Although a lot of pediatrics is dedicated to caring for sick children, most children are healthy when they come in for a routine check-up. It is a great opportunity to explore ways to keep our children safe. 

Sara Robert, MD, a pediatrician with Duke Children's Primary Care, points out some common dangers in the home and ways to keep children safe.

-- Dennis Clements MD, PhD, MPH

Sara Robert, MDInjuries are the leading cause of morbidity and mortality in children less than 19 years of age. According to the Centers for Disease Control (CDC), more than 12,000 children zero to 19 years of age die each year in the U.S. from unintentional injury.

Although the leading causes of injury death differ by age group, these preventive tips about how to keep our children healthy and safe in and about our home can be useful for everyone. 

Anoxic/Threats to Breathing

Suffocation is the leading cause of injury death for children less than one year. In the 1990s, deaths related to sudden infant death syndrome (SIDS) decreased dramatically as parents were educated to place their sleeping infant only on their back, rather than on their side or stomach.

Choking items around the home can include food, toys, and household items. Items in reach of a child should be large enough that they cannot fit inside an empty roll of toilet paper. Additionally, old plastic shopping bags or balloons should not be in reach of children, as these can cause suffocation.

Safe eating practices include sitting at a table or in a highchair while eating, cutting food into small bites, and steaming to soften to the appropriate texture. Common choking culprits include grapes, hot dogs, popcorn, hard candies, and foods that clump (such as cheese or peanut butter).

If a child chokes, know these steps for clearing the obstruction:

• Heimlich maneuver for children (health.harvard.edu)
• Heimlich maneuver for infants (health.harvard.edu)

Although it sounds great to save money and borrow a crib or likewise use an old family heirloom, there are many specifications that you will need to check to make sure the crib is safe, including newer recommendations against drop-side cribs, as well as older recommendations that the distance between slats is no more than 2-3/8 of an inch apart.

Mini-blinds should not be in reach of children. Pay close attention to the drawstrings, which should be tied out of the reach of children.

Drowning is the leading cause of death from ages one to four years. Any water source, including toilets, baths, jacuzzis, and pools should be closely supervised while children are around.

Falls

Although most parents at some point turn to find their child standing precariously on a couch, or climbing on the table, there are many steps that we can take to avoid falls.

It can take months before some babies begin to roll from back to front. But it is always safest to directly supervise a baby placed on a diaper changing table, couch, or bed top, not even leaving them for a second to grab a spare bag of wipes. A safe alternative would be to change the child on the floor.

Stairs are also a notoriously dangerous place that seem to magically draw the toddler who is just learning to climb. Sturdy safety gates are recommended, to be installed securely sometime well before your infant becomes mobile, usually by eight or nine months as most children crawl before or around this time.

Walkers are no longer recommended due to concerns the mobile infant might fall down stairs. Instead we now often recommend stationary exersaucers as a safer alternative.

Always leave car seats, bumbo, and bouncy chairs on the floor rather than perched on higher surfaces.

Lastly, falls from windows can be very dangerous. Make sure windows are securely fastened, and never assume a screen is a barrier to a child’s fall. 

Ingestions/Poisonings

Once children become mobile, they can (and love to) get into anything. How many times have you turned around to find an entire toilet paper roll unraveled on the bathroom floor? That is why we recommend spending some time looking around the house to assure ourselves all dangerous items are safely stored.

This includes cleaning products, paints, medications, or any other choking hazards. It’s a good idea to lock cabinet doors with childproof locks, keep medications in childproof containers, and store these kinds of products up high. 

Burns/Fire

Even on a little baby we see burns, often from splattering of a cup of hot coffee or tea. We recommend that hot water heaters are set at less than 120 degrees, as the rate of burn is much slower below this temperature.

Never leave electric appliances anywhere a child can reach them, especially not near the bath where they could tumble into the water. Plug all electric outlets with store bought devices. Matches should be kept out of reach of children, and children should also be taught never to touch them.

When cooking on the stove top, make sure pan handles point toward the back of the stove and therefore cannot be grabbed by little hands. Likewise, make certain no toddling kids are around when you open the door to an oven, as it only takes a second to get burns all over an explorative hand.

Remember to check that your smoke alarms are working, changing batteries at the appropriate times. Carbon monoxide (CO) detectors are also recommended to avoid CO intoxication.

Avoid feeding children food or drinks that may be at scalding temperatures -- in particular, we recommend not heating contents of bottles in the microwave as they can unevenly distribute heat and even overheat the food. Always test the temperature of food before feeding your child.

Guns

It has been estimated that anywhere between 30 to 50 percent of homes in the U.S. contain a gun. Chances are great that your child will be visiting family or friends in a house where a gun is stored. Safe gun storage methods include storing the gun and ammunition separately and locked up, such as in a safe.

Educate your child about what a gun is and if they should see one: never to touch it --instead, leave the area immediately and go tell an adult.

This is particularly important as guns are often very visible in television, movies, and video games, often glamorizing them rather than making them appear dangerous. Talk to your child about this!

Lastly, according to the New England Journal of Medicine (Suicide in the Home in Relation to Gun Ownership, A Kellerman, N Engl J Med 1992; 327:467-472), readily available guns are associated with an increased risk of suicide in the home. If you know about a family member or friend who is feeling depressed, guns should absolutely be removed from the home. 

-- Sara Robert, MD, is a pediatrician with Duke Children's Primary Care.

-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.