Preventable injuries

The good news about most childhood injuries is that they're highly preventable

You’ve probably had one of those horrifying moments — catching your toddler teetering at the top of the stairs or your 10-year-old trying to jump a wall with his skateboard. If you’re lucky, you get to take your child’s near miss as a warning to be more careful in the future. I wasn’t so lucky.

Eighteen months ago, my then two-year-old son, Grayson, was racing excitedly around the house when I heard his scream. By the time I reached him, blood was gushing from a two-inch gash in his forehead. The cause? He was running in socks on our vinyl floors. One slip and he flew into the corner of a wall, splitting his head open. After a traumatic few hours in the emergency room, we found out we weren’t alone that day: The surgeon who stitched Grayson up had already done the same for three other children, each of whom had fallen from a shopping cart.

About 25,500 Canadian children aged 14 and under — one in every 230 — are hospitalized each year for serious injuries, and approximately 390 of them die, according to Safe Kids Canada, an organization dedicated to preventing accidental injuries and deaths in children. Thankfully, says Jan Tomlinson, a public health nurse in London, Ont., most injuries are preventable. Like running in sock feet, for example.

Although there is no crystal ball to help you prevent each scrape and tumble, have a look at the main types of accidents kids experience and how you can keep your little ones out of the emergency room.

Motor Vehicle Accidents

It will probably come as no surprise that our kids are at greatest risk of injury-related death from car accidents. (In Canada, an average of 880 children under 14 are seriously injured while riding in cars every year, and 68 are killed.) More surprising is that nearly all of these injuries happen because car seats and booster seats are not being used properly — or at all.

It’s critical to choose the right restraint for your child’s age, weight and height, and to make sure it’s installed properly. There are four types of child restraints:

• rear-facing car seats — under 10 kg (22 lb)
• forward-facing car seats — 10 to 18 kg (40 lb)
• booster seats with seat belts — 18 to 36 kg (80 lb), 145 cm (57 in)
• seat belts — 36 kg (80 lb), 145 cm (57 in) and up

In some cases, a smaller baby who weighs 10 kg or more will need to remain in a rear-facing seat, until he fits better in a forward-facing one. Likewise, a longer baby who doesn’t yet weigh 18 kg may need to be in a booster seat, so that his head is properly supported. Experts concur that it’s best to avoid two-in-one or three- in-one seats, and opt instead for single-purpose seats (for example. rear-facing only), simply because children fit better in them. Many health units and fire stations offer child-restraint clinics with certified technicians who will help install your car seat, or direct you to another program in your area that will. (See Car seat guide for a comprehensive car seat package.)

And no calling “shotgun” for the younger set: Even when kids have graduated to seat belts, they’re safest in the back seat until age 12.

Drowning

Kids’ natural attraction to water puts them at huge risk for drowning, the second leading cause of accidental death in Canadian children. Kids under five lack a sense of danger and can drown quickly in as little as 5 cm (2 in). And they’re still at risk when they get older because they tend to think they’re better swimmers than they actually are.

Phil Groff, director of research and evaluation at SmartRisk, a national non-profit injury prevention organization, says supervision is key. When bathing children under age five, for example, supervision means actively watching over them, not just being within earshot. Be wary of infant bath seats that may give the impression your baby can be left momentarily unsupervised; babies may slip out of them and they tip over easily. Instead, a non-slip surface in the bottom of the tub will help you to hold your wee one safely in the water.

Swimming pools are the other main concern; that’s where half of all drowning incidents happen. Though many municipalities require only three-sided fencing, four-sided fencing with an automatic, self-closing gate should be installed around all home swimming pools, and kids under age five should always be within arm’s reach or wearing a life jacket. (For more information on how to prevent drowning, see Why children drown.)

Choking

Can you fit Barbie’s shoes inside a toilet-paper tube? Then they’re a choking hazard and should be kept out of the hands of any child under age three. When it comes to food, the worst offenders for choking are hard fruits and vegetables, popcorn, nuts and slices of hot dog. Coins, magnets and milk-bag corners are also particularly dangerous. Likewise, cut curtain cords short and keep them out of reach, and take any drawstrings out of kids’ clothes.

Outdoor play accidents

If you’ve ever watched your toddler play “chicken” with a set of swings, then you know how hard it can be to relax at the park. It’s true that playground equipment poses hazards, but kids can play very safely, provided the equipment meets current safety standards set by the Canadian Standards Association (see sickkids.ca/safekidscanada, then click on Playground). These standards were established for public playgrounds, but are worth reading before you put up that backyard play structure. In particular, a soft surface beneath equipment — such as wood chips or sand, but not grass — will help to cushion falls, and should be at least 15 to 30 cm (6 to 12 in) deep. Of course, the higher the play equipment, the deeper this surface should be.

Children under five are often convinced of their own superpowers: Always supervise them actively, and keep them off equipment 1.5 m (5 ft) or higher. (Kids aged five and up should be closely supervised when playing on equipment higher than this.) Remove strangulation hazards like scarves and drawstrings when your kids are on the jungle gym, and teach older children to assess potential hazards for themselves. After all, you want little Sophie to be queen of the castle, but not until she can also climb back down.

Likewise, kids who love scooters, skateboards and in-line skates should wear protective gear and helmets, and stay off roads. On bicycles, head injuries are the most common severe injury, and usually involve collisions with cars. All riders — children and adults — should wear properly fitted helmets, and children under age 10 should not ride on roads without adult supervision.

Burns

Keep those shiny pot handles turned away from grabbing hands, and all hot liquids (morning coffee included) out of reach. See that tablecloth? One good yank and your baby will be wearing dinner. If it’s hot, that could mean a serious burn. Because a child’s skin is so much thinner than an adult’s, it burns four times as quickly and deeply at the same temperature. In fact, children are much more likely to be hospitalized for burns caused by steam or hot liquids (including tap water) than for burns caused by fire. Turn your gas or oil water heater down to 49°C (they’re typically kept at 60°C, which can cause a third-degree burn on a child’s skin in one second). Electric water heaters should stay at 60°C, due to the risk of legionnaires’ disease (there are temperature control devices you can install to lower the water temperature to 49°C as it comes out of the tap). Install smoke alarms on every level of the house and in each sleeping area, and try to test them regularly (fire departments urge once a month) by pressing the little button in the middle.

Poisoning

Aspirin caps can be less than childproof in the hands of a diligent three-year-old. Medications (including vitamins) and household cleaners are the two leading causes of poisoning in children, and there can be enough medication in one bottle to prove fatal, so lock these potential poisons away. Remember that purses often contain medicines that curious hands can quickly get into. You’ll also want to keep your house safe from carbon-monoxide poisoning by installing detectors on every level of your home.

Falls

Falling down is part of being a kid, but it also happens to be the main reason kids are hospitalized. Jan Tomlinson’s rule of thumb is to “use things the way they were designed to be used,” meaning no more monkeys jumping on the bed, no lounging on armrests, no infant seats on countertops and buckle up whenever possible (including in shopping carts). Always have a hand on your baby while changing him and never leave him unsupervised on an elevated surface (like your bed). Kids’ skills change fast; a set of shelves that seems harmless one day may become a dangerous climbing frame the next. Keep stairways clear, use non-slip surfaces under rugs and — please — no running in socks.

Safety sites

Accident-prevention resources on the Web:

smartrisk.ca Check out the “Seasonal Tips” link for articles about keeping kids safe winter, spring, summer and fall

cfc-efc.ca/healthy-spaces Fun, illustrated site with location-specific tips

sickkids.ca/safekidscanada Detailed info on topics related to child safety

caringforkids.cps.ca The Canadian Paediatric Society’s site for parents, with brochures on specific hazards

kidshealth.org Separate gateways for parents, kids and teens with great info on safety, health and more

healthunit.com Click on Child Safety for a series of detailed brochures on topics such as “travelling safely” and “product recalls.”

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