Childhood Injury Prevention

  • Motor vehicle crashes: In 2022, 68 percent of children who died while riding with unrestrained drivers were also unrestrained. 
  • Head trauma: Includes concussions and more severe traumatic brain injuries. 
  • Burns: Nearly 75 percent of all scalding burns in children are preventable. 
  • Fractures, lacerations, and soft tissue injuries 
  • Poisoning: About 3 million people, many of whom are under 5, are exposed toor ingest a poisonous substance each year. 
  • Firearm Injury: Children as young as 3 years may be strong enough to pull the trigger of a handgun.  
  • Foreign Body Ingestion: Foreign bodies of the ear, nose, airway, and esophagus are a common cause of presentation to the emergency department for young children. 
  • Animal Bites: Nearly 1 in 5 dog bite victims need medical attention, with children often facing more serious injuries to the head, face, or neck. 

A 4-year-old child presents for a well-child visit. The parent expresses concern about ensuring the home is safe and asks for advice on injury prevention. The family recently purchased a bike for the child and is unsure about helmet use. They also have a pool in the backyard and firearms in the home. 

History

Home Safety:  

  • Are there safety gates at the top and bottom of stairs?  
  • Are cleaning supplies, medications, and other toxic substances stored out of reach or in locked cabinets?  
  • Are electrical outlets covered, and are cords secured?  
  • Is the water heater set to a safe temperature (below 120°F) to prevent burns?  

Transportation Safety:  

  • Does the child use a car seat or booster seat appropriate for their age, weight, and height?  
  • Is the car seat installed correctly, and does the child always ride in the back seat?  

Recreational Safety:  

  • Does the child wear a properly fitted helmet when riding a bike, scooter, or skateboard?  
  • Are there any trampolines at home, and if so, are safety nets and padding used? 

Water Safety:  

  • Is there a pool at home, and is it surrounded by a fence with a self-latching gate? 
  • Does the child know how to swim, or are swimming lessons planned?  

Firearm Safety:  

  • Are there firearms in the home?  
  • If so, are they stored unloaded, locked, and separate from ammunition? 

Sleep Safety (for younger children):  

  • Does the child sleep in a crib or bed that meets safety standards? 

Anticipatory Guidance for Parents on Safety:  

Car safety seats 
  • Children should be placed in a rear-facing car safety seats as long as possible (until maximum weight written on manufacturer’s tag) 
  • Transition to forward-facing car seats once children outgrow rear-facing seats, and use them until at least 4 years old 
  • Use belt-positioning booster seats from the time they outgrow forward-facing seats through at least 8 years of age or until lap and shoulder seatbelts align properly 
  • Lap and shoulder seat belts for all who have outgrown booster seats 
  • Children younger than 13 years should ride in the rear seat of the vehicle 

Safe home environment 
  • Install smoke and carbon monoxide detectors, at least 1 of each on each level 
  • Check furniture for stability and tip-over risk 
  • Put safety locks on all cabinets containing cleaning fluids, medications, alcoholic beverages/substance containing marijuana, etc.  
  • Install safety gates at the top and bottom of stairs 

Water safety 
  • Stay within arm’s reach when your child is around water 
  • Your child should always be with an adult when near a full bathtub 
  • If you have a pool, make sure that it is surrounded by a fence on all 4 sides that is at least 4-feet tall and has a self-latching door 

Firearm safety 
  • The safest home for a child is one without guns 
  • All firearms should be kept unloaded and locked using one or more of the following: trigger lock, cable lock, gun safe, or firearm cabinet safe 
  • Ask about firearms before you child goes on a playdate 

Animals 
  • Always supervise small children and dogs together, regardless of whether it's the family pet, a familiar dog, or well-behaved, as any dog has the potential to bite 
  • If your child is bitten by a dog, obtain proof of rabies vaccination and the owner's contact information 
  • Then call your pediatrician or go to the Emergency Department because your child might need antibiotics, a tetanus shot, and/or rabies shots. The doctor can also help you report the incident to your local health department. 

  • Injuries are often preventable. Educate caregivers on injury prevention strategies. 
  • Always consider non-accidental trauma: Be vigilant for signs of abuse, especially in younger children or when the history is inconsistent.