over, sit up, crawl and stand. Children of this age grab onto anything they can to boost and steady themselves. As children progress through the first two years of life, they develop a love for playing in water, raising the danger of drowning. Firearms also begin to pose a greater hazard when children reach this age. Handguns are frequently a source of dangerous accidents.

Between the ages of three and five years, children begin to explore the world outside the home in greater detail. Children are at greater risks for injuries such as falls from playground equipment or tumbling from a bicycle or tricycle. Wearing the right protection – such as helmets – can reduce the risk of injury. As children grow and begin eating more adult foods, they should be encouraged to chew their food thoroughly to avoid choking.

By age six, children display increasing independence and begin to try to prove their maturity. Parents can take advantage of these developments by allowing their children to have a more active role in implementing safety measures in their lives.

Between the ages of eight and 10, children become much more independent and look to peers for approval. They may even begin to rebel against the rules established by parents and to engage in more daring behavior. Parents are urged to show that they remain in control of setting the child’s boundaries. They also should continue to insist on safety precautions as the child’s activities evolve – such as wearing the proper equipment when participating in various sports.

Child safety is a major concern for any parent. The risks to a child’s health are present from the moment parents bring their newborn home until the child enters adolescence and beyond. As a child grows up, many different steps can be taken to reduce the potential for harm both inside and outside the home.

Injuries are the leading cause of death in children ages 1 to 14, according to the American Academy of Family Physicians. Nearly 70 percent of these fatalities occur in children under age 4. Most of these deaths could be prevented with proper safety precautions.

The following factors are most often cited for child accidents in the home, according to the Centers for Disease Control and Prevention (CDC):

• Water in the kitchen, bathroom, swimming pool or hot tub.
  
  
• Heat or flames in a kitchen or barbecue grill.
  
  
• Toxic substances under the kitchen sink, in the medicine cabinet, in the garage, or in a purse.
  
  
• Areas where falls may occur, such as stairs, slippery floors or high windows.

As children grow older, they become more inquisitive and their physical and psychological progression allows them to engage in an ever-growing list of behaviors that are necessary for development, but which can also present various risks to their health. This patient guide highlights some of the things parents can do to increase child safety at various points during a child’s life. However, some areas of child safety are explained in greater detail in other patient guides.

Each year, hundreds of children younger than age 1 in the United States die because of injuries, according to the American Academy of Pediatrics (AAP). Most of these deaths can be prevented with proper safety precautions.

Children are extremely active and curious and learn quickly, even at a very young age. Therefore, it is essential that parents take steps to childproof their home as a means of reducing the risk of potential injury to a child.

Parents can begin to provide a safe environment for their child even before birth. It is easy for adults to overlook many features of the home that may pose potential safety hazards. Crawling around the house on one’s hands and knees can provide better insight into the potential hazards that may exist for a baby.

Many types of alterations around the home are considered essential to increasing child safety. Doorknob covers should be installed to prevent children from turning the door handle, and guards should be installed to keep children from pinching their fingers. Cabinets should be secured with safety latches, especially if they contain potentially hazardous substances.

All windows above the first floor should have operable window guards, because children can fall from windows that are open as little as 5 inches (12.7 centimeters) wide. Window guards should be too difficult for children to open, but easy for parents to open in case of a fire. Safety locks or covers should also be placed on toilets, dishwashers, ovens and stoves, and stove knobs.

Bookshelves and other stand-alone furniture should be secured to prevent the risk of it tipping over. Sharp-edged furniture should be removed from or covered in any room where the child is going to play. Unused electrical outlets should be covered with safety plugs, and excess electrical cord should be bound with twist ties or wound around special spools. Poisonous plants should be removed from the home. These include a wide variety of plants, such as azaleas, daffodils, mistletoe, holly, morning glory and many others.

Walls and floors should be inspected to make sure walls have no peeling or cracking paint, and that rugs are secured to floors or fitted with anti-slip pads. People who live in homes built before 1978 should verify that there is no lead paint in the home, which may cause lead poisoning in children.

Many general safety measures can be applied to infants and older children. Some of them are more specific to children at certain ages. Some tips to increase safety for babies and children include:

• Always place babies to sleep on their backs to minimize the risk of sudden infant death syndrome (SIDS). Babies should not be placed on water beds, beanbags or anything soft enough to cover the face and block air to the nose and mouth. Babies are also at risk for falling from beds, sofas or chairs. For this reason, babies should never be left unsupervised on these surfaces. Children also should not sleep on the top bunk of a bunkbed until the age of 6 years.
  
  
• Choose safe toys for children. Parents are urged to read all manufacturers’ warnings about toys and to follow their recommendations about which toys are appropriate given a child’s age. Avoid purchasing toys with parts that can be swallowed. Painted toys manufactured before 1978 should not be given to children, because they may contain high levels of lead. Balloons should not be given to children younger than 8 years old, as they are the leading cause of choking deaths (which make up one-third of all toy-related deaths) attributed to toys. Vending-machine toys should not be given to children, as these toys do not have to meet safety regulations set for other toys. Some toys purchased via the Internet or made in other countries may not list safety regulations or may not be made to U.S. safety standards if they are not commercially imported to the United States.
  
  
• Be careful about solid foods fed to a baby. Do not feed a baby certain foods unless they are very thinly sliced. Even for toddlers and older children, some foods should be sliced. These include pieces of hard foods such as carrots or apples, grapes, popcorn, caramels, cheese cubes, hot dogs and peanuts. Foods such as grapes should be cut into quarters, while hot dogs should have the skin removed and be sliced lengthwise into four strips before they are chopped into smaller pieces. Vegetables should be cooked rather than served raw.
  
  
• Keep all strings, ropes and cords away from babies. Strangulation is a risk with such devices. Babies should not be dressed in necklaces or headbands, and clothes with drawstrings should be avoided. Pacifiers should not be placed around a baby’s neck or tethered to clothing.
  
  
• Keep all plastic bags and large sandwich bags in locked cabinets out of children’s reach. This can help prevent accidental suffocation.
  
  
• Lock up all sharp objects, such as knives, forks and scissors. Other items that should be locked in secured cabinets include appliances with sharp blades, shaving razors, tools and glass objects.
  
  
• Keep all potentially toxic substances locked up and out of reach. This includes obvious items such as cleaners, insecticides, medications and alcohol. However, it also includes less obvious substances such as iron pills, windshield washer fluid and mouthwash.
  
  
• Always supervise children around pets. This is particularly true of dogs. More than 4.7 million people suffer dog bites each year in the United States and more than half of those victims are under the age of 14, according to the American Academy of Pediatrics (AAP). The AAP suggests for parents to consult a veterinarian when deciding on getting a dog and inquire about the behavior of different breeds and then choose one that is a good match for the family. The organization also urges parents to train their dog, teach their children dog safety tips (e.g., never bother a dog when it is sleeping, eating or caring for puppies) as well as ensuring their pet is vaccinated against rabies and other diseases.
  
  
• Keep emergency numbers handy. Parents and other caregivers should have quick access to a list of phone numbers, such as those for poison control, the child’s pediatrician, the parents’ work and cell phone numbers, and numbers of a neighbor or nearby relative.
  
  
• Keep abreast of recalls. Consumer products such as car safety seats, toys and strollers are frequently recalled by their manufacturers, sometimes for safety reasons. Parents should keep documents with serial numbers associated with these products and check them when they hear about recalls.
  
  
• Purchase baby bathtubs with slip-resistant backings. Parents are urged not to use bath rings, baby flotation devices and suction seats that do not have restraining belts, because these items can flip and present a risk of drowning. Also, foam cushions should be avoided as babies can tear off pieces and swallow them. Nonskid strips should also be placed on the bottom of the tub to prevent children from slipping.
  
  
• Inform all caregivers, including grandparents, of safety practices they should follow while caring for a child. This is especially true for grandparents or other older adults, whose childrearing behavior is rooted in practices from previous decades. For example, current medical practice advises putting infants to sleep on their backs. Many grandparents remember being advised against this practice when they were young parents and put infants to sleep on their stomachs.

Prior to or just after the child is born, parents are urged to consider enrolling in CPR (cardiopulmonary resuscitation) and other lifesaving courses. Parents who gain these skills may someday save their child’s life if the baby starts choking or suffocating. Parents should also keep a first aid kit handy.

After parents bring their newborn home from the hospital, the child will spend a lot of time in the nursery. Cribs are responsible for more infant deaths than any other nursery feature, which underscores the importance of selecting a new or used crib that has the proper safety features. If parents decide to buy a used crib, they are urged to be extra vigilant, because many older cribs (even those less than 10 years old) do not have the same safety features as modern cribs. In addition, cribs made before 1978 may have a lead-based finish that can present hazards of lead poisoning for the baby.

In selecting a crib, slats should be no more than 2 and 3/8 inches (6 centimeters) apart to prevent babies from falling outside the crib or getting their heads trapped between the slats. Side rails that lower should have at least two locking devices, and these rails should always remain at least 9 inches (23 centimeters) above the mattress support when lowered and 26 inches (66 centimeters) above the mattress support when raised. To prevent accidental strangulation, corner posts should be flush with the top of the headboard and footboard, or much taller – at least 16 inches (41 centimeters).

Parents are also urged to get the firmest mattress possible, because soft mattresses have been implicated in sudden infant death syndrome (SIDS). Mattresses should fit snugly in the crib to prevent the child from slipping between the mattress and the crib sides.

Cribs should be checked regularly to make sure screws are tight. Soft bedding and toys should not be placed in the crib, as they are suffocation hazards. Once babies begin to pull themselves up, crib gyms, mobiles and bumpers should be removed. Never place a crib near a window, because a baby can become entangled in window blind cords or fall out the window.

Changing tables present other potential risks to a baby. Children who are not properly secured on these tables may fall off and get hurt. There are three major varieties of changing tables – wooden tables with guardrails, fold-up models and hinged chest adapters. Experts have warned against using the last of these, because they are at risk of falling over if a baby gets too close to the outer edge.

Fold-up models should be tested for sturdiness by giving them a good shake while they are open, and guardrail models should have rails that are at least 2 inches (5 centimeters) high. Babies frequently squirm on changing tables. A safety belt should be used to secure the baby to the table during every changing. Never turn away from a baby on a changing table.

New babies are often placed in both playpens and strollers. Parents are urged to select playpens that are at least 20 inches (51 centimeters) high when measured from the floor. Playpens with mesh sides should have holes that are no bigger than 0.25 inches (0.6 centimeters). Children should never be left in playpens unattended, and should not be allowed to use the playpen after they grow big enough that they can easily climb out of it.

Parents shopping for strollers are urged to look for a type that has reliable restraining belts, such as the “T” buckle that has a crotch strap and waist belts that connect. In addition, the stroller should not have any parts that can pinch a baby’s fingers or pose a choking hazard. Leg openings should be small enough that there is no risk of the baby falling through.

Purchasing the right equipment is a key to child safety. However, some of the dangers that surround babies are a result of the child’s behavior. Parents are urged to anticipate these behaviors and take steps to lower the risk of harm they can pose.

For example, by the time babies are between 3 months and 5 months old, they begin to wave their fists and grab at things. This significantly raises the danger that a child might accidentally become burned. Parents are urged not to carry their baby and hot foods or liquids at the same time. Also, it is advisable to reduce the maximum temperature on a hot water heater to 120 degrees Fahrenheit (48.9 degrees Celsius), which can reduce the risk of accidentally scalding the baby with hot tap water. Baby bottles should not be warmed in a microwave oven, which can result in uneven heating of milk.

As soon as six months after birth, babies begin to crawl, creating a whole new set of potential dangers. Parents are urged to place childproof gates in front of all stairways. Traditional accordion gates are dangerous because they can trap a child’s head and cause strangulation. Mesh gates also are dangerous because they can trap a child’s fingers. Instead, parents are encouraged to purchase hardware-mounted gates that attach to door frames without any openings that can trap necks or fingers. There should be no more than 1 to 2 inches (2.5 to 5 centimeters) of space between the floor and the bottom of the gate. Even after these gates are installed, children should not be left unsupervised around stairs.

Toys, shoes and other items should not be left on stairways, and guards should be placed on banisters and railings to keep children from squeezing themselves into the space between the wall and the railing.

Organizations such as the American Academy of Pediatrics (AAP) urge parents not to use baby walkers, because they may tip over or fall down stairs, leading to significant injury.

After children turn 6 months old, their pace of activity picks up dramatically as they begin to roll over, sit up, crawl and stand. Before long, they may begin to climb and, eventually, to walk. Soon, they are able to grab for items that previously were out of their reach.

As children begin to climb, they will grab onto anything they can to boost and steady themselves. This includes table legs, dresser drawers, table cloths and ironing boards. Large TVs also pose a danger to small children should these sets tip over. As a result, parents need to make further adjustments to the home to keep the child protected. Cups of hot coffee or other liquids should not be left on tables or counter edges while the child is present. Children of this age are at greater risk for burning themselves on stoves, wall or space heaters or other heated appliances. Childproof covers should be used for these devices. If a parent is unable to focus complete attention on the baby, the child should be kept in a playpen, high chair or crib.

Children at this age typically love to play in water, which raises the risk of accidental drowning. Children under the age of 1 year are most likely to drown in bathtubs, buckets and toilets. Water should be emptied from a bathtub, pail or any other container immediately after use. Children can drown in less than 2 inches of water, so children should never be left unsupervised in or near any amount of water. This includes bathtubs, toilets, buckets, hot tubs and spas, wading pools, swimming pools, irrigation ditches and wells, fish ponds and fountains. Parents are urged to remain within an arm’s length of their child at all times when the baby is in water. This is known as “touch supervision.”

Families that do not have swimming pools are urged to delay installing a pool until a child is at least 5 years of age. Households that have pools should install a fence that is at least 4 feet high and that separates the pool from the rest of the house on all four sides. This should be done before a child begins to walk. Most child deaths involving drowning occur because of a failure to take this precaution. Building a fence around the pool can reduce fatalities by 50 percent, according to the AAP.

Between the ages of 6 months and 1 year, children try to put all kinds of things into their mouths, even if they do not taste good. Parents are urged to keep cleaners, bleaches, medications and chemicals up very high in cupboards that are properly secured. All drawers and cupboards should be fastened with safety latches or locks. Lye drain cleaners should not be stored in the home. In addition, potentially toxic products should be left in their containers and never transferred to other containers, such as old soda bottles.

Cars should be locked, including trunks. Children should not be left in a car unattended. During warm weather, a car’s interior can heat up quickly, leading to serious injury or fatality.

Between the ages of 1 and 2 years, children can walk, run, climb, jump and perform many tasks that previously were beyond their capabilities. As a result, this period of a child’s life can be very dangerous, and parents must remain extra vigilant. A young child may understand the word “no,” but is not likely to follow such commands. Parents should forbid an action and still watch the child. At this age, safety gates placed before stairwells can usually be removed. Children learn to climb stairs as they walk and can be taught to come downstairs backwards, with supervision.

Firearms begin to pose a greater hazard when children reach this age. Handguns are frequently a source of serious accidents. If guns are kept inside the home, they should be left unloaded and locked, and stored separately from ammunition. Parents may want to inquire if people in other homes where the child may play or visit have secured firearms properly.

Accidental poisonings become an ever greater risk, because children at these ages can open doors, drawers and bottles with ease and are able to take things apart. All medications should be stored in childproof containers and locked away securely.

Children who are learning to walk at this age will grab anything to steady themselves, including hot oven doors and outdoor grills. This can lead to serious burns. Children should be kept out of rooms where hot devices are operating or barriers should be erected around these devices.

After a child is able to walk, parents are urged to walk behind their cars before backing out of a driveway to make sure their child is not there.

In addition, during celebrations that involve fireworks (e.g., Fourth of July), children should not be allowed near fireworks of any kind. According to studies by the AAP, more than half of children injured by fireworks were being supervised by an adult when the injury occurred.

Other potential sources of injuries for young children when outside the home include shopping carts and (moving) escalators. Most supermarkets and other stores have shopping carts with child compartments in the front. Parents should ensure that the child is properly strapped in the shopping cart at all times while at the store. Managers or other store staff should be notified if the cart is missing a child harness strap. Children also should not be left unattended in a shopping cart.

Escalators can pose risk for small children due to falls or entrapment. Young children should not be transported on a stroller, walker or cart while on an escalator. Parents or other caretakers should hold children’s hands while on escalators and not permit them to sit or play on the steps. Be aware that loose shoe laces, drawstrings, scarves and mittens can get trapped in escalators and take proper precautions with such articles of clothing.

By age 6, children display increasing independence and begin to try to prove their maturity. Parents can take advantage of these developments by allowing their children to have a more active role in implementing safety measures. For example, families can work together to plan and practice a fire escape safety route. Children should also be encouraged to explore life on their own, but within limits. For example, children may be allowed to ride their bicycle on their own to a nearby friend’s house during the day, but are still too young to ride alone before dawn or after dusk.

A child’s growing independence can also create some additional risks as children begin to overestimate their maturity level. At age 6, children still are not proficient at judging sound or distance, or in determining the speed of a moving car.

Between the ages of 8 and 10 years, children become much more independent and look to peers for approval. They may even begin to rebel against the rules established by parents and to engage in more daring behavior. Parents are urged to show that they remain in control of setting the child’s boundaries. While parents cannot completely prevent their children from behaving in certain ways, they are urged to continue to stress the need for safety, and to establish consequences for failing to follow such rules.

Parents are urged to encourage their children to take steps to lower the risk of sport-related injuries. These include stretching and warming up before activity, eating a healthy diet that can strengthen muscle tissue and support bone growth, and getting plenty of rest. In addition, it is essential that children wear all protective equipment, such as proper footwear, shoulder pads, shin pads, mouth guards and helmets for any sport. Parents and coaches also should ensure that the child drinks enough fluids, especially when participating in sports outdoors or on a hot day.

By the time children reach adolescence, they have become physically and psychologically mature enough to recognize many of the potential dangers around them and to take steps to reduce the risk of injury. However, new dangers arise as they engage in more daring behavior.

Additionally, parents should choose a safe vehicle for their young teenager and control access to that vehicle. Adolescents also should be made aware of the dangers of speeding, not wearing seat belts and driving while intoxicated. Risky teen driving behaviors, traffic violations and automobile accidents are less common when parents impose limitations.

Children of every age, gender and race may be vulnerable to child abduction. Parents can be crucial in helping prevent child abduction by teaching children about personal safety. The National Center for Missing and Exploited Children recommends the following to help prevent child abduction:

• Set boundaries regarding the places a child may go, people they may see and things they may do.
  
  
• Reinforce the importance of the “buddy system.” There is safety in numbers. An abductor is less likely to target a child who is surrounded by various other children as opposed to one who is alone.
  
  
• Teach children that it is OK to say “NO” and trust their instincts.
  
  
• Know where the child is at all times.
  
  
• Ensure that the child checks in with you if there is a change in plans.
  
  
• Teach young children that adults should not approach children for help or directions. Instruct the child that if they are approached by an adult, they should stay alert because this may be a “trick.”
  
  
• Walk the route to and from school with your children, pointing out landmarks and safe places to go if they are being followed or need help. It may help to draw a map showing acceptable routes to school, using main roads and avoiding shortcuts or isolated areas. If the child takes the bus, visit the bus stop with them and make sure they know which bus to take.  
  
  
• Know your neighborhood. This can be done by interacting regularly with the neighbors. Let the child know whose homes they are allowed to visit.
  
  
• Do not drop off children alone at malls, movie theaters, video arcades, parks or other public places.
  
  
• Let children know that they should never go anywhere with anyone without getting your permission first.
  
  
• Know your (home) employees. Do background screening and reference checks on everyone who works at your home, particularly those individuals who care for your children (e.g., nannies, babysitters). Their knowledge of your family is extensive so make sure you have an equivalent understanding of who they are.
  
  
• Talk openly to children about safety and encourage them to tell you or another trusted adult if anyone or anything makes them feel scared, uncomfortable or confused.

In addition, while the Internet can be a great learning tool for children, it also can expose them to material that is age-inappropriate (e.g., porn) as well as online sex-offenders. Parents should become aware of the Internet sites (including chat rooms and other live electronic communications) their child frequents as well as monitor their child’s e-mail. Computer sex-offenders almost always meet potential victims via chat rooms. Make children aware, especially younger ones, that people online may not be who they say they are. For instance, someone who says that “she” is a 12-year-old girl could actually be an older man.

Many Internet service providers offer parental controls and/or blocking software to deny access to children to designated or unrecognized Web sites. It may also help to keep the computer in a common room in the house (e.g., den), instead of the child’s bedroom. Most importantly, parents should communicate to their child about sexual victimization and potential online dangers.

The U.S. Department of Justice’s Federal Bureau of Investigations recommends parents and other caring adults be on the lookout for the following signs, which can indicate a child is at risk online:

• Spends large amounts of time online, especially at night.
  
  
• There is pornography on his or her computer.
  
  
• Receives phone calls from men you do not know or is making calls, sometimes long distance, to numbers you do not recognize.
  
  
• Receives mail, gifts or packages from a stranger.
  
  
• Becomes withdrawn from the family.
  
  
• Uses an online account belonging to someone else (online sex-offenders will sometimes provide potential victims with a computer account for communications with them).

Preparing questions in advance can help patients and parents have more meaningful discussions with physicians regarding their or their child’s treatment options. The following questions related to child safety may be helpful:

1. Where can I find help in childproofing my home?
   
   
2. Are there particular changes in the home that are crucial and absolutely should be made, regardless of finances?
   
   
3. Where can I find child safety products?
   
   
4. Are there resources that can help me determine the safety of cribs, strollers, etc.?
   
   
5. Where should I store my emergency numbers?
   
   
6. How many first aid kits do I need? Where should I keep them?
   
   
7. When should my child start swimming lessons?
   
   
8. How many childproofing measures must I duplicate at a caregiver’s or grandparent’s home?
   
   
9. My parents believe I’m excessive in my use of child safety items such as car seats. How can I convince them they are necessary?
   
   
10. Are there certain toys I should not give my child?
    
    
11. At what point can I remove cabinet latches and outlet covers?
    
    
12. My child walks to and from school. How can I ensure his/her safety during such times?
    
    
13. How can I prevent my child from visiting inappropriate Internet sites?