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Injury Prevention

• Unintentional Injury • Preventing Injury • Safety Practices

Unintentional Injury

Supporting healthy child development includes encouraging children’s natural curiosity and emerging skills. As children explore their environment and try new skills they often do not recognize hazards in their environment or other factors that may compromise their safety and well-being. They also do not have the ability or autonomy to remove dangerous conditions from their environment. The child’s caregiver and professionals who care for him need to keep the child safe. Keeping a child safe may be as simple as supervising him on the playground or providing information on safe infant sleep to parents. It can also include involving child protection services when those, whose role it is to protect the child, fail to provide that protection, putting the child’s safety and well-being at risk.

Supporting children’s safety and well-being is done in a number of ways:
•   Preventing unintentional injury
•   Preventing or recognizing maltreatment
•   Reporting maltreatment

Preventing Injury

• Safe Environment • Supervision • Policies and Procedures
• Safety Rules • Communicating with the Family

Unintentional injury is the most common cause of death in children over the age of one. Most deaths are the result of motor vehicle accidents, but death from fire, drowning, choking, suffocation and poisoning also occur (Farchi et al., 2006; Grenier & Leduc, 2008). Unintentional injuries also lead to bumps and bruises, burns, scalds, broken bones, head injuries and more.

It is more common for injuries to happen when

Adults are

Distracted
Very busy
Temporarily absent
Involved in situations that cause some confusion or unplanned changes in routine

Children are

Hungry
Tired
Distracted
Excited
Away from their regular routine

Injury prevention should therefore be done in a systematic approach that should include:

Providing a safe environment
Supervising children
Having appropriate policies and guidelines in place
Having safety rules for children
Communicating with the family

Safe Environment

The spaces where children live, play and learn need to be designed with the child in mind. Children need space to be physically active, and to be quiet. Watching for hazards, keeping children contained in one area, having surfaces, furniture, play equipment and toys in good working order are also important. The space should also be appropriate for the developmental stage of the child. This can be a challenge with siblings of different ages, or in a small, home-based child care setting with children of different ages. Children outgrow equipment such as infant swings or stationary activity centres very quickly. Always follow the weight and height guidelines and instructions for use. The same rules apply to cribs, cradles, playpens and bassinettes. It is also important to check the Health Canada website (www.hc-sc.gc.ca) regularly for consumer product safety and any recalls (Grenier and Leduc, 2008).

A safe environment includes:

The physical environment
Products used
Storage and handling of equipment, food and drink
Knowledge of each child's developmental stage, ability and temperament

To make the physical environment safe consider

The space
The play surface
The furniture or equipment in the space

Professionals need to put themselves at a child's level and assess their environment for any conditions that can be hazardous. Professionals also need to advocate for that same vigilance at home and provide resources for parents make a safer home environment.

Supervision

Even the safest space does not reduce the need for adequate adult supervision. Adults must always remain vigilant and anticipate the child's needs, actions and level of development. Active supervision means that the adult stays close, especially when the child is exploring new equipment, play structures or trying new skills. The adult should scan the environment for any potential hazards and remove them, if possible, and make sure the children are not creating risks to their own safety or the safety of other children.

Policies and Procedures

Early learning and child care settings have strict regulations around safety. Policies and guidelines set out by the licensing authority, the Day Nurseries Act, the Canadian Childcare Federation, or other organizations, provide consistency for all staff and children. Most settings will have preventive policies and procedures that each professional should know and follow. You can also promote or develop policies and procedures that will ensure children's safety in your setting.

Safety Rules

As soon as children respond to their name and become more mobile, they can be taught some basic safety rules. Grenier and Leduc (2008) list the key ingredients of good safety rules in Well-Beings: A Guide to Health in Childcare.

"A good safety rule …

Is simple, clear and age-appropriate
Is consistent
Is reasonable
Is reinforced
Is shared with all caregivers
Is positive
Is not scary
Has consequences" (p. 65)

Communicating with the family

Children spend much of their time at home and in the care and presence of their family. Communicating with the family and providing the child's primary caregiver with good resources on safety is therefore imperative.

Caregivers need safety information on safe practices such as:

Infant sleep environment
Vehicle and traffic
Water
Sun
Equipment and toys
Household and environmental products
Food and drink

Safety Practices

The following practices have been found to increase children's safety:

	Safety Practices to Prevent:
Falls/ Cuts	Infant or child is not left unattended on above ground surfaces (e.g., change tables, climbers) Safety gates are installed and used at stairs inside home or on decks Infant walker/baby exerciser or similar equipment on wheels is not used Baby jumpers have been properly secured to a door frame and are used only under supervision Child is always supervised near or on balcony, staircase, or playground Protective rail is used on beds for children The top level of a bunk bed is only used with children 6 years of age or older Child plays on playgrounds with impact-absorbing materials to soften falls Child wears a safety helmet during bike riding, rollerblading, skateboarding or similar activities Safety devices are installed on windows, patio and balcony doors Sharp instruments (e.g., scissors, knives) are not within child's reach
Motor Vehicle or Traffic Accidents	Car seats and booster seats are installed properly and used properly according to age, height and weight of the child Child plays in safe areas away from parked cars or road Child is taught how to "stop, look and listen"
Drowning	Swimming pools or hot tubs are fenced in and can only be accessed through a locked gate A supervising adult is within arms length of the child while near any water that is deeper than 5 cm (2 inches) (e.g., pools, bathtubs, ponds) Baby bath seats or rings are not used
Burning/Scalding	Home water temperature is set to 49 degree Celsius or less Bath water is tested before putting child in bathtub (should be 49 degrees Celsius or less) Cold water faucets are turned on before hot water faucets when washing hands Hot liquids and foods are kept away from a child especially while carrying the child Pot handles are turned towards centre of stove; hot soup is one of the leading causes of childhood scalding injury in the United States (WHO, 2008) Smoke and carbon dioxide alarms are used throughout the house or apartment Fire extinguisher is present in the kitchen and caregivers know how to use it Barrier is used around fireplace or wood burning stove Matches or lighters and other flammable substances are not within a child's reach
Sunburns	Protective clothing such as wide brimmed hats are used when children are outdoors Playing in the sun is avoided during peak sun hours (10am - 2pm) Sunscreen is applied to children over 6 months 30 minutes before such exposure and reapplied every 2 - 3 hours Spaces where children play are designed with structures providing shade
Suffocation/ Choking/ Strangulation	Small objects such as food (e.g., hard candy, nuts, popcorn, grapes, hotdog pieces), beads, coins, small parts of toys, are kept away from infants or toddlers under 3 years of age Cribs are placed away from windows, blinds, curtain cords, straps, lamps, electrical plugs, and extension cords Child is not wearing pacifier, jewelry, cord, string or skipping rope around neck Child does not play on playground equipment wearing scarves or clothing with cords or drawstrings
Poisoning/ Electrocution	Child-resistant caps/packaging are used on medications and household poisons and kept out of reach Cupboards containing poisonous items such as household cleaning products, medications, pesticides are locked with childproof locks Toxic or poisonous plants are not within child's reach or not kept in or around the home until the child understands the danger Electrical outlets are covered with plastic safety covers
Sudden Infant Death Syndrome (SIDS)/ Sudden Unexpected Death in Infancy (SUDI) (applies to infants from birth to 12 months)	Infant is placed on his back for night time sleep and all naps Infant is placed in a crib with only a tightly fitted sheet and light blanket or sleep sac Infant is not placed to sleep on waterbeds, futons, couches, loveseats, chairs, car seats, makeshift beds or adult beds Infant sleeps in the parents' room for the first 6 months Infant is not overheated Bumper pads, duvets, pillows, heavy blankets and soft toys are not used in the crib Infant is put to sleep in a smoke free environment Infant does not share a sleep surface with others
Crib and Equipment Safety	Cribs made before September 1986 are not used because they do not meet current Canadian safety regulations The crib is not modified Children younger than two years of age sleep in a crib Equipment is used according to manufacturer's instructions Equipment is used according to age limitations Equipment is checked for recalls
Environmental Toxins and Pollutants	Home is free from second-hand and third-hand smoke (toxic chemicals released by smoking that are trapped in hair, skin, fabric, carpet, furniture, and toys) Child uses good quality toys without lead Lead-free paint is used in the home Home is kept clean (dust in older homes may contain lead) and free from allergens and moulds Mercury thermometer is not used Breastmilk, formula or food is not heated in plastic bottles or containers containing Bisphenol A Cold tap water is used for drinking water or to reconstitute drinks including formula (hot tap water contains more lead) In homes older than 1990, water is run for 2 minutes every morning before using it to make formula, other drinks or baby food Vinyl toys are not used for young children (chemicals can be absorbed through chewing and sucking) Children's art materials (e.g., markers, paints) are made of non-toxic materials Outdoor footwear is removed inside (e.g., metals, pesticides, and animal droppings can be tracked into the home on outdoor footwear) Children's playground equipment or picnic tables are made from cedar, redwood or metal, not pressure treated wood (may contain arsenic) Children are kept away from paints, glues, new carpets and similar things that may give off chemical gases Pesticides or harsh cleaning chemicals are not used near children Children are kept indoors on days when the air quality is poor Additional information can also be obtained at: http://www.toronto.ca/health/hphe/children.htm http://beststart.org/resources/env_action/pdf/AppB_auditform.pdf

(Bridgman-Acker, 2009; Canadian Paediatric Society, 2004; Grenier & Leduc, 2008; Health Canada, 2008; Hunt & Hauck, 2006; Nansel et al., 2008; Safe Kids Canada, no date; Schnitzer, 2006; WHO, 2008)