Safety for Children From Birth to Age Three Contents

3 Introduction 4 Baby equipment safety tips 9 Safety: Newborn to 6 months 12 Safety: 7 to 12 months 16 Safety: 1 to 2 years 19 Safety: 2 to 3 years 22 Home safety guidelines 28 Car safety reminders 30 Outdoor safety 34 Preparing for emergencies 37 Helpful emergency resources

Reviewed October 2016 by Deborah Borchers, MD. Dr. Borchers is a primary care pediatrician currently practicing at a federally qualified health care center in Ohio. © 1994, 2016 LifeWorks US Inc. Introduction

As parents and caregivers, we all care about the safety of Remember, every child (and every home) is different. Use our children. We want to do everything we can to keep the ages in this book only as a guide. All children grow them safe. Adults often worry about violence and crime, at individual rates. Some learn to roll over, sit up, or walk but common injuries like falls, burns, and choking hurt sooner than others. It’s a good idea to read through all of young children more often. Fortunately, many accidents the different sections of the book so you can plan ahead can be prevented with a little caution and planning. to keep your child safe—now and in the future. Remember to take extra care when you are visiting. Your friends and This book will help you take some basic steps to make relatives may not have set up their homes with small chil- your child’s world a safer place to grow, learn, and play. dren in mind. Use this book to plan ahead. Children grow faster during their first three years than at any other time. You’ll find Share this book with babysitters, relatives, and others information on when and why you’ll need to take certain who care for your child. Talk about your concerns and steps to keep your child safe. Some things—like installing expectations. You can be more relaxed and confident if latches or window guards—you’ll only need to do once. you know that everyone understands the rules and guide- Others—like adjusting car seats or lowering the crib lines for your child’s safety. mattress—will need to be done as your child grows and changes.

Look at the world through your child’s eyes. One of the best ways to keep children safe as they grow is to watch them. Play with them. Follow them. Get down on the floor with them. What do they see? What might they reach for? What can they grab, pull, bang, climb up, or knock down? What can you do or change to keep them safe?

3 Safety for Children from Birth to Age Three Baby equipment safety tips

The following information will help you make informed • Keep the instructions for your car seat and refer to choices when selecting equipment for your newborn, them to make any needed adjustments as your child baby, or toddler. grows older.

Car seat • Remember that the safest place for a baby or child age 12 or under is the back seat. • Use the right type of seat for your vehicle and your child’s age and size. Make sure the seat has an FMVSS • Never put a car seat in the front passenger seat of a car (Federal Motor Vehicle Safety Standards) label. If you that has an air bag. And don’t allow children to lean or have questions about whether a seat has been recalled rest against parts of the car where side-impact air bags or doesn’t meet safety standards, call the Vehicle Safety are stored, such as the door, which can increase the risk Hotline at 888-327-4236. Or search for its brand name of injury. For more information, search for “Car Seats: and model on the National Highway Traffic Safety Information for Families at healthychildren.org. Administration website. Your local hospital or health department may be able to help you find a safe car seat.

• Once your child outgrows the rear-facing car seat, Need help installing your child’s car seat properly? he or she is ready for a forward-facing car seat, with a Many police officers and firefighters have successfully harness, but always in the back seat. Once they reach completed the National Child Passenger Safety (CPS) the upper weight or height limit of their particular seat certification training course. That program enables (usually around age 4 and 40 pounds), they can switch them to give hands-on help to parents and caregivers to a booster seat in the back seat. who need assistance with installing and fastening car seats. Stop by your nearest police station or firehouse • Adjust the car seat harness so it fits snugly against your and see if a qualified CPS technician can help. child’s shoulders. Be sure to adjust the straps as your child grows.

4 Safety for Children from Birth to Age Three Crib ◦◦No decorative cutouts in the headboard or footboard. All new cribs sold in the U.S. must meet federal safety (Cover them so they can’t catch a baby’s head or standards. Drop-side cribs cannot be made or sold, and clothing. A piece of wood that’s sanded and free of immobilizers and repair kits are not allowed. For more splinters will work.) information, see the U.S. Consumer Product Safety ◦◦No loose hardware. Check screws and bolts fre- Commission (CPSC) website. quently to make sure they’re all there and tightly fastened. • A safe crib should have: • Keep the crib away from dangling strings such as shade ◦◦Rails or slats less than 2-3/8 inches apart. (A baby’s pulls, curtain cords, or wall decorations with ribbons or body can slip through wider rails, leaving the head streamers that might wrap around small necks. Keep the trapped.) Wood rails or slats must be made of strong crib away from lamps and dressers. wood to prevent breakage. ◦◦A firm, tight mattress—no more than two fingers • Check the mattress height regularly and lower it as should fit between mattress edge and crib. (A loose- needed as your baby grows. It’s a good idea to put thick fitting mattress can cause suffocation.) Mattress sup- carpeting underneath, just in case your child tries to ports must be durable. climb out. ◦◦No crib bumpers. Crib bumpers are not recommended • Never use soft bedding or pillows, or have stuffed due to suffocation risk in younger infants and a climb- animals in an infant’s crib. Take any pillows, plastic wrap ing hazard for older babies. on the mattress, or toys with small parts (such as stuffed ◦◦Corner posts no higher than 1/16 inch, or no posts at animals with button eyes) out of cribs. all. (Clothing can get caught on them.) Unscrew or saw • Remove bibs or any other clothing tied around the neck off any corner posts that are too high. before putting a child in a crib. ◦◦No splinters. (Sand any rough wood.)

5 Safety for Children from Birth to Age Three • Be particularly careful when buying or borrowing used Changing table equipment. Check the equipment to make sure that it is • If you have a changing table, make sure it’s sturdily in good condition. Make sure that the equipment meets built, with high sides and a safety strap. Keep one hand today’s safety standards—outlined in this book—and on your child at all times when changing diapers. check for product recalls on the CPSC website. • Once a child is moving more, consider using a changing • Mesh-sided cribs and playpens should have mesh less pad or a towel on the floor. than 1/4 inch in size. They should have no tears, holes, or loose threads, which can entangle a baby. Some par- High chair ents prefer to use an easily portable cradle or bassinet • A safe high chair should have a wide base, a tray that instead of a crib for the first few weeks of their infant’s locks securely, and a safety belt with a strap between life. If you choose to do this, the American Academy of the legs to keep your child sitting securely in the chair Pediatrics says, “In general, your baby should move to a (not slipping down or standing up). crib around the end of the first month of life or by the time he weighs 10 pounds.” Bassinets and cradles must • Keep your high chair away from furniture so children meet their own federal safety standards, last updated can’t kick out and push themselves over. in 2013. Be sure to check these standards before using one that you bought for an older sibling or received • Always make sure the safety strap on the high chair is secondhand. You can find these by searching on the securely fastened and the tray is locked in place. website for the CPSC.

“Never leave a young child alone in a high chair, and do not allow older children to play on it because this could also tip it over.” —American Academy of Pediatrics

6 Safety for Children from Birth to Age Three Hook-on chair Play yard or playpen • Hook-on chairs are often used as substitutes for high • If you use a play yard or playpen, make sure it has a top chairs. Check any caps or plugs on chair tubing to make rail high enough that your child can’t climb or fall out. sure they’re firmly attached. A chair with a clamp that Only use play yards with firm, cushioned floors. Search locks onto the table is more secure. for “playpen safety” at healthychildren.org for more tips.

• Only attach hook-on chairs in places where a child’s • Never leave a child in the play yard or playpen with the feet can’t reach table legs or benches. If a child has a sides dropped down. Mesh sides can create a “suffoca- surface to push against, he may be able to dislodge the tion pocket” when folded down. chair. • Be sure playpens are away from dangling cords and strings, lamps, or other items that can be pulled down.

Make it a habit to childproof your home every few months as your baby grows. You’ll find recommendations on childproofing for specific ages throughout this book.

7 Safety for Children from Birth to Age Three Stroller Toy chest • Be sure your stroller or carriage is equipped with a • If you have a toy chest, remove the lid or install air safety strap, a wide sturdy base, a locking device to pre- holes and a special slow-closing hinge to prevent vent accidental folding, and brakes that can’t be disen- suffocation or finger and head injuries. All toy chests gaged by a child. should be non-locking.

• Do research on any purchase. Strollers come in many Walker styles and can cost anywhere from $100 to $1,000 or • Do not use walkers. Safety experts and doctors agree more, depending on whether you buy a used or new they can cause injuries and can also delay development. one and the extras you prefer. To narrow your options, visit consumerreports.org and search for the current year and “stroller buying guide” for reviews, ratings, and helpful background.

• Do your homework when choosing a stroller. Shop around and try out different strollers. Push them around the store.

8 Safety for Children from Birth to Age Three Safety: Newborn to 6 months

New babies are surprisingly active and grow very quickly. • Never prop a bottle for a baby—one big swallow Newborns who seem helpless soon turn into wiggling, can cause choking. waving babies with wills of their own. They kick their feet • Test the temperature of bottles and food using and shake their hands. In no time at all, they begin to your wrist. grab, reach, and roll. Newborn babies don’t have a lot of muscle control. They need help to support and lift their • Never use a microwave to heat a bottle—it heats wobbly heads. Always hold your baby firmly, using your liquids and food unevenly. For tips on how to heat palm or arm to support her head. formula or breast milk safely, visit the Food and Drug Administration website and search for “Once Baby Pacifiers and bottles Arrives.” Choose a pacifier that can’t come apart, such as one made of one solid piece of plastic. The danger of falling off high surfaces • Always keep one hand on a baby or young child who is • Be sure your child’s pacifier has a mouth guard and on a bed, couch, or changing table. Make sure that she ventilation holes. Throw away any pacifiers that have is fastened down also. rips or holes. • Consider using a pad on the floor to change diapers • Never use a cord or string to attach a pacifier to your once your infant learns to roll over. child or to a seat or stroller. Short pacifier clips or a very short ribbon used to attach a pacifier to a shirt are OK. • Have your infant sleep in a crib or on the floor away from “traffic.” Never use pillows or have soft toys or • Follow the manufacturer’s age range for the pacifier. bumper pads in a crib. Some older children can fit a newborn’s pacifier in their mouth and choke.

9 Safety for Children from Birth to Age Three Once your baby can pull himself up on his Babies put everything into their mouths hands and knees Keep small objects such as batteries, buttons, beads, This generally happens at around 5 months or so, coins, and older children’s toys with small parts out of although it could happen earlier. reach. If an object can fit inside a cardboard toilet paper roll, it is too small. • Remove all hanging crib toys. • Check toys for small edges and points that could cut or • Don’t use clothing with hoods, cords, or strings that scrape your child. could “hang up” a small child. Your baby could tangle his clothing or himself on toys or furniture. While some • Make sure that handles and ends of teething rings, cultures suggest the use of necklaces for little ones, it rattles, and squeeze toys are large and sturdy enough is suggested that you don’t use these. Your child could so they can’t be pulled apart or get caught in a baby’s choke. If the necklaces break, he could swallow some of throat. the pieces. • When your baby is ready to eat solid food (usually • Make sure your window treatments do not pose a between 4 and 6 months, depending on your pediatri- safety risk. Keep the cords to window blinds or drapes cian’s advice), serve only foods that are soft enough to out of reach of children by attaching them to floor swallow without chewing. mounts or wall brackets that hold them tightly. Children • A child’s airway is the size of her smallest finger. Once can strangle on loose cords. she is tolerating textured foods, make sure all pieces of food are soft or small.

To reduce the risks of sudden infant death syndrome (SIDS), the American Academy of Pediatrics strongly recommends putting your baby to sleep on his or her back.

10 Safety for Children from Birth to Age Three Safety reminders for newborns to 6 months • Always fasten the safety straps on equipment like • Remember that young children don’t understand how household infant seats, changing tables, strollers, easily a baby can be hurt. Don’t leave an infant alone in a and baby swings even if you will be right there with room with a toddler or preschooler. your child. • Never drink hot liquids or cook while holding your child. • Put infant seats (and infants) where they cannot roll or • Keep things that can burn or scald a baby’s skin (hot fall. The floor is often a safe place. Don’t put infant seats coffee, food, cigarettes) out of reach. on cushioned surfaces or near the edge of counters or tables. • Make sure that plastic bags and pillows are out of reach, too. They can smother a child. • Don’t put your baby to sleep on an adult bed, waterbed, thick rug, beanbag, pillow, or infant cushion. Babies can suffocate on thick, soft surfaces. And always put your baby to sleep on her back, sleeping alone. Don’t let her fall asleep face down on your tummy either—that’s just as much risk as if she is sleeping on her tummy in a bed. If you’re too tired to hold her and stay awake, put her down. When she sleeps, make sure there are no extra blankets, toys, bumper pads, or anything else in the crib.

11 Safety for Children from Birth to Age Three Safety: 7 to 12 months

Sometime around 6 months, babies begin to get a lot • Be careful if you hang diaper or shopping bags on the more control over their bodies. Suddenly they can go just back of your stroller. The extra weight can make it tip about anywhere—around and under chairs, from room when you take your baby out. to room, up the stairs. They’re much better at picking up • Always stay with a child who’s in the bathtub. No small objects with their fingers. This means they can grab phone call is important enough to take while your child almost anything that’s within their reach, whether it’s a is in the tub. favorite toy or a hot frying pan. The same mobile hanging over the crib that delighted your infant can present a real • Don’t use baby walkers. Doctors agree they can cause danger to an older baby who can pull up, grab it, and get falls and other injuries. They also may delay (not expand) tangled in it. an infant’s development. Make sure there are no walkers at any place where your child receives care. • If you haven’t already childproofed your home with electrical outlet plugs or covers, safety latches on cabi- nets and appliances, guards around windows, radiators, fireplaces, and wood stoves, this is the time to do it. At this age, your baby needs constant attention. You’ll need to be especially careful when you’re out- Because he doesn’t yet understand the word “no,” the doors and in other people’s homes. only way to protect him is by watching, planning ahead, Sitting and making changes to keep him safe. • Never leave a baby alone on the floor surrounded by cushions or pillows. Babies who have just learned to sit topple over easily. A child who falls over could suffocate.

12 Safety for Children from Birth to Age Three Creeping and crawling • Use sturdy screens or guards around fireplaces, radia- tors, hot-water pipes, wood-burning stoves, barbecues, • Use safety gates at the tops and bottoms of stairs. Fasten them every time you go up and down the stairs, or other heating devices. Move fireplace tools out of even if your child is sleeping. This way you will always reach. be in the habit of keeping your home safe. • Avoid space heaters in rooms where children are on the floor. • Make sure all windows above the first floor have secure guards. Standing • Be sure banisters and railings are sturdy on stairs, • Pad or remove (just for now) any furniture that has porches, decks, and balconies, and protect them with sharp or pointed edges. guards. • Be sure nothing can topple onto your baby. Put heavy • Install safety covers or plugs in every electrical outlet. things like lamps and TVs where they won’t fall if bumped. • Put safety latches on any drawers or cabinets that con- tain cleaning products, dishwashing detergent, vitamins, • Remove from the crib any toys or anything else that medicines, shampoos, cosmetics, glass, or sharp objects your child could climb up on. These could enable your (knives, silverware, cooking utensils, scissors, tools, child to fall over the rail. kitchen-wrap packages with serrated edges). If possible, move these items up and out of the way.

• Move small appliances (coffeepot, toaster) and com- Children will pull themselves up by grabbing onto puter accessories (printer, laptop) and electric cords whatever they can reach—a nearby chair, a toy, a crib out of reach. Remember, even when they’re turned off, railing. Their balance is unsteady, so it’s easy for them these can be hot or injure a child who knocks them off a to fall. With a little planning, you can help keep bumps desk or table. It’s best to unplug them when not in use. and bruises to a minimum.

13 Safety for Children from Birth to Age Three Eating and teething Sun safety • Check teething rings and pacifiers. Throw away any • Always apply sunscreen to your baby, and reapply fre- with rips or holes. quently, especially after water play. Choose a sunscreen that has an SPF (sun protection factor) of at least 15 • Keep small objects such as batteries, buttons, beads, and protects against both UVA and UVB rays. Use of coins, and toys with small parts out of reach. sunscreen starts at 6 months for traditional sunscreens. • Vacuum or sweep floors often. If you don’t find that For babies less than 6 months, either avoid the sun or stray pin on the floor, your child might. use sunscreens with titanium.

• Always stir and test food temperature carefully after • Have your baby wear a hat with a brim and, when pos- heating, especially if you’re using a microwave. sible, long-sleeved tops and pants that cover the legs.

• Try to keep pet food and kitty litter out of reach.

“Keep computers out of reach so that your child cannot pull them over on herself. Cords should be out of sight and reach.” —American Academy of Pediatrics

14 Safety for Children from Birth to Age Three Safety reminders for ages 7 to 12 months • Check your car safety seat instructions and make adjust- • Keep the toilet lid closed. If your child is fascinated by ments as your child grows. opening and closing the toilet lid, consider getting a toilet seat lock or keeping bathroom doors closed at all • Check your crib for any loose bolts or screws, and lower times. Close the bathroom door when you are not in the the mattress. Make sure that your child’s crib is approved bathroom. for usage, especially if it is older or you acquired it sec- ondhand. • Always use the safety straps in high chairs and in shop- ping carts. Never leave your baby unattended on any • Move any hanging toys, mobiles, dangling strings, or above-the-ground surface. window cords away from the reach of a child in a crib or playpen. • Never leave anything hot, including hot beverages, on the edge of a table or counter within a child’s reach. • Make sure your window cords are safe and do not have a loop at the end. Roman-style shades and roll-up blinds • Put safe toys where your child can find them easily. manufactured before 2010 (when the Consumer Prod- Soft, squishy, machine-washable toys are best, since uct Safety Commission recalled millions of these shades creepers and crawlers take delight in pushing, throwing, or blinds for safety reasons) could pose a strangulation and dropping their toys. risk. • Avoid giving your baby your smartphone or tablet. The • Empty water immediately after using buckets, wading long-term effects remain unknown about early exposure pools, and baths. These do more than pose a risk of to these devices, according to the American Academy of drowning. Standing water outdoors can breed disease- Pediatrics. Try to read or sing to or play with your child carrying mosquitos. instead of handing over a digital device. In addition, phones and tablets are breeding grounds for germs, germs that will easily enter the mouth of a child who puts everything into his or her mouth.

15 Safety for Children from Birth to Age Three Safety: 1 to 2 years

Children at this age are full of curiosity, and they’re Climb and play always eager to explore. They can walk, jump, and climb. • Check again to make sure you have locks or childproof The world is their playground. For them, couches aren’t latches on all drawers and cabinets, especially ones that just for sitting, but for climbing and bouncing. The toys in hold poisonous or sharp items. the crib aren’t just for snuggling, but for making ways to climb up and out. Some children even figure out how to • Be sure windows have secure guards. move chairs and use them as stairs to get whatever they • Don’t store your child’s favorite foods over the stove. want—whether it’s a favorite toy or a bottle of pills. She might be tempted to climb on a hot stove to reach Between the ages of 1 and 2, children understand more them. than they can say, but they are still too young to remem- • Remove the knobs from the front burners on your ber most rules. They don’t know the meaning of danger, stove if your child seems overly interested in turning so you still need to stay one step ahead of them. They can them, or install an oven-knob guard. reach higher and get more places than ever before. Walk around your home and look for things that could fall if • Lower the crib mattress as much as possible. Make sure your baby climbed on them. You may want to fasten your that the crib you are using has not been recalled for bookcases to the wall, for instance, or put hook-and-eye safety. latches on doors you want to keep closed. If you haven’t already, remove any large toys from the crib. A child could • Keep riding toys (rocking horses, cars, tricycles) away use them to climb on and get out. from porches, stairs, pools, and cars. Use safety gates. • Check pull toys. Cut cords or strings to less than 8 inches and remove any knobs or loops at the ends. It’s always easier to remove a hazard than to have to • Keep small toys that children can choke on out of reach tell your child over and over again not to touch it. and (if possible) out of sight.

16 Safety for Children from Birth to Age Three Outdoor safety • Make sure little children do not walk or run into the swing areas where they could get kicked or knocked • Remember to always apply sunscreen, and reapply fre- quently, especially after water play. Choose a sunscreen over. that has an SPF (sun protection factor) of at least 15 • Teach your child not to put plants or leaves in his and protects against both UVA and UVB rays. mouth. Try to keep him away from insects and animals that could sting, scratch, or bite. • Have your child wear a hat with a brim and, when pos- sible, long-sleeved tops and pants that cover the legs.

• Ask your pediatrician if your child should start wearing “Use sunscreen with at least SPF 15 and UVA and UVB sunglasses. Many doctors recommend that children protection every time your child goes outside. For begin wearing sunglasses at about 6 months. Exposure the best protection, apply sunscreen generously 30 to the sun can cause sunburned corneas, cancer of the minutes before going outdoors. Don’t forget to protect eyelid, and other problems. And children are at higher ears, noses, lips, and the tops of feet.” risk because the lenses of their eyes block out less sun- light then adult lenses do. —Centers for Disease Control and Prevention

• Check play areas and remove tools, trash, broken glass, animal feces, poisonous plants, etc.

• Don’t dress your child in clothes with drawstrings or hoods. These can catch on toys or playground equip- ment.

• Monitor your child closely on slides and climbers. If your child shows fear, respect the fear and don’t force the issue.

17 Safety for Children from Birth to Age Three Water safety • Make sure that children are always supervised by • Never leave your baby alone in the tub, not even for a few seconds. And don’t ask children younger than 11 or adults when playing near water or pools. 12 to watch a younger child in the bath. Even with the • Remember to empty water immediately from pails, best intentions, they can be distracted or turn on water buckets, and wading pools. For outside play, try using that’s too hot. sprinklers or hoses instead.

• Ignore phone calls when children are in the bath.

Always be vigilant when your baby is in the bath or playing in or near water. Children can drown in just an inch or two of water.

Safety reminders for children of all ages • Never let children play with balloons without close • Carefully read all toy labels. Some toys can hurt. Don’t adult supervision. Children choke or suffocate easily on give a baby toys that are labeled “for children ages 3 deflated balloons or broken pieces of balloons. Latex and older.” These toys could have small parts that young balloons are especially bad. If families want balloons, children could easily choke on or swallow. Mylar balloons are acceptable, but should be kept at a distance.

18 Safety for Children from Birth to Age Three Safety: 2 to 3 years

Between the ages of 2 and 3, children walk, talk, run, • If your child may wander out of the room at night, use jump, climb, throw a ball, and maybe even ride a tricycle. a gate in the doorway, which will allow him to look At this age, they begin to understand the idea of danger. out and cry if he needs to while still staying safe in the But they still don’t understand the limits of what they can room. Make sure that any furniture in the room is stable and cannot do. If you seem to be constantly telling your and cannot be pulled over onto your child. Also secure child what she can’t do, you may find it easier to show lamps and items on top of dressers. her some things she can do. Try gently removing her from a harmful place or situation and then letting her choose Water safety from one or two safe options. • Make sure children are always supervised by adults and wear Coast Guard approved flotation devices (PFDs) When children do things the safe way, let them know how when playing near pools or water. Remember that pleased you are with them—praise them, hug them, clap even when children learn to swim, they can still drown. for them. Just remember that 2- and 3­-year-olds still don’t Inflatable flotation devices are not sufficient to protect know their own limits. They still need your constant love children in water. and protection. • Start teaching basic water safety rules (no running near Climb and explore pools, no pushing, no holding others under water, no • Some children move from cribs to beds or mattresses jumping into the water, etc.). Explain why these rules on the floor during this stage. If your child can climb out are important and repeat them constantly. of her crib, this could be the time to make the change. If you do use a bed, put guardrails on both sides so your child can’t roll out. “Never take your eyes off children when they are in or • Don’t let children climb too high on playground equip- near any body of water, not even for a second.” ment. Three feet is high enough for any child younger —National Safety Council than age 3.

19 Safety for Children from Birth to Age Three Bicycle safety Traffic and car safety • Be sure that everyone in your family who rides a Teach your child two simple rules about cars and traffic bicycle—including young children on tricycles—wears a right now: bicycle helmet that has been certified by CPSC, ASTM, 1. Stay out of the street. or Snell. Look for these helmets in a bicycle store rather 2. Always hold a grownup’s hand before you step off than a toy store. A nearby Children’s Hospital may also the curb. sell and fit bike helmets. Check your child’s helmet to make sure it fits well and is always buckled. • Children this age are still too young to learn compli- cated rules about crossing the street. • Start using a helmet from the very first ride so your child always associates a helmet with wheels, and insist • Set a good example for your child now. Children learn on it. No helmet, no bike. by imitating other people. Use sidewalks and crosswalks wherever possible. Cross with the light and walk sign. • Make sure that tricycles or riding toys are the right size. If they’re too big, children can’t stop or steer them. Toilet and potty safety • Don’t let your child ride a tricycle in or near a street or • Many children feel safer on small portable potties or driveway. Kids on riding toys can’t always control where folding potty seats that prevent them from slipping into they’re going, and they’re too low to be seen from cars. the toilet. The best place for children to ride is in a fenced-in yard or neighborhood park. Always supervise your child • Make sure there is a stool for getting up and down. when riding a bike. Children are happier and safer getting on and off by themselves.

Children can move very quickly at this age, but they don’t always look where they’re going. They don’t understand that streets, driveways, and parking lots can be dangerous places.

20 Safety for Children from Birth to Age Three Safety reminders for children of all ages • Be vigilant about keeping poisonous substances away • Program the number of the National Capital Poison from your child. The American Academy of Pediatrics Center, 800-222-1222, into your phone. Also post it in a writes that “Most poisonings occur when parents or visible spot at home. Be sure all child care providers and caregivers are home but not paying attention.” babysitters have it as well. If you have a poisoning emer- gency, the center can provide immediate help and direct • You’ll find tips throughout this book on keeping your you to additional resources in your area. child safe from poison.

21 Safety for Children from Birth to Age Three Home safety guidelines

Windows Doors and stairs • Secure any windows above street level. Screens can’t • Lock or use safety latches on your front door and any keep children in—they’re only strong enough to keep doors leading to unsafe areas such as the bathroom or bugs out. basement.

• Use window guards, put on safety locks that keep • If you use a door latch or a hook-and-eye latch, put it windows from opening more than 4 inches from the out of reach of little fingers—at least 5 feet above bottom, or only open windows from the top. the ground.

• Make sure inside doors to rooms and closets can be unlocked from both sides. “Pay attention to the doors between rooms. Glass doors are particularly dangerous, because a child • Keeping your stairs well lit and free of toys and other may run into them, so fasten them open if you can. objects will help prevent falls. Swinging doors can knock a small child down, and • Check stair railings and fasten any that aren’t secure. folding doors can pinch little fingers, so if you have Make sure the ends of rails aren’t open, which can either, consider removing them until your child is old catch clothes or sleeves. enough to understand how they work.” —American Academy of Pediatrics • Use child safety gates at the top and bottom of stairs and at other dangerous areas. Don’t use accordion gates with openings that can strangle a baby or pinch fingers.

22 Safety for Children from Birth to Age Three Floors Kitchen • Anchor carpets and rugs to floors to prevent slipping. • Never hold a child while you’re cooking, or eating or drinking anything hot. • Don’t use wax that can make your floors slippery. • Keep all hot items that can scald or burn your child • Have children wear shoes, socks with treads, or go (hot drinks, food, pots) out of reach. Be especially barefoot on floors that don’t have rugs. Your floor can careful not to leave anything hot on a tablecloth. If your feel like a skating rink to a child who’s only wearing child pulls the cloth, hot liquids and food can come socks. crashing down. Most burns happen in the kitchen when children touch hot surfaces or are scalded by hot liquids Furniture or foods. • Move furniture so your child can’t climb it to reach windows or hazardous objects. • When you’re cooking, try to use the back burners of your stove, turn the handles of pots and pans toward • Secure heavy furniture (such as bookcases) to the wall. the back so a child can’t grab them, and keep children This will prevent furniture from tipping if a child tries to from playing on the kitchen floor. Keep your child away climb up. from the oven both during and after baking.

• Put heavy objects like lamps, TVs, or computer moni- • Small appliances (coffeepot, toaster, electric frying pan, tors where they won’t fall if bumped, or block access to etc.) can hold their heat for a long time—even after these. they’re turned off. Keep appliances and their cords out of reach. Unplug appliances when they’re not being • Porches, decks, and balconies used so little fingers can’t turn them on. • Be sure porches, decks, and balconies are sturdy and in good repair. Fix loose railings and boards. Never let • If your child seems interested in opening large appli- children play alone on a high porch or balcony. ances, such as the dishwasher, oven, microwave, or refrigerator, you can use safety latches or special Velcro • If the space between banisters or railings is wider than straps to keep them closed. Keep tablets, laptops, and 4 inches, use securely fastened plastic guards or safety similar items in a case you can easily move to a shelf netting to prevent falls. your child can’t reach when not in use.

23 Safety for Children from Birth to Age Three • Vitamins—especially fun-shaped, sweet-tasting kids’ • Soft covers over the bathtub spout as well as the vitamins or anything containing iron—need to be kept hot- and cold-water handles can protect your child’s out of reach, along with all other medicines. Never call head from bruises and bangs. any medication “candy.” • To keep your child safe from drowning, empty standing • Cover trash and recycling and place it out of reach. water from buckets, sinks, and bathtubs immediately after using them, and keep the bathroom door closed or • Put pet bowls, dishes, and litter boxes out of a latched at all times. Keep the toilet lid closed, or install child’s reach. a toilet locking guard so children can’t reach or fall in. • Don’t keep small magnets on your refrigerator door. Close the bathroom door when you are not in the bath- If they fall or break, a child could swallow or choke on room. them. • Move all appliances that could cause electrical shock (hair dryer, curling iron, electric razor, radio, TV) away Bathroom from water and out of your child’s reach. • Hot water can burn a child’s sensitive skin. Check the temperature of your hot water to make sure it is not • Make sure you have ground-fault circuit interrupters above 120 degrees Fahrenheit. (You can use a candy (GFCIs) on all bathroom and kitchen outlets and any thermometer.) You may want to adjust your hot water place near a sink, such as an unfinished basement. heater or install anti-scald devices on sinks, bathtubs, or GFCIs shut off electric power circuits when a current showers. Always feel the water before you put a baby in flows through water, a person, or other unintended the tub. path, and are often required by law.

• Remember to never leave a child alone in the tub. A child can drown in 1 to 2 inches of water in a matter of seconds.

• A bathmat or non-skid cutouts or strips on the bottom of your bathtub can help prevent slips and falls.

24 Safety for Children from Birth to Age Three Poisons and toxic materials • Keep all poisonous items out of a child’s reach. Store these items away from food products in cabinets and drawers that are secured with locks or childproof safety latches. Be sure to check for medicines (prescription, herbal, and over-the-counter) and vitamins, cosmetics (shampoo, perfume, mouthwash, etc.), cleaning supplies (bleach, polish, ammonia, dishwasher detergent, etc.), alcoholic beverages, pet supplies, home repair tools and supplies (turpentine, paint, solvents, etc.), plant food, pesticides, gasoline, kerosene, etc. Always keep these in their original container.

• Keep cigarettes and cigarette butts, lighters, and matches out of reach.

• Remove all poisonous plants from your home. If you’re not sure whether a plant is poisonous, use the online tool at the National Capital Poison Center to ask a question or call 800-222-1222. Your pediatrician also may be able to help.

If you have a poisoning emergency, call the National Capital Poison Center at 800-222-1222. The center can provide immediate help and direct you to additional resources in your area.

25 Safety for Children from Birth to Age Three • If you have a poisoning emergency, call the National Choking and suffocation Capital Poison Center at 800-222-1222. The center • To help prevent choking, keep dangerous items out of can provide immediate help and direct you to additional reach, including balloons; small household items (keys, resources in your area. Keep this number handy at all coins, paper clips, etc.); batteries; medications; marbles, times and programmed in your phone in case you need small balls; rocks; trash bags or plastic bags that could to call from a friend’s or relative’s home. If you don’t suffocate a child; small toys or an older child’s toys with have the number, call 911. If your child ingested some- small parts; small buttons on clothing or toys; foods thing that may be poisonous, try to have the container that can cause choking, such as hard candies, gummies, nearby when you call for help. Or take it with you to the raisins, peanuts, grapes, hot dogs, and carrots. (Ask your emergency room. doctor when your child is ready for these foods.) • If you or anyone in your home smokes cigarettes, don’t • You can help prevent choking by making sure children do it near children and do clean up right away. Children always sit upright when they eat (no running or lying can easily burn themselves running into lit cigarettes, down) and by staying with them until they finish. lighters, or matches. Secondhand smoke is dangerous. Eating cigarette butts can make a child very sick. • Keep all pocketbooks and briefcases out of reach. They Remember, too, that in all or some counties in more might contain medicines or small items that could poi- than a dozen states, it’s against the law to smoke in a son or choke a child. car that’s carrying children. • Keep long cords (window, phone, electric), plastic bags, • Follow your doctor’s advice about screening your child and soft pillows out of your child’s reach. Make sure any for lead toxicity. To avoid lead exposure, wash hands window shade or blind cords do not have a loop at the frequently, don’t wear shoes inside your home, and wipe end or pose any kind of strangulation risk. down surfaces where you eat frequently.

• If you live in an area where radon is common, you can learn about testing by calling the Environmental Protec- An empty toilet paper roll is a useful tool to check the tion Agency (EPA) at 800-SOS-RADON (800-767-7236). size of small toys and other objects. Anything that can Or search for “radon” at epa.gov. fit through the toilet paper roll is too small for a young child.

26 Safety for Children from Birth to Age Three Burns and shocks Weapons • Use safety outlet covers or plugs in every electrical out- • Store all weapons in an area where they cannot be let. Children can poke fingers and toys into outlets and reached by any child. If you choose to keep a gun, keep get an electrical shock. it unloaded and locked up. Use gun locks on each gun. Do not keep a gun by your bed or in your purse. • Check to see that electrical cords are in good condition and out of a child’s reach. Place cords so they do not • Lock guns and ammunition in separate places. Never run under rugs or carpets. Replace any cords that are get your gun out when your child is around, as it is nor- frayed or damaged. Avoid extension cords if possible. mal for her to be curious.

• Use sturdy screens or guards around radiators, • Be careful when choosing children’s toys. Play guns can hot-water pipes, fireplaces, wood-burning stoves, or be dangerous: it is often easy to mistake a real gun for a other heating devices so your child cannot touch them. toy, or a toy for a real gun. Avoid burning a fire when a child is in the room.

• Remove space heaters from rooms commonly used by children. In other rooms, move heaters at least 3 feet away from flammable objects like beds and curtains, and unplug them when not in use.

• Use ground-fault circuit interrupters (GFCIs) on outlets and appliances to prevent electrical shocks.

27 Safety for Children from Birth to Age Three Car safety reminders

• Check metal and plastic parts before putting your child • Don’t let a sleeping child stay in a car in a garage. in a car seat during hot weather. Use shades on rear car • Don’t let children play in or near areas with moving windows and a towel to cover the seat if you park in cars—streets, parking lots, or driveways (even your the sun. own). Children—especially children on riding toys—are • Never leave your child alone in a car, even for a few too low to be seen from cars. The best place for children minutes. Apart from the “stranger dangers” that this to play and ride is in a fenced-in yard or neighborhood poses, leaving your child alone could result in serious park, always with supervision. injuries or death from heatstroke in summer. If you have • Before backing up, check for children or have an adult to run a quick errand, always take your child inside with monitor for children behind your car. Don’t only rely on you. Children left alone in locked cars can also get out back-up cameras. of their seats and hurt themselves.

• By making sure everyone who rides in a car buckles up, you’ll set a good example and protect your child’s safety. Children in car seats can be seriously injured or “Leaving kids alone in cars is not only illegal in many killed if an adult or child is thrown against them during states, but on a warm day it’s downright lethal—so an accident. lethal that 636 children died in hot cars between 1998

• Never let children ride in a car if the driver has been and 2014.” drinking alcohol or using marijuana or other drugs. —National Highway Traffic Safety Administration More than one-third of all traffic-related deaths in the U.S. are caused by impaired driving.

28 Safety for Children from Birth to Age Three • Keep any cars and trucks you park near your home locked so children cannot play in them.

• If your child plays near an area with an electric garage door, make sure the remote opener and wall switch are out of reach. Check the door to make sure it reverses direction when it meets resistance.

“Each year, more than 9,000 children are treated in emergency rooms for injuries that occurred while they were unattended in or around motor vehicles.” —Safe Kids Worldwide

29 Safety for Children from Birth to Age Three Outdoor safety

Bicycles and tricycles Water safety • Be sure that everyone in your family who rides a • Most safety experts recommend using sprinklers or bicycle—toddlers in baby seats on the back of adult hoses for water play instead of wading pools. Remember bikes, young children on tricycles, and other children to empty water immediately if you do use a wading pool and adults on bicycles—wears a helmet approved by or any containers like buckets or ice chests—children CPSC, ASTM, or Snell. Check children’s helmets to make can drown in 1 or 2 inches of water. sure they fit properly and are always buckled. Adults • If you use a swimming pool, stay within arm’s reach of who wear helmets set a good example. infants and toddlers and supervise children at all times. • Children riding as passengers on the back of adult bikes • Keep riding toys (tricycles, wagons) away from the pool. should be buckled up in rear-mounted child seats with a harness to hold them in place and a design that protects • Make sure children follow basic water safety rules their hands and feet from spokes. (no running, no pushing, no jumping in the water, etc.). Praise them when they follow the rules. • Most safety experts agree that children under the age of 1 don’t have enough body support and shouldn’t be • If you have your own pool, learn CPR and rescue riding with adults on bicycles. breathing techniques.

“While only 1 percent of all trips taken in the U.S. are by bicycle, bicyclists face a higher risk of crash-related injury and deaths than occupants of motor vehicles do.” —Centers for Disease Control and Prevention

30 Safety for Children from Birth to Age Three • If you have a pool, make sure that it meets U.S. govern- • When you want your child to learn how to swim, ment requirements and any additional state and local check your local recreation department, Boys and Girls rules that apply. (Check also with your insurance com- Clubs, or the Y to find out about swimming lessons. But pany to see what it requires.) In most places, you will remember, even children who know how to swim can need to put up a fence that completely surrounds the drown. Your child still needs constant adult supervision pool and is at least 5 feet high. Install a self-closing and near water. latching gate (or a ladder that locks at least 4 feet above the ground if you have an above-ground pool). Sun • Keep babies under the age of 6 months out of direct • If you have a pool, keep rescue equipment (pole and sunlight. Find shade under a tree, stroller canopy, or ring buoy with a rope) and a phone with emergency umbrella. If your child is going to be outside, sunscreens numbers near your pool at all times. with titanium are safe to use in children under 6 months • Inflatable toys are not life preservers. Have children on of age. boats and near pools wear properly fitting Coast Guard • Protect your child with a child-safe sunscreen and a approved personal flotation devices (PFDs). Be sure life hat with an all-around brim. Use a sunscreen with an jackets are always fastened securely. SPF (sun protection factor) of at least 15 that protects • Children (and adults) should stay away from water against both UVA and UVB rays. Reapply sunscreen when it’s raining—or when a thunderstorm is nearby often, especially after water play. or predicted to arrive soon—to avoid getting hit by • Find sturdy child-sized sunglasses with at least 99 lightning. percent UV protection for your child (prescription • Be especially careful around rivers, lakes, and ocean sunglasses if your child wears glasses). beaches. Slippery rocks, strong undercurrents, and steep drop-offs can make these areas particularly dangerous.

31 Safety for Children from Birth to Age Three Pets • Place home play equipment at least 6 feet away from vehicles, buildings, fences, walkways, trees, large rocks, • Most experts do not recommend leaving a young child alone with an animal—not even your own pet. What and other play equipment. your child may consider being “nice” to a dog or cat may • Cover protruding bolts or screws on play equipment cause the animal to scratch, snarl, or even bite. with plastic safety caps.

• Pets can be unpredictable. If you see an unfamiliar • If you have a swing hung by chains, be sure that any animal when you are outside, pick up your child to chain link openings are less than 5/16 inch, or that the avoid contact between them. lowest 4 feet of the chains are covered with plastic tubing. Play areas • Check play areas for dangerous objects such as tools, • If the swing uses S hooks, be sure all hooks are com- trash, broken glass, rusty nails, poisonous plants, or pletely closed off to prevent pinched fingers. low tree limbs. • Remove any heavy wooden or metal swing seats and

• Keep the play area fenced if it is near a busy street, lake, replace them with lightweight plastic seats. river, pond, well, railroad track, trash dump, or any other • Never allow children to play around swings that are dangerous area. in use.

• whenever possible. Keep pets out of play areas • Check the distance between the steps on climbing toys

• Cover the sandbox or sand play area with a tarpaulin or or ladders—small heads can get caught in openings that wooden cover when it is not in use to prevent diseases measure between 4-5/8 and 9-1/8 inches. caused by animal droppings. • Don’t let children climb too high on playground

• Safety experts recommend that play areas have an equipment—3 feet is high enough for any child younger impact-absorbing surface, such as sand or wood chips than age 3. (8 to 12 inches deep). This surface should extend at • Keep storage areas such as basements, garages, or least 8 feet beyond the edge of slides, swings, etc. sheds locked or barricaded so children can’t get in.

32 Safety for Children from Birth to Age Three Stores • If your child sits in a shopping cart, make sure she is protected with a safety strap so she can’t stand up and fall out. Falling from shopping carts is a leading cause of head injuries.

• Never allow your child to sit or stand in the back of the cart.

• Never leave your child unattended in a store while shopping, whether he or she is in your cart or not.

33 Safety for Children from Birth to Age Three Preparing for emergencies

Emergency numbers First aid • Check your phone book or online directory or call tele- • Keep a complete first-aid kit in either your kitchen or phone information for your local emergency numbers bathroom, stored out of your child’s reach. (don’t assume you are in a 911 area) and the number of • It’s a good idea to have a small, portable first-aid kit for the nearest poison control center. your diaper bag, the car, or trips to the park. • Keep a list of local emergency numbers right by your • Ask your doctor to recommend items that will be best phone and programmed on your cell phone. Be sure you for your child’s age. You’ll need to check your kit as write down the phone numbers for: your child grows. Some of the things you may want to ◦◦police include are: ◦◦fire ◦◦digital rectal or armpit thermometer (ask your doctor) ◦◦rescue squad/ambulance ◦◦children’s acetaminophen ◦◦poison control center ◦◦sterile gauze pads and cotton balls ◦◦doctor and dentist ◦◦elastic “cling” bandages (babies can choke on ◦◦a neighbor or friend adhesive strips) ◦◦your own phone number and address ◦◦adhesive strips (for older children) • Make sure your home has a cell phone or a landline ◦◦antiseptic spray or antibiotic ointment that is not cordless so you can make calls even in a ◦◦hydrogen peroxide power outage. ◦◦tweezers • Always leave written directions to your house with a ◦◦scissors sitter in case of an emergency.

34 Safety for Children from Birth to Age Three ◦◦soft cold pack • Make a fire exit plan with your entire family. Make sure ◦◦insect sting preparation there are at least two escape routes to the outside on each level of your home and that everyone is aware of ◦◦“artificial tears” to flush eyes them. Choose a meeting place outside your home. (It’s Rescue important to teach children not to hide during a fire.) Practice your plan at night as well as during the day. By learning and practicing some basic rescue procedures, you may be able to save precious moments in an emer- • Tell babysitters and others who care for your child gency. Many local safety groups and the American Red about your plan. Cross offer classes in infant and child CPR, rescue breath- ing, the Heimlich maneuver, and first aid. • Practice basic fire safety rules with older children, including how to leave a burning building, how to “Stop, Fire prevention Drop, Roll, and Cool,” and how to make an emergency phone call. • Install smoke detectors on each floor in your home and in each bedroom. Check the batteries in smoke detec- • Have a safety ladder if you have a multistory home. If tors once a month by pushing test buttons or blowing possible, have a drill with older children so that they smoke into them. Change batteries at least twice a year. learn how to use it. When the clocks change can be a good reminder.

• Have a multipurpose fire extinguisher on hand and know how to use it. “To avoid injury from a garment that catches fire, all children should wear flame-retardant sleepwear and • Use only flame-retardant sleepwear and other clothing clothing. Make sure the label indicates this. These for your child. garments should be washed in laundry detergents, not • Planning ahead can be a matter of life and death in soap, because soap will wash out the flame retardant.” household fires. —American Academy of Pediatrics

35 Safety for Children from Birth to Age Three Emergency preparedness • Know the phone number of your local fire department and police. Keep these posted in a prominent place in your kitchen and program them into your cell phone. Be sure child care providers and babysitters have these numbers as well.

• Think through the steps your family might need to take in case of any natural disasters—hurricanes, tornadoes, earthquakes, lightning storms, forest fires or wildfires, blizzards, or floods—that may occur where you live. The American Red Cross website has several checklists for what you can do to be prepared in an emergency.

• Keep a working flashlight, a battery-operated radio, and fresh batteries in a place where they’re convenient for you—but out of your child’s reach.

• Keep water jugs for drinking and bathing/hygiene needs and hand sanitizer to wash hands.

• Store extra diapers and wipes and check them monthly to be sure they are still the right size.

36 Safety for Children from Birth to Age Three Helpful emergency resources

Local resources Online and national resources The American Red Cross offers courses in infant and child Healthy Children CPR as well as other courses in general safety, babysitting, healthychildren.org and first aid. Many chapters provide swimming instruc- A website from the American Academy of Pediatrics with tion at local pools as well. Contact the Red Cross chapter doctor-approved articles for parents and caregivers about nearest you for more information. many aspects of children’s health, development, and safety. Your fire department. Local fire departments offer rescue and emergency help, as well as safety education. Most fire National Capital Poison Center departments can provide information on fire emergency poison.org planning, community fire safety programs, regulations In addition to being able to help in an emergency, this on wood stoves, fireplaces, and space heaters, as well center may be able to direct you to resources near your as education about installing car seats and more. Know home. You can call 800-222-1222 to connect to your your local fire department’s emergency number. Call the local poison control center. nonemergency number for safety education questions or National Highway Traffic Safety Administration concerns. Vehicle Safety Hotline Your state’s Department of Public Health. Most state safercar.gov Departments of Public Health have injury-prevention 888-327-4236 programs. In some states, the state Maternal and Child For information about safety seat recalls, safety notices, Health Division may have another. and replacement parts.

37 Safety for Children from Birth to Age Three National Safety Council Radon Hotline U.S. Consumer Product Safety Commission asc.org cpsc.gov 800-S0S-RADON (800-767-7236) You can search the site for this government agency for Call for information about radon testing. Or visit the news of safety recalls for products such as cribs, strollers, radon section of the EPA website. bike helmets, and car seats. The CPSC site also has arti- cles on toy safety and other topics. SAFE KIDS Worldwide safekids.org Zero to Three: National Center for Infants, Toddlers, This national organization focuses on childhood injury and Families prevention. It has over 400 coalitions that sponsor local zerotothree.org community safety days. SAFE KIDS also offers free publi- An organization that promotes the social and emotional cations on child safety in English and Spanish. well-being of children from birth to age 3. Its website has helpful articles for parents on young children’s needs and behavioral issues, some of which can cause or contribute to safety risks.

38 Safety for Children from Birth to Age Three 39 Safety for Children from Birth to Age Three