by Heather Cunningham
We all want to keep our children safe from injury and worse, and most of us go to great lengths ensure it. Latches appear on our cabinet doors, gates on our stairs and the best car seats in our vehicles. As our children grow older, we develop rules to keep our school-age youngster safe, even as they goad us for more independence. But it is enough? Experts say that even the most conscientious parent may neglect to take an important step, or make a crucial decision, that could keep their child from harm.
Unintentional injury still is the No. 1 killer of America's children, taking more lives than disease, violence and suicide, according to the National SAFE KIDS campaign. An estimated 90 percent of these injuries could have been avoided.
"There are accidents and injuries that we can prevent, and those that we can't," says Elizabeth Powell, pediatric emergency physician at Chicago Children's Memorial Hospital. "I may not be able to keep my 4-year-old from falling at the playground, but there are other things that I can do. And making sure those things are done can make a difference."
You may assume you have done everything you can to keep your children as safe as they can be. But, experts say, you could be making a mistake that could have horrendous consequences.
Mistake No. 1.
Not adequately baby proofing or toddler proofing against falls. Falls are the king of unintentional injury, accounting for more that half of all nonfatal injuries to children. Just like Dr. Powell, maybe you can't keep your 8-year-old child from slipping off the swing on the playground, but other falls can be easier to predict and prevent.
Infants are at greatest risk of falling from furniture, stairs and baby walkers; toddlers from windows. If you have a baby walker, get rid of it-period, says the American Academy of Pediatrics (AAP), which is adamant that baby walkers can be dangerous and do not recommend their use. Gate each stairway both at the top and the bottom. Move chairs and beds away from windows, and consider installing window guards on precarious second-story windows.
Ever set your baby's infant car seat on the table while you get on your coat before you head out the door? Many parents have, only to end up in the emergency room when the seat slips or is accidentally knocked to the floor, Powell says. The Children's Memorial Hospital Center for Childhood Safety recommends that no child be placed on any raised surface such as a bed, sofa, changing table or counter, without direct supervision.
Mistake No. 2.
Allowing children to bike without a helmet. "For a long time I have tried to push for legislation in Illinois for a bicycle helmet law," said Anthony Deluch, an Orland Park pediatrician and chair of AAP's injury and poison prevention committee for the Illinois chapter. "Wearing a helmet reduces head injury involved with bike falls and accidents considerably. And what some parents don't understand is that kids need to wear the helmets even when they ride in the driveway," says Deluch, "because that is where many falls happen."
The National SAFE KIDS campaign reports that after cars, bicycles are associated with more childhood injuries than any other consumer product. Wearing a helmet can reduce a child's risk of head injury-even in minor spills-by as much as 88 percent-and a helmet can prevent 75 percent of all bicycle-related deaths, advocates say.
Wearing a helmet should be non-negotiable. Buy one that meets or exceeds the safety standards developed by the U.S. Consumer Product Safety Commission, www.cpsc.gov. It should fit snugly, but not too tight and should be centered on your child's head, not tipped back, which exposes the vulnerable forehead area. Wearing a helmet incorrectly increases the risk of head injury by 50 percent.
Mistake No. 3.
Not correctly installing your child's car seat, or failing to use a booster seat. All parents are required by law to put their child in a car seat to protect them in the event of an accident. A recent national study shows that nearly 85 percent of us don't install car seats correctly. Research indicates the most common mistakes include not having the seat or harness strap buckled in tightly enough, not routing harness straps correctly and failing to use a locking or harness retainer clip.
"Parents need to know that it might look right, but not be right," said Garry Gardener, a Darien-based pediatrician and member of the AAP's national committee on injury and poison prevention. "To fully protect, the seat must be in the correct position in the back seat, buckled properly and age-appropriate."
Children should remain in a booster seat until they are at least 8 years old, heavier than 80 pounds and 4 foot 8 inches tall. "This positions the lap belt correctly for this size of child," says Powell.
Because many parents don't take this additional step, some legislators are pushing to mandate booster seats, just as they did with infant seats.
To ensure your child is as safe as possible while riding in the car, use a rear-facing infant car seat until your baby is both 1 year old and 20 pounds. Children between 20 and 40 pounds should ride in forward-facing child safety seats. Those over 40 pounds should use a booster seat.
Because there are hundreds of child safety seats, combined with dozens of seat belt configurations, there are literally thousands of ways to install car seats. Doing it right is crucial. To determine whether you are or not, call the U.S. Department of Transportation Auto Safety Hotline (800) 424-9393, the National SAFE KIDS Campaign Buckle Up Program (202) 662-0600 or your local hospital for the nearest free car seat check sites.
Mistake No. 4.
Not installing enough smoke detectors in the right places, and not maintaining them. Installing smoke alarms on every level of your home and in every sleeping area cuts in half the chances of your child dying in a home fire. A smoke detector should be installed in or near each child's room and on each floor of your home. Each unit needs fresh batteries. A good rule is to change the batteries every time you reset your clocks for daylight savings time.
"In the City of Chicago, fire is actually the leading cause of childhood deaths from injury in the first four years of life," says Powell. "We know that smoke detectors work, everyone knows that they should have one, but some of us need to be poked a bit about making sure that batteries have been recently replaced."
Once the smoke detectors are ready to detect a fire, it's time to make sure you've done everything possible to prevent a fire. Keep matches, lighters and other heat sources out of your children's reach to eliminate the risk of child-play fires, the leading cause of fire-related death for children ages 5 and under. Talk with your children about what to do in the event of a fire, plan and practice a family escape route.
Mistake No. 5.
Not safely storing firearms and not asking whether there are guns in homes your child visits. Teaching children not to play with guns isn't enough, says the Children's Memorial Center for Childhood Safety. Even children who have been taught that guns are dangerous are interested in them, and will play with them if they have the opportunity. If you must keep a gun in your home, keep it stored unloaded in a locked box. Keep the bullets locked in a separate, secure place.
Then ask the parents of your children's friends whether they keep guns. PAX, www.pax.com, a national organization dedicated to reducing gun violence, says 40 percent of all homes with children have guns in them. They suggest asking about guns along with the usual questions you present another parent before you send your child to their home to play-such as whether there are enough seatbelts for every child if they will be going out or whether they have animals.
If the home does have a gun, don't be embarrassed to ask where it is and how it's stored. "You have a right and a responsibility to know that the place you send your child to play is a safe one," says Gardener.
Mistake No. 6.
Not supervising kids closely enough outdoors, especially near busy streets or driveways. Each year, an estimated 25,000 children are hit by cars. It remains the second leading cause of unintentional injury-related death among children ages 5-14. Few children under the age of 10 should be expected to manage themselves in an unsupervised yard if there is traffic nearby. They have difficulty judging how fast cars are moving, as well as recognizing or reacting to danger. Often, they think a driver will see them first and stop. Research shows that most children are struck in streets or driveways near their homes when darting out between parked cars, walking along the edge of the road, crossing in the middle of the block or in front of a turning car.
Your child might be at even greater risk if you live in an area with a high volume of traffic, many parked vehicles on the street, faster speed limits and few crosswalks. In these cases, it might be best to consider "pedestrian-proofing" your yard. "Perhaps in busy areas the backyard play area should be fenced and locked," says Gardener.
Mistake No. 7.
Not being aware of product recalls. This is an easy one to fix. Make it a practice to check the U.S. Consumer Product Safety Commission Web site, www.cpsc.gov, either at home or at your local library, to regularly get updates on recalls of baby equipment and toys. While on the Web site, register to have e-mail alerts sent to you automatically regarding specific new toys or baby products that have been designated as dangerous for children. If you are not aware of recalls until you hear about a particularly dangerous toy or baby product discussed on the news, you might be missing thousands of others that haven't been mentioned. "It's important to keep your knowledge about toy recalls up to date because the list is constantly changing," says Gardener.
Mistake No. 8.
Letting your child swim without direct supervision. "In California they often begin teaching children how to swim when they are under the age of 1, and have hoped that it would help decrease the mortality rate involved in swimming pool accidents," says Delach. "But, in fact, it has not-it has just encouraged parents to be more complacent about swimming pools and kids. If they think that the child can swim well, they don't always watch as closely."
All elementary school children and many teens still need to be watched while they swim; those under 6 may need even a closer eye. "We recommend touch supervision for that age group," says Gardener. "Parents or the adult in charge should never be more than an arm's length away when the child is in or near water."
It is important to teach your child to swim, but both the American Academy of Pediatrics and the National SAFE KIDS campaign recommend organized classes wait until he or she is 4. Even after those classes are completed, however, do not assume anything. "The key to prevention here is continuing simple supervision," says Gardener. And if you have a pool or spa, make sure it is surrounded with a fence at least 5 feet high with self-closing, self-latching gates that eliminates any direct access from the house or yard.
Mistake No. 9.
Assuming that your baby's caregiver knows to put him to sleep only on his back. Most parent know infants should be put to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). But does every adult watching your baby know to do the same? The rate of SIDS deaths has dropped by more than 40 percent since the AAP first made this recommendation in 1992, but it remains the leading cause of infant death in the U.S.
Research has shown that nearly 20 percent of caregivers put infants younger than 4 months to sleep on their stomachs. Take the time to remind your caregiver that your baby should continue to be put to sleep on her back until she can turn over on her own. In the meantime, do not put your infant to sleep on a waterbed, sofa or soft mattress, or on top of a pillow, quilt, comforter or sheepskin. Also, doctors recommend it is best to keep stuffed animals, loose bedding or pillows out of your infant's crib or sleep area entirely.
Mistake No. 10.
Allowing your children to eat food that could choke them. You might know that some foods pose choking risks for toddlers-such as peanuts, grapes, raw carrots, nuts and seeds. But you might be surprised to find that there are new foods being added to that list as they hit the market. "For example, Gerber has been promoting a meat stick for toddlers that can be a significant choking risk," says Gardener. "It is similar to a hot dog, which is a choking risk as well. We have been trying to get the company to modify the product, but so far they are refusing."
Another new risk is the popular gel candies that become slippery when children suck on them. If they slip down the throat, they are virtually impossible to get out. "Choking, whether it is on the foods that we have always warned about, or new ones, is really common and still a major safety issue," says Gardener.
Avoid the foods that you can, slice others, such as grapes, into small pieces, and shelve foods like nuts and popcorn until your child is at least 6 years old. "Even so, choking will probably happen once in every family, whether it is to the 6-month-old infant or the 6-year-old child," says Deluch. "The best thing that parents can do is supervise their children while they are eating and learn the proper way to do the Heimlich maneuver on a child, as well as CPR [cardiopulmonary resuscitation]."
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