I remember bending down to get something from the exam table -- only to reach with my foot just in time to catch an infant from rolling off the table. And this was in the doctor’s office.

Safety preparation begins before children even arrive home and continue throughout childhood. Supervision and attentiveness is always of paramount importance with respect to your child’s safety.

So how can you help keep your child safe? Dr. Jennifer Lawson of Duke Children’s Primary Care gives us tips on what to look for and how to keep our children safe from the interesting but potentially dangerous environment.

-- Dennis Clements, MD, PhD, MPH

Jennifer M. Lawson, MD

Accidental injury is the leading cause of morbidity and mortality in children. The tips listed here can help you be prepared before and after your child arrives at home.

In the Crib or Bed

• Infants should be positioned to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS).
• An infant’s crib should have slats no more than 2-3/8 inches apart to prevent the baby from getting his or her head stuck.
• The mattress should fit snugly in the crib, and the crib should be free of soft objects on which the infant could suffocate.

Preventing Burns

• Hot water temperature should be set no higher than 120ºF to prevent accidental burns.
• Don’t carry hot beverages while holding a child to reduce the potential for a painful accident.
• In the kitchen, keep handles turned in to preventing groping hands from spilling hot liquids and food.
• If your child gets burned, place the burned area in cold water and call your physician’s office.
• Do not smoke while holding a child. Better yet – don’t smoke any time.

In the Car

• Infants should arrive home from the hospital properly restrained in a car seat.
• Children should be in an appropriately sized and positioned car seat.
• Children should use booster seats until the seat belt fits properly, which usually occurs between ages nine to 12.
• The safest place for children is the back seat. Never place a rear-facing seat in a passenger seat with an air bag. A child should be in a rear-facing seat until one year of age and a weight of at least 20 pounds. After that the child can be moved to a forward-facing seat.
• Children should be moved to a booster seat when they have reached the maximum weight for the car seat (usually 40 to 65 pounds; check specific manufacturer’s information), or their shoulders are above the harness slots or ears have reached the top of the seat.
• Shoulder belts should fit across the middle of the chest and shoulder, not the neck or throat. Lap belts should fit low and snuggly across the thigh, not stomach.
• Knees should bend over the seat without the child slouching, which usually occurs around a height of 4-feet, 9-inches, ages nine to 12.
• Model good car safety behavior by always wearing your seatbelt.

Around the House

• Fire safety: Homes should have working smoke detectors, and the batteries should be changed regularly. When children are old enough, families should make and practice a fire escape plan.

• Never leave your infant unattended. While newborn infants may not appear very mobile, all that wiggling makes them so. And once they start crawling be alert to stairs. Gates that anchor into the wall are best.

• Avoid walkers. A colleague once said, “Putting a child in a walker is like giving a 10-year-old the keys to the car.” Opt for a stationary activity center instead.

• Watch for choking hazards. Children explore with their hands, fingers, and, of course, mouths. Take care not to leave small objects around on which they can choke; toys appropriate for older children may have small parts on which a younger child can choke. Cut food into small pieces. Hard foods, plastic wrap, bags, and balloons are other potential choking and suffocation hazards.

• Try to see the world from your children’s perspective. In fact, try to anticipate their next step; get there before they do and have a look around. What looks interesting? That lamp cord? That socket by the cord? The tablecloth, curtain cord? Protect cords, cover sockets, and move objects that may fall and cause injury. Pad or remove objects with sharp edges and corners.

• Place childproof locks on the cupboards and drawers. Also remember that children are clever and curious; they may figure out how to open them more easily than an adult!

• Keep medicine and poisons out of reach. Make sure medicine bottles have safety caps on them. Particularly when visiting older relatives look to see if medicine has been left out. While you are talking your child is exploring. Keep the poison control number in an accessible location, such as on the phone. If your child swallows a toxin, do not induce vomiting. Call the poison control number immediately and proceed as advised. As children gets older, teach them how to dial 911.

• Be aware of guns. Store fire arms unloaded and locked securely; store ammunition separately. Ask about firearm status at the homes your child visits.

• Lock windows that are high above the ground. Install window guards on windows above the first floor.

Outside the Home

• Teach children about street safety. Remind them not to chase that ball into the street and when crossing the street to hold the hand of an adult, and to look both ways, and back again. Bike helmets should always be worn when riding. Make sure they ride in a safe area and teach them the rules of the road.

• Watch the lawn mower. It is important for children to help with chores, but lawn mowers can throw debris, so young children should not help with mowing, nor should they be on or near a mower when it is in use.

• Check for drowning hazards. Is there a pool, a creek a pond around? Or perhaps just a bucket of water? Children can drown in just two inches of water, so always supervise children around water, including the bathtub, even if they have learned to swim.

The world is an exciting place for a child, full of interesting things about which to learn. However, it also presents opportunities in which serious accidents can occur.

Allow your child to grow and explore, but help provide the safest environment you can by following safety guidelines, educating and always supervising.

-- Jennifer M. Lawson, MD, is a physician with Duke Children’s Primary Care.

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