Accidents and Child Development

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G U I D E L I N E S F O R P R A C T I T I O N E R S

Accidents and

child development

www.capt.org.uk


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The Child Accident Prevention Trust (CAPT) is a national charity

committed to preventing and reducing the number of children and

young people killed, disabled and seriously injured as a result of

accidents. It provides information, briefing advice and training

services to professionals. It organises high profile safety campaigns.

The distribution of this Guide is supported by the Department

for Children, Schools and Families.


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G U I D E L I N E S F O R P R A C T I T I O N E R S

Accidents and

child development


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The challengeEvery year, some two million children thatsabout one in five are seen at hospital Accidentand Emergency Units after suffering anunintentional injury. Around 250 children die eachyear as the result of accidents. These stark factsgive an indication of how great a challengeparents, carers and practitioners face in trying tokeep children safe.

There is, however, a good deal about whichto be positive. Very many of these injuries are

preventable. With education, information andthe right equipment, we can make a differenceto these unacceptable statistics. Childhood deathsfrom accidental injuries have consistently fallenover recent years, due to legislation, improvedsafety standards, education campaigns andbetter medical care. Attendance at hospitalcontinues to be high, however, and there is noroom for complacency.

The GuidesAn increasing focus on early years learning,development and care brings new opportunitiesto safeguard children, to promote their safety,health and well-being, and to support parents,carers and practitioners in their day-to-day workwith children in many different settings.

This Guide is one of a series of four publicationsaddressing topics in child safety and injuryprevention. They are aimed at anyone involvedwith the safety or care of children who has the

opportunity to promote safety to parents, carersand decision-makers, or control the environmentwhere children spend their time.

Each Guide addresses a particular issue related tochild safety and focuses particularly on the actualexperiences of field workers. The principlesbehind these Guides are:

G to share the experiences of practitioners witha wider audience so that effectiveinterventions can be publicised and commonpitfalls avoided

G to get child safety messages and accidentprevention strategies to families on lowincomes and those whose first language isnot English two groups who are particularlyat risk from accidents.

The four Guides in the series are:

G Accidents and child development

G Preventing childhood accidents: Guidanceon effective action

G

Safety equipment schemes

G Safety in day care and play settings

In addition to these Guidelines, we publishinformation packs, posters and other resourcesfor professionals working with children andfamilies. We also publish a wide variety ofleaflets and booklets aimed at parents andcarers themselves. See our websitewww.capt.org.uk for further information.

Join our mailing list! Its free and you willreceive regular news and information aboutnew awareness campaigns, resources andresource promotions see page 36.

Preface

GUIDELINES FOR PRACTITIONERS2


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4 Introduction4 A word about age and ability

5 Birth to crawling5 Facts and statistics5 Abilities and characteristics5 Common accidents in close-up and safety tips5 Falls6 Suffocation7 Choking7 Strangulation7 Burns and scalds8 Drowning

9 Cuts and bruises9 Out and about10 Education10 For the child10 For parents

11 Rolling/crawling towalking (about 6months to 15 months)11 Facts and statistics11 Abilities and characteristics

11 Common accidents in close-up and safety tips11 Falls12 Suffocation12 Choking13 Poisoning13 Strangulation13 Burns and scalds14 Drowning15 Cuts and bruises15 Out and about15 Baby-walkers - a warning16 Education16 For the child16 For parents

17 Toddlers(about 1-3 years)17 Facts and statistics17 Abilities and characteristics17 Common accidents in close-up and safety tips17 Falls18 Suffocation18 Choking18 Poisoning18 Strangulation19 Burns and scalds19 Electrical burns19 Drowning

20 Cuts and bruises20 Out and about21 Other safety points21 Education21 For the child21 For parents

22 Children agedabout 3 to 5 years22 Facts and statistics22 Abilities and characteristics22 Common accidents in close-up and safety tips22 Falls22 Suffocation23 Choking23 Poisoning23 Strangulation23 Burns and scalds24 Drowning24 Cuts24 Out and about25 Education25 For the child25 For parents

26 Children agedabout 5 to 7 years26 Facts and statistics26 Abilities and characteristics26 Common accidents in close-up and safety tips26 Falls26 Suffocation27 Choking

27 Poisoning27 Strangulation27 Burns and scalds28 Drowning28 Cuts28 Out and about29 Education29 For the child29 For parents

30 Children agedabout 8 to 11 years

30 Facts and statistics30 Abilities and characteristics30 Common accidents in close-up and safety tips30 Falls30 Choking30 Strangulation31 Burns and scalds31 Drowning32 Cuts32 Out and about33 Education33 For the child33 For parents

34 Useful websites35 Resources to help you

36 Join our mailing list

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Contents


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Accidental injury in childhood is so common that,sadly, we accept it as an inevitable andunavoidable part of growing up. But while it isimpossible to prevent every minor bump andgraze, there is much that can be done to preventmore serious injury if parents, carers andpractitioners are aware of the links betweenaccidental injury and a childs physical, intellectualand emotional development.

This Guide aims to give practitioners anoverview of why injuries to children happen andwhat can be done to prevent them. It concentratesmostly on providing a clear and straightforwardguide to the relationship between child

development and accidental injury, in order towiden understanding as to why injuries occur.

We have divided the Guide into a childsdifferent stages of development and age. Eachsection is then sub-divided into:

G Facts and statistics*

G Abilities and characteristics

G Types of accidents and safety tips

G Education.

It can be difficult to walk the line between keeping

children safe from accidental injury and over-protecting them. The Trust has always advocatedthe childs right to explore his/her surroundingswith as little interference from adults as possible.However, we also believe that children have theright to grow up in an environment in which theycan test their limits without the risk of seriousinjury. By understanding the relationship betweena childs abilities and the injuries they incur, bothpractitioners and parents can be better equippedto recognise potential danger and minimise itwhere possible.

This publication is not intended as a completeguide to injury prevention that would take

several volumes. What we do hope is that itprovides a useful backdrop to your work withchildren and their parents and carers.

A word about ageand ability

We have deliberately used developmental stagesrather than ages when talking about babies andyounger children. Although there are generallyaccepted age bands when children are likely toreach a certain point in their development (e.g.most children have started standing or walking by12 months) every child is different and will reachthe various developmental milestones in theirown time.

Children have an unnerving knack of catching

their parents and carers out and doing something whether it is crawling, walking or whatever before the text books tell you they should bedoing it. One of the most common phrases heardfrom parents after a child has been injured is Ididnt know s/he could do that whether thatwas crawling for the first time, unscrewing a bottletop or climbing through a window. Telling a parentthat their baby will not be able to roll over untilthey are four months old is potentially dangerousif that baby manages to roll at three days and is ona changing table at the time. So when we doquote an age or age range, it is only intended as a

guide. Please remind parents that they know theirchild best and they need to be one step ahead insafety at all times.

We have divided each chapter into types ofinjury. Some of the information and advice givenwill apply to more than one age or stage forexample, smoke alarms are essential safety deviceswhatever a childs age but it will be mentioned ineach chapter to which it is applicable to ensurethat each section is complete in itself.

Introduction


* The statistics presented in each chapter come from the Department for Transport, the former Department of Trade and Industry

and the former Office of the Deputy Prime Minister. For up-to-date statistics, see links at end of Guidelines (page 32).


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Facts and statisticsEvery year:

G around 22,000 babies under six months areinjured in accidents

G four in five of these accidents happenin the home.

Abilities and characteristicsVery young babies depend utterly on their parents

and carers for all their needs. They have absolutelyno control over their environment and need anadult to keep them healthy and safe.

New-born babies have:

G very thin skin some fifteen times thinner thanan adults

G very large heads compared to their bodies

G a skull that is still fusing together, leaving asoft spot the fontanel on top

G immature bone development

G

little or no voluntary control over their limitedmovement

G the ability to grip an object if it is placed intheir hands

G the ability to lift their heads for two orthree seconds

G the ability to wriggle, kick and flail their arms.

Before babies acquire more deliberate movementsuch as reaching or rolling, any accidental injurythey suffer is generally as a result of someone elsesactions, rather than their own, so it is entirely

down to parents and carers to keep babies safefrom harm.

By three months, babies may be able to:

G roll over independently when placed on theirbacks or stomachs (although babies of a fewdays may wriggle their way over while flailingarms and legs about)

G reach for and grasp an object.

By six months, babies may be able to:G remain in a sitting position on the floor

G roll greater distances to get to objects

G do simple manual tasks such as pushingand pulling

G start crawling.

Common accidentsin close-up and safety tips

Falls

From raised surfaces Babies can suffer seriousinjury in falls from comparatively low levels. Eventhe youngest baby can wriggle his or her way tothe edge of a bed or changing table if leftunattended. Sometimes the movement is not eventhat of the baby in the US recently, a babysuffered a skull fracture after his parents strappedhim into his baby car seat and left him on top of awashing machine in mid-cycle. The vibration of themachine moved the car seat far enough to tip thebaby off the edge on to the floor.

Many parents use baby-bouncing chairs, but ifthese are left on a table or work surface even thesmall movements of a baby could cause the chairto move enough to fall.

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Birth to crawlingprotection and prevention

Safety tips

I Babies should never be left unattendedwhile on a raised surface

I Nappy changing is safest done on the floor

I Baby car seats and bouncing chairs shouldalways be placed on the floor.


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Down stairs One of the most common ways for ababy of this age to be injured on the stairs is whens/he is being carried by a parent or carer and theyslip or trip. Busy parents will take other objects upand down stairs while carrying their child, leavingno hands free to hold on.

Toys and other objects left on the stairs can alsocause falls, as can other children playing on oraround the staircase. Children have also beeninjured when the adult carrying them has tried toclimb over the safety gate rather than opening itand tripped.

Young children should not be allowed to carrythe baby up or down the stairs.

Suffocation

By bedding Very young babies have limited andinvoluntary movement and they can be suffocatedby clothing, bedding or other material that theyare not able to push away. Position him or her inthe feet to foot position so that he or she cannotwriggle down under the blankets. Soft paddedbedclothes such as pillows and duvets are therefore

unsuitable for children under a year old (by thisage, children have sufficient movement to pushbedding away from their face). There have alsobeen cases of babies suffocating when leftunattended on bean bag cushions and pillowsoutside the cot.

Other types of suffocation Sadly, some babieshave been accidentally suffocated by their parentsor carers. This usually happens when a parent falls

asleep while feeding or just holding a baby. Thebaby may then become trapped under the adultsbody and suffocate. We should emphasise that thisis not a common occurrence and many parents andyoung babies sleep quite happily together in thesame bed. However, parents who have beendrinking or taking drugs (legal or otherwise), whoare particularly tired, or who smoke, should let thebaby sleep in its own cot.

Young babies who have been put down for asleep on sofas or adult beds next to walls havesuffocated when their heads become trapped ingaps between cushions or between the bed andthe wall.

Cats, who instinctively head for warm places,have been known to curl up on top of babies,suffocating them. Young children sometimesregard tiny babies as dolls to be dressed orcovered up, and this needs to be born in mind.


Safety tips

I Do not use duvets or pillows for childrenunder the age of one year

I Put babies down to sleep on their backs

I Never leave a baby unattended on a cushionor bean bag.

Safety tips

I Do not sleep with or hold a baby if yourhealth or judgement is impaired

I Avoid leaving babies to sleep on sofas oradult beds

I Use cat nets on prams and cots to deter cats

I Keep an eye on toddlers and young childrenaround the baby.

Safety tips

I Stairs should be kept clear of clutter

I Anyone carrying a baby or child up or downstairs should keep one hand free to hold on

I Before a baby starts to crawl or climb, asafety gate or barrier is needed at thebottom of the stairs to stop him or herstarting to climb the stairs and then falling.At the top, the gate or barrier needs to stopa crawling baby getting to the stairs. It is

better not to place it directly across the topof the stairs for two reasons:

some gates have a bar across the bottomand this can be a tripping hazard. If thegate is at the top of the flight, a trip canlead to a fall down the stairs, which is muchworse than simply falling over the bar

adults and older children sometimes climbover the barrier or gate rather thanopening it. Again, this can lead to a falldown the stairs

Its safer to put the gate or barrier across

the landing or even across the babysbedroom door.


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ChokingChoking is related to suffocation in that it causesan obstruction to breathing. The most commonform of choking, whatever the age, is from food ordrink. Young babies have automatic suckinginstincts, but will only start to learn how to dealwith more solid food after a few months. A babyshould never be left alone to feed from a propped-up bottle, as s/he may choke and be unable topush the bottle away.

There is also the possibility of older childrentrying to feed the baby unsuitable foods such assweets, peanuts and fruit.

StrangulationBy clothing Regulations have reduced the fewrisks associated with baby clothing. Ribbons andother ties, which in the past have been as long asthe designer wanted them to be, are nowrestricted to a length which is not long enough topose a strangulation threat. However, theseregulations do not cover home-made clothes suchas knitted hats and cardigans. If a long ribbon atthe neck of a baby gets caught on the side of acot, car seat or other item, there is a danger ofstrangulation. There is also a small danger fromcollars and necklines catching in a similar way. A

related hazard is that of a babys fingers or toescatching in knitted or nylon clothing. The wool canwind around the digit, cutting off the bloodsupply, which can result in fingers or toes beingamputated.

By other ribbons and jewellery Anything placedaround the neck of a small baby is potentiallyhazardous. Necklaces, dummies on ribbons andother items hung around a babys neck shouldalways be avoided.

Burns and scalds

Babies have extremely thin, delicate skin that iseasily damaged. They can suffer severe burns andscalds at temperatures that may only sting anadult. Their immature body size also means that asmall area of heat or a few drops of boiling watercause a proportionally larger amount of damage.Babies are also unable to move away from thesource of heat, so whereas an adult will jump awayfrom a spilt hot drink to avoid further injury, a

baby will suffer the full effects.

From hot liquid It has become common practicefor parents and carers to heat bottles of milk inmicrowaves. While this is quick and convenient, themilk is heated unevenly and there may be hotspots in the milk that can scald a babys mouth.Another potential hazard is if the parent or carerhas a hot drink while feeding the baby. A joggedelbow, the baby suddenly flailing its arms, the cupslipping through fingers or someone includingpets bumping into you could result in seriousscalding. Liquid can remain hot enough to scald a

baby for at least 15 minutes after boiling longafter it would hurt an adults skin.This principle applies to bathing a baby as well.

There are many bath thermometers available tobuy these days, but the old-fashioned elbow in thewater technique is just as effective. A good rule isto run the cold water first, then add the hot tobring it up to a comfortable temperature. Thewater should not feel either hot or cold.

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Safety tips

I Always stay with a baby when bottle-feeding

I Keep an eye on older children andteach them not to put anything in thebabys mouth

I Keep small objects away from a babysgrasp.

Safety tips

I Always make sure babies clothing isnot too tight around the neck

I Trim ribbons on home-made garments asshort as possible

I Keep an eye open for fingers and toescaught in knitted or nylon items

I Never put necklaces or dummies on ribbonsor other threads around a babys neck

I Never hang things such as bags with cords

or strings over a babys cot.


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From the sun Recent research has indicated thatchildren who suffer sunburn are more prone toskin cancer in later life. Aside from this, theimmediate effects of sunburn are unpleasant and

potentially dangerous for young children. In theUK, we tend to under-estimate the strength of thesun and consequently do not take as manyprecautions as we should. We also forget that it ispossible to get sunburn while in the shade. Babiesand young children need much higher levels ofskin protection than adults, and professionalsadvocate keeping children out of the sunaltogether at certain times of the day.

Accidental burns from hot objects are notcommon in babies this young, as they have no realmobility to get near fires and other hazards.

It is, however, possible for hot things to be

dropped on a baby by others such as cigarettes orhot food or for the baby itself to be dropped ona heat source.

Fires in the home Each year babies and childrendie in house fires, mostly as a result of smokeinhalation rather than actual burns. Young babiesare incapable of escaping from a fire on their own,which makes them particularly vulnerable. Thereare general fire safety rules which apply to all agegroups, child and adult, and which can potentiallysave lives:

Drowning

In the bath Babies can drown in just a fewcentimetres of water, very quickly and with nonoise or struggle. They do not have the knowledgeor experience to recognise danger or try to reachthe surface. Babies and young children needconstant supervision while in water of anydescription. Bathing a tiny baby can be a daunting

experience for a new parent, and bath time can bechaotic for an experienced parent trying to bathtwo older children and a newborn, but under nocircumstances should a baby ever be left alone inwater, even for a few seconds. Going to answer thephone or door bell, going to check on otherchildren, getting nappies or clothes from anotherroom if it has to be done, then the baby shouldbe taken too.

It is also important for parents to realise thattoddlers should not be given the responsibility oflooking after the baby in the bath. A two or threeyear old is still not old enough to recognise danger.One mother, bathing her three-year-old and her

nine-month old baby, turned away from the bathto get towels from the cupboard. She turned backto find the baby had slipped under the water andthe three-year-old playing impassively beside him.


Safety tips

I Fit a smoke alarm on every level of yourhome and check the batteries every week.

Alarms give vital extra seconds to escape afire

I Extinguish cigarettes and matchescompletely

I Avoid using chip pans a common cause ofhome fires

I Keep matches and cigarette lighters out ofchildrens reach

I Do not overload electric sockets and replaceold or worn flexes

I Close interior doors to contain any fire

I Work out a family escape plan now do notleave it until it is too late.

Safety tips

I Dress young babies in close-knit, cotton

clothing and hats that shade the face andback of the neck. Use special childrens sun-block cream

I Keep young babies out of the suncompletely between 11.00am and 3.00pmwhen the sun is at its strongest.

Safety tips

I Avoid heating bottles in microwaves. Use abottle warmer or jug of hot water. Afterwarming, which ever method is used, shakethe bottle thoroughly and test thetemperature of the milk by placing a fewdrops on the inside of your wrist. It shouldfeel luke warm not hot

I Never have a hot drink while holdinga baby

I Always check the water temperature with

an elbow before putting a baby in the bath.The water should not feel either hot or cold.To avoid rapid and severe scalds, athermostatic mixing valve (TMV) should befitted to the bath hot tap. If there is noTMV, always put cold water in the bath first,then add hot water.


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There are a number of bath seats now availablein which to place babies in the bath. They are nosubstitute for adult supervision as they are notsafety devices.

Cuts and bruises

As mentioned before, a young baby has very fewchances of inflicting injury on himself. One of thefew exceptions to this is if s/he is given somethingto hold. A young baby can grip quite strongly if anobject is placed directly in its fist. What s/he cannotdo is control the movements of that object. Sothere will be times when a baby manages to hithimself with a rattle, a toy or whatever else he isclutching. As long as the object is light or soft, nodamage will be done, but heavier or pointedobjects can inflict cuts or bruises.

There is also the chance that objects may bedropped on the baby as a parent reaches acrossthe cot or the pram, if the baby is lying in a carseat or bouncing chair in the kitchen etc.

Out and about

By car It is essential that a baby is securelystrapped into a correctly fitting infant carrier whentravelling by car. A baby should be carried in arear-facing seat for as long as possible, ideally forat least a year. This is because babies haveproportionately large heads for their bodies andweak neck muscles that cannot support the headindependently for the first few months of life. Arear-facing seat will support the head and neck in

a crash, helping to prevent injury. It is now a legalrequirement to properly restrain young children incars. Babies must never be carried in a passengersarms.

Parents should get a car seat before the baby isborn, so that from the very first trip home fromthe hospital, s/he is safely restrained. It is also veryimportant to check that the car seat fits the carbefore buying, as some models fit some cars betterthan others.

By pushchair/buggy Most parents will use apushchair for their baby at some stage in the firstfew months. Aside from ensuring that it is in goodcondition if it is old or second-hand, parents shouldalso make sure that there is a five-point harnessfitted and that they use the harness every time.This will prevent the baby falling out if thepushchair is pushed or knocked over.

In a baby sling Baby slings, or carriers, arebecoming increasingly popular. Most can be usedwhen the baby is just a few days old and can be avery convenient way of carrying a small babywithout having to use a pram. Babies seem to likethem for the closeness they bring and the soothing

motion of the parents walking and breathing. Theyshould never be used in a car as a substitute for ababy car seat. The main hazard that faces parentsusing these slings is the possibility of injuring theirbaby if they trip over or fall down stairs.

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Safety tips

I Never leave a baby alone in the bath, evenfor a second

I Do not rely on older children to alert anadult to danger.

Safety tips

I Always use a correctly fitting rear-facingbaby seat when transporting a baby by car,even on the shortest journey its the law

I Never put a rear-facing baby carrier in a seat

with an airbag fitted.

Safety tips

I Check old or second-hand pushchairs/buggies for damage before using

I Always use the five-point harness to strapthe baby in.

Safety tip

I Always adjust and secure the slings strapscorrectly and take care when using stairs orover uneven ground.

Safety tips

I Make sure a baby is only given appropriatetoys for his or her age

I Keep an eye on what older children aregiving a baby to hold

I Avoid passing objects over a baby.


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EducationFor the child

Young babies have absolutely no way of learningto keep themselves safe. It is entirely down to theadults who care for them to ensure their safety.

For parents

New parents have been likened to spongesby marketing companies, because of theireagerness to absorb any information and advice

about their new baby. We can take advantage ofthis by providing clear and accurate advice onkeeping their baby safe at a time when parentsare most receptive.

This could be in the form of:

G leaflets and hand-outs

G talks at parents groups

G one-to-one advice.

Most new parents will be inundated withinformation and advice, much of it coming from

family and friends. Advice from grandparents canbe very helpful. However, some of it can also beobsolete, especially on the issue of child safety.What may have been accepted practice ageneration ago, such as travelling in a car withouta restraint and putting babies down to sleep ontheir fronts, has now been proven to put babies atunnecessary risk of injury or death.

It is better not to devalue information from othersources, instead emphasising that your advice isbased on the latest evidence.

The most important information that can be given

is concerned with babies developmental stages:their skills, abilities and characteristics. If parentsknow what to expect from their baby, it helpsthem plan for the next stage, and have thenecessary equipment ready.

The Child Accident Prevention Trust produces arange of up-to-date publications which provideclear, concise safety advice for new parents. Theseinclude:

Keep your baby safe A one-stop guide toequipment, safety standards and keeping baby

safe.

Babies A comprehensive list of tips to keep babiesout of danger.

Im only a baby but... A pictorial book on babysafety designed for all parents, but especially thosewith low literacy or with English as an additionallanguage.

To order any of these publications, or samplecopies, please visit the CAPT website:www.capt.org.uk or call 020 7608 7368 for apublications catalogue.



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Rolling/crawling to walkingon the move (about 6 months to 15 months)


G around 38,000 babies under a year old aretaken to hospital after a fall

G around 17,000 babies aged one year and undergo to hospital with burns and scalds

Abilities and characteristicsBabies of about six months and over are nowstarting to develop a measure of control over their

bodies. They can make deliberate movements inorder to reach something they want and becomemore dextrous in picking up small objects. Theymay start to crawl any day now, although it is wellworth remembering that a significant number ofbabies do not crawl but will shuffle on theirbottoms to reach what they want. They are morealert and aware of their surroundings and will startto explore their environment more actively nowthey have better movement.

Babies between about six and fifteen months:

G still have proportionately larger heads

G will put everything in their mouths it isanother way of feeling objects for them

G are still largely uncoordinated in theirmovements

G may still be wobbly when sitting unsupported it takes time for the neck and back muscles tostrengthen

G may climb or walk without going through acrawling stage

G may have started to cut teeth

G will be starting to eat more solid food

G do not have the ability to learn fromexperience.

By eight months, babies may be able to:

G crawl on all fours or shuffle on their bottoms

G pull themselves up and climb on to furniture

G use their hands to open and shut or to fill andempty objects

G chew on anything.

By a year, babies may be able to:

G stand unaided

G walk with or without assistance

G realise that things are still there even when putout of sight.

Babies of this age and stage are still completelydependent on adults for their safety, but are nowstarting to be capable of getting themselves intopotentially dangerous situations.

Common accidents inclose-up and safety tips

Falls

Down stairs Once babies have started to move,the stairs become an especially dangerous place.

Their natural instinct is to explore as far as theycan get, but they have no concept of theconsequence of their actions. A physical barrier isessential to keep them clear of steps and stairs. Atthis stage, there are also still many cases of parentsand carers falling down stairs while holding a baby.

From raised surfaces Once a baby has started to

move independently, it is even more dangerous toplace him or her on a raised surface, for whateverreason. Their movements can be sudden and swiftand cause them to fall. Even falls from low levels off sofas or beds can cause broken bones and

Safety tips

I Stairs should be kept clear of clutter

I Anyone carrying a baby or child up or downstairs should keep one hand free to hold on

I

Before a baby starts to crawl or climb, asafety gate or barrier is needed at thebottom of the stairs to stop him or herstarting to climb the stairs and then falling.At the top, the gate or barrier needs to stopa crawling baby getting to the stairs. It isbetter not to place it directly across the topof the stairs for two reasons:

some gates have a bar across the bottomand this can be a tripping hazard. If thegate is at the top of the flight, a trip canlead to a fall down the stairs, which ismuch worse than simply falling over thebar

adults and older children sometimes climbover the barrier or gate rather thanopening it. Again, this can lead to a falldown the stairs

Its safer to put the gate or barrier across thelanding or even across the babys bedroomdoor. This can help restrict access to thebathroom where there are other hazards,such as cleaning fluids and very hot water.


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other injuries. A baby who has started to crawlmay well also start to try to climb up on furniture,creating the potential for falls.

From highchairs Babies start to use highchairsonce they are sitting upright more confidently.They will quickly grow more confident in theirhighchairs and many babies will try to climb out orreach for things beyond their grasp. This lattercould result in the highchair over-balancing. Usinga five-point harness will keep a baby in thehighchair, but adult supervision is still essential atall times.

From cots Newly mobile babies may try to climbout of their cots, using toys to stand on or anyother footholds s/he can find.

Suffocation

By bedding Although the danger of suffocation bybedding reduces as a baby grows, it is still apossibility. An active baby may twist their beddingand entrap themselves in the folds. Once a baby hasindependent movement, putting them to sleep ontheir backs is no longer necessary, as they are ableto roll or twist out of one position into another.

Other types of suffocation Plastic bags arepotentially a source of great danger. As a babyplays and explores, anything s/he comes across willbe seen as a toy, including plastic bags. Despite airholes in most carrier bags, there is a real danger ofsuffocation.

It is still not wise to sleep with a baby if youhave been drinking or are under the influence ofdrugs, are particularly tired or smoke (see page 6).

Choking

Weaning usually takes place at around three or fourmonths, when more solid food is introduced to thebabys diet. At first, this will be pureed into almostliquid form, but gradually more challenging food is

introduced. Pieces of food are one of the mostcommon items to cause choking in both adults andchildren. A baby has to learn the complex process ofchewing and swallowing solid food and will beprone to choking during the learning process.

Once a baby has learned to pick up items, hisinstinct will be to put them straight in his mouth.A baby uses his/her mouth to feel new things, inthe same way an older child or adult feels thingswith their hands. Anything smaller than thediameter of a two pence piece roughly the sizeof a childs windpipe can cause choking ifswallowed, so everyday items like coins, boiled

sweets, buttons, small parts of toys and beadsshould not be left where a baby can reach them. Itis worth remembering that choking can becompletely silent, with no sound to warn thatsomething is wrong. An additional hazard can betoys belonging to older children they havesmaller parts on which a young baby could choke.


Safety tips

I Keep plastic bags out of reach and tie a

knot in themI Do not sleep with or hold a baby if your

health or judgement is impaired

I Keep an eye on toddlers and young childrenaround the baby.

Safety tip

I Always use a five-point harness every timethe baby sits in a highchair.

Safety tip

I Once a baby can sit up, remove large

cot toys and keep the drop side in theup position.

Safety tip

I Do not use duvets or pillows for childrenunder the age of one year.

Safety tips

I Babies should never be left unattendedwhile on a raised surface

I Nappy changing is safest done on the floor

I Baby car seats and bouncing chairs shouldalways be placed on the floor

I Be aware that babies might climb

on furniture.

Safety tips

I Always stay with a baby when eating ordrinking

I Keep small items out of the babys reach

I Watch older children and teach them not toput anything in the babys mouth or givehim small objects or toys.


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PoisoningBabies from about six months onwards begin to putthings in their mouth which can lead to themswallowing something harmful such as medicinetablets or cleaning fluid.

Strangulation

By clothing As pointed out before, it is possible butrare for a child to be strangled by her clothing. Oneexample is if a child is climbing on something, slipsand the neckline of their clothes catches, leavingthem suspended above the floor. Parents shouldavoid coats or tops with drawstring fastenings.

By other ribbons and jewellery In the sameway, anything fastened around the neck can catchand cause strangulation. Babies and toddlers shouldnot wear necklaces and ribbons around the neck.

By other means Once a baby is on the move,whether crawling, shuffling or walking, there are anumber of unexpected hazards. In recent years,there have been cases of babies becomingentangled in adult clothing like bras or the danglingstraps of a highchair. Window blind cords, belts androtary washing lines can also be dangerous.

Burns and scalds

Once a baby is mobile, the opportunities forsuffering scalds and burns increase. S/he can nowget to things that were previously out of reach likehot drinks left on low surfaces, radiators, heaters,ovens and fireplaces. Their skin remains very thinand susceptible to burns.

From hot liquid A babys mouth is as sensitive asits skin, so hot drinks will scald. A new danger

arises from the babys new mobility reaching upand pulling on dangling kettle flexes or saucepanhandles. They may also start to imitate adults bydrinking from cups, so hot drinks need to be putout of reach.

If using a highchair in the kitchen, dont place itwhere the baby can reach the cooker, kettle orhot drinks.

Safety tips

I Always make sure babies clothing is not tootight around the neck

I Never put necklaces or dummies on ribbonsaround a babys neck

I Keep all blind cords and other similar itemsout of reach or trimmed short or tied up

I Do not put cots or beds near windows withblind or curtain cords

I Never hang things such as bags with cords

or strings over a babys cot.

Safety tips

I All medicines should be locked away or kepthigh up and out of reach and sight

I Cleaning products should be kept high upout of reach and sight or, if necessary, safety

catches should be fitted to low cupboarddoors where they are kept. When buyingcleaning fluids, those containing a bitteringagent (that makes the product taste nasty)should be sought

I Bottle tops and lids should always be firmlyclosed when not in use

I Carbon monoxide alarms should be fittedwherever there is a flame burning appliance(such as a gas boiler) or open fire.Appliances should be serviced regularly.


16/40

From the sun With increased mobility, it is harderto keep babies in the shade. Sun cream and cottonclothing are essential.

From hot objects Once a baby is rolling, shufflingor crawling, s/he will want to explore theenvironment. This may include touching things likeradiators and fireplaces. It is important toremember that babies do not learn from experienceat this stage, so parents should not expect a babyto remember not to touch the hot radiator.

Fires in the home Once a baby is in any waymobile, it is time for matches and cigarette lightersto be put out of reach. Even a six or seven monthold baby may, through luck not judgement,manage to strike a match or ignite a lighter. Thereare general fire safety rules which apply to all agegroups, child and adult, and which can potentiallysave lives:

Drowning

Once underwater, babies have no particular instinctto scrabble to the surface for air. By this stage,most children will enjoy playing in or with waterand have no reason or knowledge to fear it. Theymay have started to use paddling pools, so thedangers of drowning increase. Althoughincreasingly rare in this country, nappy buckets where terry nappies are left to soak in water have been the cause of a number of drownings in

the US and Australia. A baby may pull himself upto peer inside and topple over into the water andbabies of this age do not have the physical skills toget out safely. Even small amounts of water, suchas rainwater collected in a paddling pool orupturned dustbin lid, can prove lethal.


Safety tips

I Fit a smoke alarm on every level of yourhome and test the batteries every week.Alarms give vital extra seconds to escape a

fire

I Extinguish cigarettes and matches completely



I Do not overload electrical sockets andreplace old or worn flexes


I Work out a family escape plan now do not leave it until it is too late.

Safety tips

I Never leave a baby alone in the bath, evenfor a second

I Do not rely on older children to alert anadult to danger

I Supervise all water play closely

I Always empty paddling pools, buckets,watering cans etc. immediately after use.

Safety tips

I Avoid heating bottles in microwaves. Use abottle warmer or jug of hot water. Afterwarming, which ever method is used, shakethe bottle thoroughly and test thetemperature of the milk by placing a fewdrops on the inside of your wrist. It shouldfeel luke warm not hot

I Never have a hot drink while holding a baby

I Keep hot drinks well out of babies reach

I Always check the water temperature with

an elbow before putting a baby in the bath.The water should not feel either hot or cold.To avoid rapid and severe scalds, athermostatic mixing valve (TMV) should befitted to the bath hot tap. If there is noTMV, always put cold water in the bath first,then add hot water

I Always use a kettle with a short lead orcurled flex

I Consider using a safety gate to bar accessto the kitchen when hot food and liquidsare around or use a playpen if theres

room.

Safety tips

I Dress babies in close-knit, cotton clothingand hats covering the back of the neck andthe face and use childrens sun-block cream

I Keep babies out of the sun completelybetween 11.00am and 3.00pm when the sunis at its strongest.

Safety tips

I Fit fireguards to all fires and heaters. Fit asparkguard if you have a coal or wood fire

I Leave irons to cool out of reach and avoidironing when a baby is there.


17/4015

Safety tips

I Always use a correctly fitting safety seatwhen transporting a baby by car, even onthe shortest journey

I Only move the baby to a forward-facingseat when s/he can sit unaided for longperiods of time, not before

I Discourage babies from fiddling or touchingthe release button on their harness byfitting a play tray or distracting with toys.

Cuts and bruisesA babys first independent movements arecharacterised by unsteadiness and poor co-ordination. As they learn to roll and crawl, babieswill bump into anything and everything, leading tomore accident potential. Their increased mobilitymay also mean they grab for items left lyingaround on tables etc.

Out and about

By car Once a baby can sit unaided for longperiods of time i.e. his neck has strengthenedsufficiently to support his head he can be moved

to a forward-facing car seat. However, expertopinion is that it is best to keep babies in the rear-facing infant carrier for as long as possible, as thisis the safer way to travel.

Although it usually happens when babies are alittle older, it is possible that a baby might start totry to wriggle out of her harness or fiddle with theharness release button. This is all part of theirexploring their environment, but clearly has safetyimplications. More on this in the next section.

By pushchair Once a baby becomes more active,it is even more important to strap them into theirpram or pushchair using a five point harness. Theymay well start to lean out to reach for objects ortry to escape.

Baby walkers a warning

This is the most popular age for parents to puttheir babies in baby walkers - in some casesbecause they think they help babies learn to walk.This is not the case. Rolling, sitting, crawling andplaying on the floor are all important stages indeveloping strength before learning to walk.From a safety point of view, walkers can allowbabies to reach things they could not before.They are associated with more injuries than any

other single item of baby equipment especiallyfalls down stairs and burns, the most severe ofwhich arise when the baby walker collides with afireplace or because the baby can reach, forexample, a hot mug of drink.

Safety tips

I Check old or second-hand prams andpushchairs for damage before using

I Always use the five-point harness to strap ababy in.

Safety tips

I Keep an eye on what older children aregiving the baby to hold

I Move dangerous objects like knives, scissorsand other heavy or sharp items out of reach

I Position furniture with hard or sharp edgesso that there is less chance of the babyhurting herself.

Safety tips

I Only use a baby walker that complies withthe latest standard BS EN 1273:2005 (while itis too early to say whether or not thisstandard has reduced the numbers ofaccidents that babies have in walkers, weknow that baby walkers complying witholder standards allowed babies to movequickly and get into trouble)

I Dont use a baby walker in the kitchenbecause it can allow babies to reach higherthan normal so that they can grab atdangling flexes and tablecloths, and touch ahot oven door

I Use a safety gate at the top of stairs andsteps to stop the walker falling down

I Ensure that you have a fireguard to stop thewalker getting close to any fire

I Keep the baby walker well away fromgarden ponds.


18/40GUIDELINES FOR PRACTITIONERS16

EducationFor the child

Babies at this stage will still have no way oflearning to keep themselves safe. It is entirelydown to the adults who care for them to ensuretheir safety. Parents and carers can start to set agood example in their own practices and reinforcesimple safety messages and statements to get inthe habit, but do not expect the baby tounderstand or remember them.

For parentsThe principle of staying one step ahead as a babygrows is a very important one. Parents and carersneed to be informed about what the next likelystages are in their babys development and whatthey should be doing to prepare for them.

This could be done in the form of:

G leaflets and hand-outs

G talks at clinics and baby and toddler groups

G one-to-one advice.

Most parents will be receiving help and advicefrom family and friends. Aim to supplement thiswith information on development and safety in thehome, out and about and in the car.

Parents need to understand that a child of this agewill not remember or learn from experience.Careful supervision and avoidance of dangeroussituations and items are the best ways to preventaccidental injury.

The Child Accident Prevention Trust produces arange of publications and resources to support

your work with parents. For this developmentstage, they include four leaflets:

Keep hot drinks out of my reachPut small things where I cant choke on themWhat might poison your child?

Also:Now I can crawl, I can... A pictorial book on babysafety designed for all parents, but especially thosewith low literacy or with English as an additionallanguage.

To order any of these publications, or sample

copies, please visit the CAPT website:www.capt.org.uk or call 020 7608 7368 for apublications catalogue.


19/40


G around 200,000 children aged one to threeyears old attend hospital after a fall

G around 22,000 children aged one to three yearsold attend hospital after suspected poisoning.

Abilities and characteristics

Toddlers are inquisitive little people with enormousamounts of energy coupled with very littleunderstanding of the consequences of their actions.Most parents nerves will suffer during the toddlingperiod due to their childs seemingly limitless abilityto put him or herself in alarming situations.

Toddlers have:

G thin skin

G bones that are still developing

G improving speech

G improving ability to manipulate objects like

screw tops and door handles

G a short attention span

G difficulty in telling from which direction asound comes

G limited powers of concentration.

By fourteen months, toddlers may be able to:

G walk without help

G crawl upstairs

G operate knobs, switches and dials.

By two years, toddlers may:

G operate taps and unscrew tops

G be interested in the smell, taste and textureof objects

G start imitating adult behaviour

G be able to repeat simple instructions but willnot necessarily understand or obey them.


Falls

Toddlers are forever tripping and falling as theyplay, resulting in grazed knees and scuffed elbows.This is absolutely natural and not something weneed to particularly address. They are learning theboundaries of their ability, which is a crucial part ofdevelopment. However, it is important to minimisethe risk of serious injury by recognising what posesan unacceptable threat to a toddlers safety.

Down stairs Falls down stairs are still one of themost common accidents to befall toddlers. Theirnew-found ability to climb will mean that stairs areparticularly attractive. Safety gates themselves cannow become a problem, if a toddler tries to climbthem or works out how to open them.

From windows Many toddlers are injured eachyear after falling from a window. Even from a low,

ground floor window, if it is above concrete orstone, the injuries can still be severe. A toddlersmore dextrous fingers can now learn to operatewindow catches and s/he can squeeze throughsurprisingly small gaps.

17

Toddlers (about 1-3 years)toddling into trouble

Safety tips

I Before the baby starts to crawl or climb, asafety gate or barrier is needed at thebottom of the stairs to stop him or her

starting to climb the stairs and then falling.At the top, the gate or barrier needs to stopthe toddler getting to the stairs. It is betternot to place it directly across the top of thestairs for two reasons:

some gates have a bar across the bottomand this can be a tripping hazard. If thegate is at the top of the flight, a trip canlead to a fall down the stairs, which is muchworse than simply falling over the bar

adults and older children sometimes climbover the barrier or gate rather thanopening it. Again, this can lead to a fall

down the stairs

Its safer to put the gate or barrier across thelanding or even across the toddlers bedroomdoor. This can help restrict access to thebathroom where there are other hazards,such as cleaning fluids and very hot water.

I Begin teaching toddlers how to climb stairsbut never let them go up or down ontheir own.


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Suffocation

Toddlers can easily free themselves from bedding, soparents can start using pillows and duvets once theirchild is over a year old. The main risk of suffocationnow comes from playing and exploring, sopotentially hazardous objects should be recognisedand kept out of reach. It is also important toremember that toddlers should not be allowed toplay with or keep things in plastic bags, even underadult supervision, as they will then assume that it isOK to play with any bag that they find.

Choking

Food is still the main culprit when toddlers choke.Reconstituted meat, like hot dogs and burgers isone of the main dangers, along with hard sweetsand nuts. Toddlers are still learning about chewingand swallowing, so they need to concentrate oneating. Children of this age are still prone to puttingeverything in their mouths so coins, buttons, bits oftoys and other small objects still pose a threat.

A by-product of toddlers fascination withputting things in their mouth is their pushing smallobjects up their nose or in their ears. It is anentirely natural action for a child of that age, butneeds to be discouraged as it can cause injury.

PoisoningIt is at around the toddling age that accidentalpoisoning becomes a particular danger. A youngchild will try eating or drinking anything, evensomething that tastes or smells unpleasant. Anychemicals or medicines including vitamin tabletsand contraceptive pills should be kept at leastfive feet off the floor and preferably locked away.Toddlers can demonstrate amazing determinationand climbing ability in their bid to reachsomething, so parents need to be on their guard.One toddler used the open door of the washingmachine to climb on the work surface and then

managed to open a cupboard door fitted with achild-resistant catch, all to get at what he thoughtwere sweets but were in fact pills.

N.B. Child-resistant lids and catches are exactly that child-resistant, not child-proof. Although generallyspeaking, children are older before they learn howto open these catches and lids, some toddlers havemanaged to work them out or use brute force.

Strangulation

A toddlers head is still proportionately larger to hisbody than that of an older child or adult. Thismeans that toddlers are vulnerable if they try tosqueeze through a small gap their heads may wellget stuck. This is particularly dangerous if it is offthe ground, potentially leaving the toddler hangingby his head. Most modern play equipment is madewith gaps large enough to pass through withoutincident, but it is a point worth remembering.


Safety tip

I Keep plastic bags of all descriptions out ofreach and out of sight.

Safety tips

I Always supervise young children when theyare eating

I Sit with toddlers and make them sit stillwhile they eat, even biscuits

I Keep small objects out of reach

I Do not give toddlers peanuts or boiledsweets peanuts contain aracus oil whichcan cause the bronchial tubes to swell andclose off air in-take if inhaled.

Safety tips

I Keep medicines and chemicals locked awayor high up out of reach and sight

I Keep chemicals in their original containers,to avoid confusion

I Do not keep medication in handbags or bythe bed

I Check the garden for poisonous plants

I Carbon monoxide alarms should be fittedwherever there is a flame burning appliance(such as a gas boiler) or open fire.Appliances should be serviced regularly.

Safety tips

I Fit locks or safety catches to stop windowsfrom opening more than 6.5 cm (2.5) to allwindows that a child could reach byclimbing

I Avoid putting furniture like beds, chairs andtables underneath windows. They can beclimbed on to reach the window.


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Burns and scalds

Toddlers are still vague about the concept of hot

and cold. They can start to be taught not to touchcertain items, but they will not necessarilyremember or understand why. If matches orlighters are left in reach, they may well work outhow to operate them without understanding thedangers. Their curiosity or desire to copy adultsmay lead them into danger tugging at panhandles or electric flexes, trying to use a hot ironor hair straighteners left to cool on the floor,lighting matches, playing with the bath hot tap.Their skin is still thin and liable to burn and scaldmore easily and seriously than an adults.

Fires in the home Each year babies and childrendie in house fires, mostly as a result of smokeinhalation rather than actual burns. There are

general fire safety rules which apply to all agegroups, child and adult, and which can potentiallysave lives:

Electrical burns

Electrical burns and shocks are not very common.Generally, they happen because of faulty electricalequipment such as frayed wires or exposed plugs.It is very difficult for toddlers to get an electricshock by playing with a socket. You do not needsocket covers to make them safe as they aredesigned to be safe. Socket covers may stop youngchildren plugging in appliances that can causenasty burns, or even start a fire, but they shouldnot be relied upon to prevent electric shocks asthey are not regulated. It is better to make surethe appliances are safely put away.

Drowning

Being mobile, toddlers can reach potentiallyhazardous places on their own, unlike youngerbabies. Bathwater is a key hazard and leads to aseveral drownings every year. As well as duringbath time where a toddler has been leftunsupervised, baths with water in can lead todrownings (and scaldings) if toys are dropped inand toddlers try to retrieve them. Gardenponds,often those in neighbouring gardens orbelonging to friends or relatives, are also

19

Safety tipsI Always check the water temperature with

an elbow before putting a toddler in thebath. The water should not feel either hotor cold. To avoid rapid and severe scalds, athermostatic mixing valve (TMV) should befitted to the bath hot tap. If there is noTMV, always put cold water in the bath first,then add hot water

I Keep irons and hair straighteners out ofreach and avoid ironing with a toddleraround

I

Always use a kettle with a short or curledflex

I Use the back rings on the cooker and turnhandles to the rear

I Keep matches and lighters out of sight andhigh up

I Use sun block, a hat and loose clothing onwarmer days.

Safety tips

I Check appliances and wiring are in goodworking order

I Avoid children plugging in appliances thatcould burn them or start a fire, by makingsure appliances are put safely away.

Safety tips

I Fit a smoke alarm on every level of yourhome and check the batteries every week.Alarms give you vital extra seconds toescape a fire




I

Do not overload electric sockets and replaceold or worn flexes


I Work out a family escape plan now do not leave it until it is too late.

Safety tips

I Supervise climbing games

I Be aware of necklines catching inplay equipment

I Keep harness straps, cords and otherhanging loops tucked out of the way.


22/40

responsible for a number of drownings and near-drownings every year. Even small amounts ofwater, like puddles and rain water gathered industbin lids or paddling pools can be enough tocause a fatal accident. Indoors as well, water left inthe bath or in buckets and other containers hasproved fatal.

While toddlers should be encouraged to enjoywater play and swimming in pools with parents,there is a danger of their becoming over-confidentand having no fear of water.

Cuts and bruisesThe odd minor bump or bruise is an occupationalhazard of being a toddler. However, door jambspresent a very painful danger to inquisitive littlehands fingers can be lost in this type of accident.Cuts are potentially serious and parents shouldtake steps to prevent them. Toddlers who seeadults cutting paper or vegetables, or shaving maytry to imitate them if they get hold of scissors, aknife or a razor.

Serious cuts can also result from toddlersrunning into low glass, such as patio windows andglass panelled doors.

Out and aboutBy car Toddlers can safely travel forward-facing ina seat suitable for their weight and developmentalstage. It is usually around this time that manychildren start to try escaping from their car seat,whether by wriggling out of the straps or pressingthe harness release button. They are notdeliberately being naughty they are just exploringand experimenting. However, it poses a serious riskto the child and unfortunately there is not a realsolution. Try fitting a play tray or talking aboutother things to distract them or tightening straps.

Leaving a toddler in the car on his own can be

dangerous. Even strapped in, he may fiddle withwindow or door controls and an unrestrainedtoddler could burn himself on the cigarette lighter,get a limb or his neck caught in an electricwindow, knock the hand brake off or suffer fromthe heat in summer.

On foot Toddlers are unpredictable and quick.They can run off and be out of sight in second.This can put them in dangerous situations. Whenout on the street, an exciting place for toddlers, allthe distractions may mean that they wander offinto trouble. Cars are responsible for moreaccidental childhood deaths than any other singlecause, and while a toddler might recognise a car,s/he will not have the first idea of the dangers that

come with them.


Safety tips

I Keep scissors, knives and razors out of thereach of toddlers

I Replace low glass with safety glass, board itup or cover with safety film

I Be aware of little fingers near door jambs consider using foam door stops from largerchild specialist shops or department andDIY stores. Remember to close doors atnight in case of fire.

Safety tips

I Always use a correctly fitting forward-facingchild car seat when transporting a toddler,even on the shortest journey

I Do not leave toddlers unattended in cars

I Encourage toddlers not to touch or fiddlewith their harnesses.

Safety tips

I Use a harness and reins when toddlers arewalking on the road

I Walk with the child on the inside and theadult kerb-side do not forget to swapwhen a road is crossed

I Fasten the five point harness in thepushchair every time

I Set a good example when crossing the road

by choosing a safe place and talk to yourchild about what youre doing

I Make sure the garden gate is secure so thetoddler cant run into the road.

Safety tips

I Closely supervise toddlers in paddling poolsor playing near water

I Empty baths, paddling pools and bucketsimmediately after use

I Fence off or fill in the garden pond andcheck that boundaries are secure if there is apond next door

I Put covers on water butts

I Stay with toddlers in the bath.


23/40

Other safety pointsToddlers are very selfish little people. It is notmalicious selfishness; they are simply unable tograsp that anyone has any rights or feelings otherthan themselves. As far as they are concerned,they are the centre of the universe andeverything is there just for them. They also loveto copy the adults around them and have noconcept of their actions having consequences. Thismeans that they may inflict harm on otherchildren without understanding the outcome oftheir actions. If there is a new baby in the home,toddlers should be supervised around him or her.

There have been cases of toddlers feeding sweetsand peanuts to new-born babies or trying to givethem a bath on their own. One toddler even puthis new baby sister in the washing machinebecause her nappy was dirty. Many toddlers willpoke and prod younger children quite hardwithout realising they are hurting.

Education

For the child

A toddler has an ever increasing vocabulary and

can understand simple instructions. However,toddlers are still not old enough to understand theconcept of danger and what it means to them, soprevention and supervision are still the watch-words. Toddlers are keen to learn and copyeverything, so parents and carers can capitalise onthis by setting good examples with their ownactions and by repeating simple safety messageslike Hold on tight when you climb the stairs orDont touch the hot radiator. However, repeatingis not remembering reliable memory takes yearsto develop so supervision is still necessary.

Simple safety games can also be played, such as

showing a toddler some pictures of things like icecreams, fires, matches and fridges and asking themwhats hot and whats cold. Keep things simple anddo not expect a toddler to remember.

G set a good example and talk about whatyou are doing

G play safety games

G keep things simple.

For parentsWhile it is only natural for parents to think thattheir toddler is the brightest, most advanced childaround, it is vital they do not over-estimate theirchilds abilities. While children of this age willparrot words and phrases they are taught, it doesnot automatically follow that they eitherunderstand what it means or will remember itwhen necessary. Parents also need to understandthat children of this age still do not really learn byexperience, so just because a toddler has hurt hisfingers by touching a hot radiator it does not meanhe will not do exactly the same thing tomorrow

and the day after.In many cases, the best injury prevention

technique at this age is to simply separate thetoddler from the hazard by a physical barrier e.g.a fire guard, a closed door or a locked cupboard.Tearful frustration at not being able to get at whatthey want is better than painful experience.

Parents should concentrate on setting a goodsafety example to their toddler, praisingappropriate behaviour like holding on when goingup or down steps and gently correcting unsafebehaviour like putting fingers near door jambs.

G do not over-estimate a childs ability

G toddlers do not always learn from experience

G praise good safety behaviour.

The Child Accident Prevention Trust produces arange of publications that provide clear, simpleadvice to parents of toddlers. These include thefollowing leaflets:

How safe is your child from a serious fall?How safe is your child from burns and scalds?How safe is your child in the car?How safe are your childs toys?

Make sure my fingers dont get trapped

Also:Toddlers and up A comprehensive list of tips tokeep toddlers safe

How safe is your child at home?A room by roomguide to making the home safe forunder 5s.

To order any of these publications, or samplecopies, please visit the CAPT website:www.capt.org.uk or call 020 7608 7368 fora publications catalogue.

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24/40

Facts and statisticsG in 2005, 529 children aged one to four years old

were injured in fires in the UK and 13 died

G in 2006, there were 3,010 road accidentcasualties of children aged three to five years inGreat Britain, with 16 deaths. Of these, 42%were injured as pedestrians and 47% as carpassengers.

Abilities and characteristics

Children of this age group will have improvingphysical co-ordination and dexterity along withincreasing understanding of action andconsequence. They are likely to forget safetyinstructions when distracted, excited, tired orupset, but have better memories and powers ofconcentration. However, the reasons for safetyrules will still largely be a mystery to them.

They will enjoy testing their own abilities andsetting themselves challenges. Exploration andexperimentation are still major parts of their play,along with role playing, like being doctors orteachers. They use imaginative play and love

pretending to be any number of things animals,super heroes, adults around them, cartooncharacters etc. They will find ways to use toys andother everyday objects the designer, manufacturerand parent never intended or imagined.


Falls

Down stairs Safety gates are no longer an

effective barrier to a three to five year old, soparents and carers need to ensure that their child istaught to go up and down stairs safely. The stairsshould also be out of bounds for play.

From windows At this age, children can havepowerful imaginations and unrealisticexpectations. They see Superman on the TV fly outof a window and imagine that, given the rightcostume, they could do it too. A physical barrier totheir doing this is the best prevention.

From play equipment Modern play equipmentis generally made to a relevant British Standard,which means it will have certain safety featureslike safely spaced bars or securely fastenedfittings. But however safe the equipment is, if asmall child falls from the top of a climbing frame,injury is the likely consequence. It is impossible

and undesirable to remove every element of riskfrom play because it is important that play ischallenging and interesting. However byensuring that children only use appropriate playequipment, preferably over impact-absorbingsurfaces and under supervision, some of the moreserious risk is removed.

Although not play equipment, bunk beds areoften used in childrens play. Theyre not reallysuitable for children aged under six, who couldsuffer a serious fall from the top bunk.

Suffocation

Plastic bags still pose the greatest threat ofsuffocation to children of this age, although it isfairly rare. Avoid storing toys in plastic bags and donot give them to children to keep things in.

Children aged about 3 to 5learning about safety


Safety tips

I Teach children to hold on to the bannisterswhen going up or down stairs

I The stairs and landing should never be usedas a play area

I Encourage children not to leave toys etc. onthe stairs.

Safety tips

I Select play equipment suitable for yourchilds age and development

I Choose playgrounds that have impact-absorbing surfaces fitted

I Discourage playing on bunk beds

I Show children how to use equipmentcorrectly, but expect them to use it inunexpected ways!

Safety tips


I Avoid putting furniture like bedsunderneath windows

I Tell children about the danger of playingwith or near windows.


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Choking

Generally speaking, by the age of three, mostchildren have grown out of the habit of puttingeverything in their mouths. However, parents knowtheir children best and should continue to avoidtoys with small parts if the habit persists. A greater

danger comes from choking on food, which can betackled by children sitting still to eat and having anadult presence to supervise. Small solid food itemssuch as some types of sweets and ice cubes canpresent a hazard, so avoid if at all possible.

Poisoning

Despite increasing knowledge of what is and is notedible, children of five and under are still the mostsusceptible age group to accidental poisoning.They may be easily confused by medicines thatlook like sweets and poisonous berries whichresemble red currants and blackberries. Childrenwill also have much improved breaking andentering techniques with which to get to whatthey want. Parents may find it safest to keep allharmful items including vitamins, contraceptivepills, alcohol and cigarettes in one well-usedroom where children are unlikely to beunsupervised for very long.

N.B. By this age, most children will be able to openchild-resistant tops on medicines and chemicals, sothese alone will not prevent accidental poisoning.

StrangulationThere is still a small risk of strangulation tochildren of this age from their clothing, mostlywhen it gets caught in or around another object,like play equipment or railings. Other dangers maybe washing lines, particularly rotary lines, blindcords and elasticated rope and cord.

Burns and scalds

Children of this age are keen to help or copy theadults around them. This can be hazardous when itcomes to handling hot food and liquids, using theoven, lighting candles, running hot taps etc. Bynow most children will understand the concept of

hot, do not touch, but this is easily forgotten atany time. Parents and carers will need to use theirown judgement as to what their child is capable of,but generally speaking, the under fives are safestdoing jobs that do not involve hot objects or liquids.

Their improved manual dexterity means thatchildren of this age can turn on taps, operate ovencontrols and switch on heaters. Parents need to beaware of this and take appropriate action.

23

years

Safety tips

I Keep medicines and chemicals locked awayor high up out of reach and sight

I Do not keep medication in handbags

I Teach children not to eat anything they pickoutdoors until they have checked with anadult.

Safety tips

I Ensure childrens clothing doesnt fit tootightly at the neck

I

Cover rotary washing lines when not in useI Do not leave any type of rope or cord lying

around. This should include dressing gowncords.

Safety tip

I Keep plastic bags of all descriptions out ofreach and sight.

Safety tips

I Encourage children to sit still while they eat

I Avoid giving peanuts to children under six.

Safety tips

I Always check the water temperature before

putting a young child in the bath. Fit athermostatic mixing valve (TMV) to the bathhot tap to prevent rapid and severe scaldingif a toddler manages to turn on the hot tap

I Keep irons and hair straighteners out of reach

I Always use a kettle with a short or curled flex

I Use the back rings on the cooker and turnhandles to the rear

I Keep matches and lighters out of sight andhigh up

I Use sun block, a hat and loose clothing on

sunny days.


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Fires in the home Each year children die in housefires, mostly as a result of smoke inhalation ratherthan actual burns. There are general fire safetyrules which apply to all age groups, child andadult, and which can potentially save lives:

Drowning

Although the risk of drowning in the bath or insmall amounts of water is lesser, children in this agegroup are still vulnerable in and near water. Theymay be more confident in the water, but there arestill many risks. The garden pond remains a threat,as does playing near open water like streams,canals and reservoirs, even under supervision. Oncechildren are about four, it is generally OK to leavethem in the bath, as long as they cannot lock the

door and an adult is in ear-shot.

CutsThis age group can start to be taught how to usesome knives and scissors safely, such as using around-ended knife to butter bread or usingchildrens scissors in craft activities. Their manual

dexterity has improved since they were toddlers,and teaching them to use knives and scissorscorrectly early on will help establish good practice.Any sharp object, including razors and nail files,should still be stored out of childrens reach. Evenplastic knives can be sharp, if they snap. Low glassstill poses a threat as boisterous play can result inchildren falling against doors and windows.

Out and about

By car By the age of four, most children will beable to use a booster seat or cushion in the car.Their bodies have matured sufficiently for them tobe restrained just with an adult seat belt fittedaround an appropriate booster seat or cushion.

It is still important to not leave childrenunattended in cars, as their improving physicalskills combined with curiosity and imagination canlead to accidents.

On foot The Department for Transport (DfT)

recommends that children aged under five arealways accompanied by an adult on the road.They simply do not have the understanding orexperience to deal with traffic. Parents should talkto their children about how to cross the road safelyand set a good example, but never expect them toreally understand and remember.

On bicycles Many children will have started riding


Safety tips

I Closely supervise children in paddling poolsor playing near water

I Fence off or fill in the garden pond

I The safest place for swimming is a publicswimming pool.

Safety tips

I Store knives and scissors safely and teachchildren the correct way to use them andput them away

I Replace low glass with safety glass, board itup or cover with safety film.

Safety tips

I Always use a correctly fitting booster seat orcushion when transporting a child, even onthe shortest journey

I Do not leave young children unattendedin cars.

Safety tips

I Never allow a child under five out alone

I Encourage children to hold your handwhen out

I Set a good example when crossing the road.

Safety tips

I Fit a smoke alarm on every level of yourhome and test the batteries every week.Alarms give vital extra seconds to escape afire




I Do not overload electric sockets and replaceold or worn flexes

I Teach children what to do if they discover afire or hear the smoke alarm going off


I Work out a family escape plan now

do not leave it until it is too late.


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tricycles or even bicycles by the age of five. A childthis young should never be allowed on the road ontheir bike or trike for the same reasons that theycannot yet cross a road alone. All cyclists,regardless of age, should wear correctly fittinghelmets, so parents have the opportunity toestablish the habit very young.

Education

For the child

As a child grows out of toddler-hood, their capacityfor learning is still enormous. Now is the time tostart explaining why some things are dangerous, asopposed to simply saying dont touch or dont goin there. This will make the child feel grown upand more likely to respond positively. However,there are still many limits to their understanding

and abilities, so information needs to be tailored totheir level and repeatedly reinforced.

Learning safety rules will help with memorydevelopment and can still be fun for the child, butparents and carers should still not over-estimate achilds ability to remember. Adult help andguidance is still essential during this period, whilethe child gains confidence and good habits arestarting to be established.

As they pass out of the self-obsessed toddlerperiod, children can also start to understand thattheir actions have an effect on others aroundthem. They are still too young to take

responsibility for others, but can be taught thatothers might be hurt because of the things theydo, such as leaving toys on the stairs or givingsmall objects to a baby.

G set a good example

G explain whysome things or actionsare dangerous

G make learning about safety a fun and positiveexperience

G teach children that their behaviour and actionsaffect other people.

For parents

It can be difficult for parents to remember thatjust because their child is now walking, talking

and generally acting much more like a child thana toddler or baby, they are not necessarily readyfor more responsibility. A four year old is stillan impulsive, forgetful and physically andemotionally immature little person. Whileundoubtedly they will be learning more and moreevery day, they are still in need of an adultsguidance and supervision.

On the other hand, parents and carers alsoneed to realise that children in this age group canstart to be taught some basic safety techniquesand how to apply them. It is very much down tothe parent to be the judge of their own childsabilities and understanding, but there is merit in

teaching children the safe way to deal withsimple tasks such as using a knife to butter breador cut up a piece of fruit. Supervision is still all-important, but so is allowing the child the actualexperience where it is safe and appropriate.

Praising good safety behaviour rather thanonly picking on bad behaviour is a positive movethat will also increase a childs confidence andhighlight for them what theyre doing right.Children of this age are eager to learn and keento please those they look up to, so it is importantto be positive about what they do and use thistime to give them as much information and

guidance as is appropriate.

G do not over-estimate a childs ability

G teach children how to cope with somehazardous situations

G praise good safety behaviour

G supervision is still the best accidentprevention technique.

The Child Accident Prevention Trust produces arange of publications that provide clear, simpleadvice to parents of pre-school age children.These include the following leaflets:

How safe is your child in the garden?How safe is your child from burns and scalds?What might poison your child?How safe are your childs toys?

Also:Its fun to go out, but.. A comprehensive list of tipsto keep toddlers safe

How safe is your child at home?A room by roomguide to making the home safe forunder 5s.

To order any of these publications, or samplecopies, please visit the CAPT website:www.capt.org.uk or call 020 7608 7368 fora publications catalogue.

25

Safety tips

I All cyclists should wear correctly fittingcycle helmets

I Do not allow children in this age group to

ride on the roads.


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G around 150,000 children aged five to sevenyears old attend hospital after falls

G over 13,000 children in this age group go tohospital to get cuts treated

G over 400 children aged five to seven years oldattend hospital after a choking incident.

Abilities and characteristicsAs full-time schooling starts, children in this agegroup are coping with a lot more in their everydaylives. They may feel more grown-up as they dealwith the challenges of being away from theirfamily and home for a large part of the day. Therewill be many more outside influences on theirbehaviour and outlook and they may start to getmixed messages about safety But so-and-sosmum lets him do that!

Play is still a very important part of their lives,as is challenging themselves and testing their

physical abilities. This is the age when they mightstart to join clubs and organisations that mightteach them more about safety and other life skills.

While their risk assessment skills are improvingand increasing, children of this age are still impulsive,occasionally thoughtless, liable to over-estimate theirabilities and in need of adult guidance.


Falls

Down stairs The stairs are still a dangerous placefor children. If they are treated as an extension ofthe play area and used in games, accidents arelikely to happen. Safety gates, other than foryounger children in the home, are no longer aneffective barrier.

From windows An unguarded or open windowcan still be a danger. Children may lean out too far,or try and climb from one window to another.They might accidentally lean on a partially openwindow. They may also misjudge how far it wouldbe to jump to the ground.

From play equipment Good, modern playequipment is designed to stimulate and challengechildren, which means that some mishaps areinevitable. It is impossible and undesirable toremove every element of risk from play, but byensuring that children only use appropriate playequipment, preferably over impact-absorbingsurfaces, some of the more serious risk is removed.Children of this age require new challenges to

keep them stimulated and interested, and over-familiarity and boredom with a well-used play areamay result in their using the equipmentinappropriately or dangerously.

Suffocation

Suffocation is comparatively rare in this age group,although plastic bags should still not be used forplay. There have been cases of children becomingtrapped and suffocating in sand while digging orplaying, so parents and carers should be vigilantwhen children are playing.

Children aged about 5 to 7still learning


Safety tips

I Teach children to hold on to the bannisterswhen going up or down stairs

I The stairs should never be used as a play

areaI Encourage children not to leave toys etc. on

the stairs.

Safety tips


I Teach children about the danger of playingor fiddling with windows.

Safety tips

I Select play equipment suitable for a childsage and development

I Choose playgrounds that have impact-absorbing surfaces fitted and try to vary theplay areas visited

I Show children how to use equipmentcorrectly, but expect them to use it inunexpected ways!


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Choking

Children of this age have generally grown out ofthe habit of putting things in their mouth thisusually stops around the age of three so chokingdangers are mainly restricted to food stuffs.

Running or playing with food or sweets in theirmouths means that children are not concentratingon chewing thoroughly, which makes chokingmore of a danger. Peanuts are still probably bestavoided until the age of about six.

Poisoning

By now, children will have a better grasp on whatis and is not food and drink. However, they maystill mistake items like tablets for sweets andbrightly coloured liquid chemicals for soft drinks.Also remember that some things that are fine foradults are potentially dangerous for children.Alcohol can be poisonous to a young child, whosesmaller body mass will not be able to absorb it inthe way an adult can, and iron tablets can causeserious illness if taken by children.

StrangulationEach year, children are accidentally strangled whileplaying with belts, scarves, ties, ropes etc. Theirimaginative play means that they use the everydayobjects around them as props and costumes. It is avery difficult accident to prevent, as no-one wantsto inhibit play, the objects involved are notdangerous in themselves and children of six orseven cannot be supervised all the time.

Burns and scalds

Children of this age are keen to help or copy theadults around them. This gives parents and carersthe dilemma of giving children tasks that are nottoo difficult or dangerous yet are stimulating andsatisfying for the child. At this age, children can dosimple household jobs, but their physicalimmaturity means that they cannot manage tasksthat require an adults strength and dexterity.

Jobs involving hot food or drinks need to becarefully supervised. Children should be taughthow to perform tasks safely but at an age theparent thinks is appropriate.

Matches and lighters are still dangerous thingsto leave in reach, but there is merit in teachingolder children how to safely strike a match,thereby removing the attraction of the unknown.

27

years

Safety tips

I Enc

Documents

Accidents and Child Development