Keeping Children Safe in Early Care and Education Settings

Keeping Children Safe in Early Care and Education Settings
Introduction to Safety and Injury Prevention in Early Care and Education Settings

Keeping Children Safe From Injuries in Early Care and Education Settings
Welcome Date Location PRESENTER INFORMATION HERE Welcome everyone and thank participants for coming. Introduce yourself. Connect with participants and get an idea of who they are. If the group is small enough, ask participants to introduce themselves, tell where they work, and describe their type of early care and education facility and their role. Alternatively, ask participants to raise their hands if they are center directors, early care and education workers, Head Start providers, family child care providers, parents, grandparents, etc.

Learning Objectives State most common injuries in early care and education Recognize safety hazards Prevent most common injuries Know requirements for injury reporting Partner effectively with community Review learning objectives with participants. By the end of today’s lecture, you will be able to: State the most common injuries in the early care and education setting Recognize safety hazards Prevent the most common injuries Know the requirements for reporting an injury Partner effectively within your community Design note: There is no participant manual. The slides will be used to create the participant handout (without speaker notes). The learning objectives need to be on the screen so participants can refer to them.

“If a disease were killing our children in the proportions that injuries are, people would be outraged and demand that this killer be stopped.” C. Everett Koop, MD Former US Surgeon General C. Everett Koop helped raise injury prevention as a public health issue.

Injury Deaths Compared With Other Leading Causes of Death for People Ages 1 – 44, United States, 2013 When it comes to public health, many people focus on diseases. But the fact is that more people die each year from injury and violence than from diseases. In fact, the number one cause of death and disability among children alone in the US is from injuries. Most injuries are preventable AND predictable. Source Centers for Disease Control and Prevention (CDC) Injury Prevention and Control) -

Injury More than 9,000 children die each year from injuries, which is equal to 150 school buses all loaded with children. However, injury deaths are only part of the tragic story. Each year, millions of children are injured and have to live with these injuries for a period of time; however, sometimes their injuries have a lifelong effect. With a fatal injury, family, friends, coworkers, employers, and other members of the child’s community feel the loss. With a nonfatal injury, family members must often care for the injured child, which can cause stress, time away from work, and lost income. Injuries to children can result in major expenses, including medical costs for the injured child and loss of wages for the parent/caregiver. The consequences of these fatal and nonfatal injuries to children have a physical and emotional cost to the individual and our society. An injury affects more than just the injured child—it affects many others involved in the child’s life. The community also feels the cost burden of child injuries, as does the state and the nation. For children, even minor injuries causes pain and may limit their activities. Major injuries may involve hospitalizations, ER visits, and multiple doctors’ visits. Sometimes the injury can lead to one or more of the following: physical limitations, stress, depression, constant pain, and a major change in their lifestyle or quality of life. Source Centers for Disease Control and Prevention, Vital Signs (

Injuries Among Children
Leading cause of death and disability 10% of injuries in preschoolers happen in an early care and education settings Not accidents Preventable and predictable Injuries are the main cause of death and disability among children in the United States. Ten percent of those injuries in young (preschool) children happens in the early care and education setting. Injuries are NOT accidents as that implies or suggests that they occur randomly and could not be prevented. But we know that is not true, because we know that most common injuries among children are preventable and predictable. Source Hashikawa AN, Newton MF, Cunningham RM, Stevens MW. Unintentional injuries in child care centers in the United States: A systematic review. Journal of Child Health Care Mar;19(1): doi: / Epub 2013 Oct 3.

Safe Kids USA Show the video. Imagine a World Where Every Kid is a Safe Kid – Help each child reach their full potential by reducing preventable injuries.

The Early Care and Education Provider
Relationship with family and child Model safety for children and families Why is your role as a early care and education provider so important? Children spend a lot of time in the early care and education setting. In fact, some children spend more awake hours there than they do at home. Children depend on caregivers to provide a safe environment away from home. As a provider, and because of your relationship with the family and child, you are the perfect person to focus on safety. You have the chance to not only keep the children safe, but to find ways to teach them about how they can prevent injuries. This can be done by modeling and explaining safe behaviors in a way that is appropriate for the age and developmental level of the children in your care. Explain to participants the importance of role modeling. Adults often underestimate their impact with role modeling. Children will follow your example. Always practice safe behavior. The effectiveness of health and safety education is enhanced when shared between the caregiver/teacher and the parents/guardians. Source CFOC Standard – Staff modeling of healthy and safe behavior and health and safety education activities. (

Caring For Our Children Standards
Caring for Our Children: National Health and Safety Performance Standards—Guidelines for Early Care and Education Programs 3rd edition Available at (free download and purchase options) Caring for Our Children contains standards for injury prevention and safety practices.

Pediatric first aid kit Pediatric CPR and first aid training
Injuries Pediatric first aid kit Pediatric CPR and first aid training Communication device for emergencies (911) Document and notify parents and state licensing agency Report serious injuries to appropriate authorities Pediatric First Aid kits should be stocked and available in each location where children are cared for. This includes a transportable first aid kit that can go with the children for a walk or in a vehicle. Pediatric First Aid and CPR training You are most likely to need first aid skills, therefore, all staff members that have contact with children should be current on training for first aid. At least 1 staff member currently certified in CPR should be present at all times. Communication device Emergencies can happen quickly. Each staff member should have a way to call for help. This is especially important when children are taken away from the facility to a playground, for a walk, or on a field trip. Document and notify parents In the event of an injury a report should be completed and filed. Parents should be notified immediately of an injury or illness of their child. Require that child care providers report any serious injuries or deaths of children occurring in child care to a designated state, territorial, or tribal entity. Source Child Care and Development Fund, Section – Enforcement of licensing and health and safety requirements. (b)(4)

Case Presentation: Bobby
3-year-old boy on playground Phone rings You turn away and answer it Bobby starts crying He fell off slide onto pavement Present this scenario to your participants. Bobby, a 3-year-old boy in your center, is playing outside on the playground when the phone rings. You turn away from him to answer it. When your back is turned, you suddenly hear Bobby crying. When you find him, you realize that he fell off the slide and landed on the pavement below.

What do you do next? What could have prevented this? How should you document and report any injuries? Ask the participants these questions and have them provide responses.

What do you do next? Make sure child is alert Check for injuries Give first aid, if needed What do you do next? Check to make sure he is alert Evaluate for injuries Get the first aid kit, if needed, for cuts or scrapes

Preventing future incidents and injuries Ensure adequate supervision Limit distractions (eg, cell phones) Never leave children unattended Make sure shock-absorbing surface is under equipment What could you have done to prevent this? Have other adults around to supervise the children There is nothing that can replace adult supervision. When adults are supervising children, they should always pay attention to what the children are doing. Limit distractions Never leave the child unattended or turn your back on them while you are supervising them Make sure that all playground equipment is on shock-absorbing surfaces

Reporting and Documentation Use a standard reporting form and provide details Call parents Discuss how to prevent this from happening again How should you document and report any injuries? Use the Standard reporting form to document the incident and any injuries Call the parents to inform them of the incident and any injuries Brainstorm with other staff to discuss how to prevent this from happening again For Head Start Programs: You can also use the CFOC Incident Report Form, Appendix CC, which sometimes works better for early care and education programs, as it has language that aligns with injuries in early care and education programs. Injury reports are important because they can be used to look for patterns of injuries and figure out the causes, so that the same injuries don‘t happen over and over again. Sources CFOC Appendix CC – Incident Report Form. ( CFOC Appendix DD – Child Injury Report Form for Indoor and Outdoor Injuries. (

Pre-Quiz What is the most common injury among 0-5 year olds?
What is the most common preventable cause of death for children age 1-4? Is there a requirement to report injuries? Where do the most infant drowning deaths occur? What object causes the highest rate of death from choking? As we go through this presentation, be thinking about the answers to these questions. We will answer and discuss them at the end of the talk.

Preventable Injury Preventable Injuries are:
Unintentional (not on purpose) Not accidents More common among children Let’s talk about preventable injuries. A preventable injury is unintentional (not something that was done on purpose). It is something that can be avoided by taking steps to ensure that the child’s environment is safe and that adult supervision is in place at all times. Children are more likely to get injured because of their size, their growth and developmental stage, inexperience, and curiosity. Sources Centers for Disease Control and Prevention ( Stepping Stones to Caring for Our Children, 3rd edition. Child Ratio Chart. (

Preventable Injury These injuries can be prevented by:
Creating/maintaining safe areas Providing adult supervision at all times Keeping maximum child:staff ratio Injuries can be prevented by: Making sure their environment is safe according to safety standards Having safety precautions in place Making sure there is adult supervision at all times Maintain maximum child:staff ratio Source CFOC Standard Ratios for large family child care homes and centers. (

Types of Preventable Injuries
Falls from playground equipment Ingestions/Poisonings Drownings Burns Motor vehicle accidents Suffocation Injuries from wheeled toys Here are some examples of preventable injuries, both in early care and education settings, as well as other places.

Causes of Nonfatal Injuries in Young Children
Most common nonfatal injuries seen in the ER in young children Falls 50% of injuries in children <1 year Struck by or against an object Animal bites/insect stings Injuries due to falls were the leading cause of nonfatal injury. Each year, approximately 2.8 million children had an initial emergency department visit for injuries from a fall. For children less than 1 year of age, falls accounted for over 50% of nonfatal injuries. The majority of nonfatal injuries are from five causes. Falls was the leading cause of nonfatal injury for all age groups less than 15. For children ages 0 to 9, the next two leading causes were being stuck by or against an object and animal bites or insect stings. For children 10 to 14 years of age, the next leading causes were being struck by or against an object and overexertion. For children 15 to 19 years of age, the three leading causes of nonfatal injuries were being struck by or against an object, falls, and motor vehicle occupant injuries. Source CDC Childhood Injury Report. (

Causes of Fatal Injuries in Children
Main cause of death for children Ages 1-4: Drowning Under age 1: Suffocation (while sleeping) or strangulation Boys vs. Girls Boys are twice as likely to have an injury-related death than girls The number one cause of injury-related death for children ages 1-4 is drowning The leading cause of injury-related death for children under the age of 1 is unintended suffocation (mostly while sleeping) or accidental strangulation. Injury-related deaths are more likely to occur in boys (twice as likely as girls) Source CDC Childhood Injury Report. (

Safety/Injury Hazards
General Physical Environment Elevated surfaces (steps, stairs, stage) Strangulation (straps, strings) Furniture (can tip over) Sharp corners or points Electrical outlets Protruding nails/bolts/other small objects Unsafe sleeping environments Ask participants to identify possible safety/injury hazards in the physical early care and education environment. Potential hazards in early care and education settings and home settings: Stairs, steps or stage (children can fall down them if not properly gated) Strings or straps (can cause strangulation if it gets around the child’s neck) Tip-over hazards (bookshelves, chairs) Sharp corners or points Electrical outlets that are not properly covered Protruding nails/bolts and other small objects that may become detached Unsafe sleeping environments

Safety/Injury Hazards
Prevention of these hazards Put gates at stairways Remove straps/strings Secure furniture Cover sharp corners Install tamper-resistant electrical outlets/outlet covers Discuss strategies to prevent and minimize injuries from these hazards. Source Stepping Stones to Caring for Our Children, 3rd edition. (

Choking Choking rates highest among infants 140 per 100,000
Risk decreases with age 90% of choking in children under 4 years of age Objects less than 1.5 inches in diameter have higher choking risk Choking rates are highest among infants (140 per 100,000) and risk decreases with age Almost 90% of fatal choking occurs in children younger than 4 years of age Objects that are less than 1.5 inches in diameter (or 1.75 inches for small spherical objects) are higher risk for choking Just because a toy is on the market does not guarantee its safety Source American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention policy statement. Prevention of choking among children.

Common Choking Hazards
Latex Balloons Leading cause of choking death Round or Cylinder shapes High Risk Foods Hot dogs, hard candy, peanuts, seeds, whole grapes, popcorn, marshmallows, gum The most common safety hazards for children are: Latex balloons – leading cause of choking death; conform to airway to create a seal that blocks breathing Round or cylinder shapes – if they are small enough, they can fit snugly in the throat and block airway Foods – the most common foods that children choke on include hotdogs (most common among fatal choking), nuts, seeds, whole grapes, raw carrots, popcorn, marshmallows, gum, peanut butter, and sausages. Source American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention policy statement. Prevention of choking among children.

Choking Signs Inhaled objects or food Coughing Drooling
Trouble breathing/noisy breathing Turning blue Ingested objects or food Vomiting Abdominal pain/refusal to eat Early care and education providers need to know the signs for choking, both for objects and food that are either inhaled or ingested. Keep in mind that a choking child may not make any signs, so it’s important to watch the children while they are eating to look for potential sudden signs of distress. Supervision is key to choking prevention, especially for younger children who are learning to feed themselves. Source CFOC Standard Adult supervision of children who are learning to feed themselves. (

Choking Prevention Cut food in small pieces
¼ inch or smaller (infants) ½ inch or smaller (toddlers) Avoid high risk foods (children under 5) Children should be seated while eating (no playing/running) Supervise children Check toys for small, loose pieces Keep magnets/batteries away from children Early care and education providers can take precautions to prevent potential choking incidents. Cut food in small pieces ¼ inch or smaller (infants) ½ inch or smaller (toddlers) For children with teeth, food selection should be different. If the child has his/her molars, it’s a good indication that the child will be able to chew harder foods Avoid high risk foods (children under 5) Make sure children are seated while eating Children should never be playing or running while eating Supervise children Check toys for small, loose pieces Keep magnets and batteries away from children Sources CFOC Standard Foods that are choking hazards. ( Stepping Stones to Caring for Our Children, 3rd edition. (

Most Common Fall/Crush Hazards
Televisions Bookcases Furniture and dressers Stairs with poorly installed gates Unlocked windows Heavy objects on shelves The most common hazards that can result in falls and children being crushed include: Televisions Bookcases Furniture and dressers Stairs with poorly installed gates Unlocked windows Heavy objects on shelves

Fall/Crush Hazard - Televisions
Every 3 weeks, a child dies from a television tipping over Over past 10 years, a child visited the ER every 45 minutes for injury related to a TV tipping over 36-inch TV falling 3 feet = 1-year-old falling 10 stories Source Safe Kids Worldwide: ( (

Injuries from Falls/Crushes
Broken bones Skull/brain injuries (can be life threatening) Concussions

Preventing Fall/Crush Hazards
Secure televisions (to wall or on stable table) Secure heavy furniture (bookshelves) with brackets, braces, or wall straps Keep heavier items on lower shelves Don’t place items high – children will want to climb for them (eg, toys) There are many precautions that should be taken in the early care and education setting to prevent falls or children being crushed by an object. Put televisions on low, stable furniture (if it’s a tube TV) or on wall (if it’s a flat screen TV) and assess stability Use brackets, braces, or wall straps to secure heavy furniture to the wall (eg, bookshelves) Keep heavier items on lower shelves Don’t place items (such as toys) too high, as children will want to climb for them Source Safe Kids Worldwide. TV and furniture tip-over prevention tips. (

Preventing Fall/Crush Hazards
Keep windows locked Use approved safety gates (top and bottom of stairs) Strap babies and young children in high chairs, strollers, and swings Never leave children unattended Adult supervision Make sure that windows are locked; if they are open, install window guards to prevent falls from windows Screens are meant to keep bugs out, not children in! Use approved safety gates (top and bottom of stairs) and follow manufacturer’s instructions Strap babies and young children in high chairs, strollers, and swings Never leave children unattended Don’t leave children in propped up seats, car seats, or on counters Adult supervision is crucial

Water Safety Bathtubs or Large Buckets
Majority of infant drowning deaths Swimming Pools Most common place for drownings of 1-4 year olds The majority of infant drowning deaths occur in bathtubs or large buckets The most common place for drownings of 1-4 year olds is a swimming pool and smaller “kiddie” pools Source Safe Kids Worldwide. Water Safety. (

Drowning Prevention ALWAYS supervise children
Make sure pools are fenced in with gates/latches Avoid distractions (eg, reading, talking) Be aware of hazards (even in shallow water) Close bathroom doors and toilet lids Never leave a child alone in a bathtub ALWAYS supervise children in/around water Make sure pools are fenced in with at least a 4 foot high fence with self-closing and self-latching gates Avoid distractions (eg, reading, talking on phone) Be aware of potential water hazards (even shallow water) Close bathroom doors and toilet lids and drain tub when done Never leave a child alone in a bathtub Sources Safe Kids Worldwide. Water Safety. ( Stepping Stones to Caring for Our Children, 3rd edition. (

Training Requirements for Providers
Early Care and Education Providers must have pediatric first aid and CPR training Valid certificate is required Directors of early care and education centers should have documentation that their staff have completed training in first aid and CPR. Satisfactory completion of the training should be noted by a certificate. Source Stepping Stones to Caring for Our Children, 3rd edition. Standard – First aid and CPR training for staff. (

Training Requirements for Providers
Early Care and Education Providers must: Have pre-service training in health management recognize signs of illness Know about infectious disease prevention Know about safety/injury hazards Have knowledge about safe sleep practices (infants) Reducing SIDS risk Preventing shaken baby syndrome The next couple of slides can be important training requirements not covered in this lecture but can be found as training elsewhere by AAP: 1. Infectious Disease Training 2. Medication Administration 3. Reducing SIDS risk 4. Shaken Baby Syndrome It is important that early care and education providers have pre-service training in health management in the early care setting. They need to be able to: Recognize the signs of illness Have knowledge about infectious disease prevention Understand what injury/safety hazards there are in the center and how to prevent potential injuries For infants, it’s important that providers know about safe sleep practices (on the back), which reduces the risk of Sudden Infant Death Syndrome (SIDS) They should also be aware of how to prevent shaken baby syndrome/abusive head trauma, including how to cope with a crying infant Early care and education providers should also: Have knowledge of normal child development and know the indicators when a child is not developing typically Know how to appropriately respond to a child’s needs Understand the importance of the adult-child relationship, as it nurtures the child’s brain development and builds important connections Have medication administration training

Legal Reporting/Documentation Requirements
Notify parent/guardian immediately if: Injury or illness required first aid or medical attention Child is lost or missing, fire, or closure of the center Document notification of parent/guardian and law enforcement Know and follow state notification regulations After calling 911, legal requirements for reporting injuries in the early care and education setting require notification of parents/guardians immediately if: The injury or illness required first aid or professional medical attention There is any other significant event that effects the health and safety of their child (eg, child is lost or missing, a fire or other damage, or closure of the center) Typically best to notify parent if any injury (even if minor) – sometimes bruises, swelling can develop later and parents may wonder what happened Document that the child’s parent/guardian was notified immediately for any of the cases just mentioned Documentation should also occur when law enforcement is notified Follow state regulations for notification requirements to state agencies (eg, licensing agency and local/state health department)

Documentation Requirements
An incident report form should be completed (Appendices CC and DD in Caring for Our Children) Injuries that need to be reported include: Child maltreatment Bites Falls Ingestions Use incident reporting form to document injuries Injuries that need to be reported include: Child maltreatment (physical, sexual, emotional, and neglect/abuse) Bites (continuous, painful, break skin) Falls, burns, broken limbs, other injury Ingestion of non-food substances There are certain injuries that need to be reported and documented. The full list is available in Caring for Our Children - Sources CFOC Appendix CC – Incident Report Form. ( CFOC Appendix DD – Child Injury Report Form for Indoor and Outdoor Injuries. (

Documentation Requirements
Complete 3 copies of injury report form Parent/Guardian Child’s folder at the Center Injury log book Keep based on state regulations Send copy to state licensing agency if medical attention required Three copies of the injury report form should be completed Parent/Guardian Child’s folder at the Center Injury Log Book This should be chronologically filed that is analyzed periodically to determine any patterns regarding time of day of the incident, equipment involved, location of the incident, and supervision at the time of the incident. The copy should be kept for the period required by state regulations A copy of the injury report should be sent to the state licensing agency if it required medical attention Source CFOC Standard Records of Injury and CFOC Standard Documentation of Parent/Guardian Notification of Injury, Illness, or Death in Program) – Appendices CC and DD (

Corrective Action The center should take action based on logs
Adjusting schedules Removing or limiting use of equipment Relocating equipment or furnishings Increasing supervision Review forms regularly for injury trends/patterns Based on the injury logs, the early care and education center should plan to take corrective action. This would include: Adjusting schedules Removing or limiting use of equipment Relocating equipment or furnishings Increasing supervision Review these forms regularly for injury trends and patterns Source CFOC Standard Records of Injury. (

Partnering with the Community
Community Resources for child safety information Safe Kids Worldwide ( National/Local organizations Offers classes and events Healthy Children ( Educational articles and videos Supported by the AAP It is important to know your community resources that you can reach out to and partner with on child safety issues. There are educational materials, classes, and events that are available in most communities.

Post Quiz What is the most common injury among children age 0-5?
Broken bones Falls Choking burns At the beginning of the presentation, 5 questions were posed that you were asked to think about during the talk. We will now revisit these questions, answer them, and discuss them. Please refer to the standards in Caring for Our Children for more information. Source Caring for Our Children Standards. (

Post Quiz What is the most common injury among children age 0-5?
Broken bones Falls Choking burns Falls are the most common injury among this age group. As we learned, more than 50% of the injuries among children less than 1 year old are from falls; and just under half of children ages 1-4 suffer the most injuries from falls.

Post Quiz What is the most common preventable cause of death for children ages 1-4? Burns Choking Drowning Bicycle accidents Getting hit by a car

Post Quiz What is the most common preventable cause of death for children ages 1-4? Burns Choking Drowning Bicycle accidents Getting hit by a car Drowning is the most common preventable cause of death for this age group, and swimming pools are the most common place where these drownings occur.

Post Quiz Is there a requirement to report injuries? Yes No

Post Quiz Is there a requirement to report injuries? Yes No
We just discussed the documentation and reporting requirements for injuries that occur in the early care and education setting.

Post Quiz Where do the majority of infant drowning deaths occur? Pools
Ponds/Lakes Falling off a boat Bathtubs/Buckets

Post Quiz Where do the majority of infant drowning deaths occur? Pools
Ponds/Lakes Falling off a boat Bathtubs/Buckets Drowning in a bathtub or large bucket is the number one place where the majority of infant drownings occur. It is vital that when infants are in the bathtub that they are supervised at all times and the adult supervising the infant does not turn away, even for a second.

Post Quiz What object is associated with the highest rate of death from choking? Grapes Hotdogs Latex Balloons Marbles Coins

Post Quiz What object is associated with the highest rate of death from choking? Grapes Hotdogs Latex Balloons Marbles Coins Latex balloons pose the biggest threat for death by choking. The balloon can get lodged in the throat and create a seal that completely blocks the airway.

Review of Topic-Specific Modules
Burn Prevention Transportation Safety Playground Safety Medication Safety and Poison Prevention Helmet Safety Note to Presenter: The remaining slides of this presentation are optional and can be removed from the presentation, depending on your needs and as time permits. Each of these modules is available as a separate presentation. I am now going to highlight some information from the other topic-specific modules that are part of the larger safety and injury prevention curriculum. The information in these modules are consistent with the Standards established in the American Academy of Pediatrics (AAP), American Public Health Association (APHA), National Resource Center for Health and Safety in Child Care and Early Education, and the Maternal and Child Health Bureau (MCHB) publication Caring for Our Children: National Health and Safety Performance Standards—Guidelines for Early Care and Education Programs, 3rd Edition. The MCHB resource can be accessed online at or purchased at

Burn Prevention We will start with Burn Prevention.

Explain why children are at risk for burns
Learning Objectives Explain why children are at risk for burns List the most common causes of burns in children younger than age 5 List potential burn dangers in your environment List at least 3 key strategies to prevent burns List resources for preparing fire and burn prevention lessons The objectives for this module include being able to: Explain why children are at risk for burns List the most common causes of burns in children younger than age 5 List possible burn dangers in your environment and explain what you can do to make sure the children you care for are safe List at least 3 key strategies to prevent burns List resources for preparing fire and burn prevention lessons for children

Every hour 16 children are injured Every day:
Fire and Burn Injuries Every hour 16 children are injured Every day: 300 children are treated in emergency rooms 2 children die So how big of a problem are burns among children? The answer might surprise you! Every hour, at least 16 children are injured from burns or fires, and more than 300 children are treated for burn injuries in the ER every day. Two children die every day from burn injuries. Source Safe Kids Worldwide (

Burden of Burn Injuries
Younger children Scalds Liquid or steam Older children Contact burns Fire or hot objects Scald burns from hot liquids or steam are common injuries in younger children. Burns on the skin happen when fire or hot objects touch the skin, and they are most common in older children. Sources Safe Kids Worldwide. Burns and Fire Safety Fact Sheet ( Simon PA, Baron RC. Age as a risk factor for burn injury requiring hospitalization during early childhood. Archived Pediatric and Adolescent Medicine. 1994;48(4):394–397. ( Morrow SE, Smith DL, Cairnes BA, et al. Etiology and outcome of pediatric burns. Journal of Pediatric Surgery. 1996;31(3):329–333. ( American Burn Association. National Burn Repository 2011 Report: Dataset Version 7.0. (

Burden of Burn Injuries
Lifelong care Multiple surgeries Scars Physical and emotional Limited movements Costly Good news Preventable Fire and burn injuries in children can lead to: Skin that cannot stretch as it normally does Many surgeries as the child grows to fix the skin that no longer stretches Significant scarring Care that is needed for a long time (sometimes lifelong) Changes in the way the child moves, as joints are not flexible Physical and emotional problems Major cost to the family, medical system, insurance company, and society Deaths and injuries from fires and burns are absolutely preventable.

May not recognize hazards Physical
Children and Burn Risk Developmental Test their limits May not recognize hazards Physical Children’s skin is thinner than adults’ skin Burns quicker and at lower temperatures Larger and deeper burns Children are curious and like to test their skills and abilities, and they do not always understand their limits. Children are unable to protect themselves (hot water in tub or hot playground swing). Skin of young children is much thinner than adult’s skin and can burn at temperatures that adults find comfortable. Children burn more quickly than adults because of their thinner skin. Compared with adults, exposing a child to the same heat for a similar amount of time leads to larger burns that cover more skin and causes deeper burns because of the child’s thinner skin. Source American Burn Association (ameriburn.org)

Causes of Burn Injuries
As you can see in this chart, the most common causes of burn injuries are: Contact with fire/flame—43% Scalding—34% Contact with hot objects—9% Electrical burn—4% Chemical contact—3% Other—7% Source American Burn Association National Burn Repository Report of Data From 2004–2013, Version ( American Burn Association, National Burn Repository® Version All Rights Reserved Worldwide.

Most common in young children 3rd degree burn (severe) 149°: 2 seconds
Scald Burns Most common in young children 3rd degree burn (severe) 149°: 2 seconds 120°: 2 minutes Prevention Anti-scald devices Temperature setting of hot water heater Hot tap water is a common cause of scald injuries in young children. Scald burns happen with hot liquids or steam. Time it takes for a 3rd-degree burn (severe) to occur: 149°—2 seconds to burn (demonstrate with hand clapping). This can happen in a blink of an eye! 120°—2 minutes to burn. This extra time could allow you to remove the child from the hot water source to prevent a burn. Because of their thinner skin, children burn more quickly and over a larger area of their skin causing a bad injury. Prevention of scald burns You can buy products for sinks that can be permanently installed, if necessary, to control the temperature of water at the faucet and prevent scalds. You can adjust your hot water heater to help, which is what we are going to cover next. Source CFOC Standard – Water heating devices and temperatures allowed. (

100°F 110°F 120°F 150°F Hot Water Heater
To reduce risk of scalding, set your hot water heater no higher than: Directions for Activity Quizzes For all of the activity quizzes, present the question and ask participants what they think the correct answer is. As you read each response, have participants raise their hands if they think that response is the correct answer. After participants have responded, discuss the important points of the topic.

120°F Hot Water Heater 100°F 110°F
To reduce risk of scalding, set your hot water heater no higher than: To reduce the occurrence of a scald burn, the temperature on hot water heaters should be set no higher than 120°F. Early care and education programs need to be familiar with local and state health department regulations in their jurisdictions. For example, Connecticut regulations require setting hot water heaters at 115°F. Source O’Brien SP, Billmire DA. Prevention and management of outpatient pediatric burns. Journal of Craniofacial Surgery. (2008);19(4):1034–1039.

Spill-proof containers: False sense of security
Hot Beverages NO hot beverages Holding, caring for, or working with children Children = no access Spill-proof containers: False sense of security Early care and education providers should never drink hot beverages when caring for children. If a teacher or caregiver is carrying a child while holding a cup of coffee or other hot liquid and the child reaches out to grab the cup, the child can be burned. The only way to prevent scald burns from hot liquids is to have a policy that does not allow workers to drink hot liquids when they are caring for or holding children, or working in an area where children are present. Even with a lid, they are not 100% spill proof.

Stir and test before serving NO bottles Slow-cooking devices
Warming Devices Microwaves Children = no access Stir and test before serving NO bottles Slow-cooking devices Out of reach, including cords Wipe dry Caution Electrical cords Children should not be able to reach or touch microwave ovens. Children as young as 18 months can open the microwave door and spill hot food on themselves as they take it out of the microwave. Bottles should never be heated in a microwave oven because it does not heat milk evenly and can lead to burns from hot spots in the bottle. The recommended temperature of the water from a tap or in a crock pot for heating a bottle is 120°F, and the bottle should not be warmed for longer than 5 minutes. Stir and test hot food before serving it to a child, especially if it was heated in a microwave oven. Infants have received burns from hot water dripping from an infant bottle that was removed from a crock pot or by grabbing a dangling cord and pulling the crock pot down on themselves. Wipe bottles to dry them after removing from a crock pot or other source of hot water. Remove and secure all dangling electrical cords so that children can’t pull hot appliances containing hot/boiling water down on themselves. Discussion What other devices may be a danger to children if the cord is pulled? Sources O’Brien SP, Billmire DA. Prevention and management of outpatient pediatric burns. Journal of Craniofacial Surgery. 2008;19(4):1034–1039. Quinlan KP, Robinson M, Gottlieb LJ. Protecting children from fires and burns. Pediatric Annals. 2010;39(11):709–713. ( CFOC Standard – Microwave ovens. ( CFOC Standard – Warming bottles and infant foods. (

Never hold child when preparing hot food or liquids Kid-free zone
Kitchen Never hold child when preparing hot food or liquids Kid-free zone Restrict access Safety gates Visual markings Burn Safety in the Kitchen Kitchens and areas where food is prepared need to be kid-free zones: Use safety gates, barriers, and/or signs or other visual markings while you are actively watching the children. Consider using a tape line on the floor to teach a child not to cross into a dangerous area (in addition to gates/other barriers). Never hold a child while preparing hot food or liquids Source O’Brien SP, Billmire DA. Prevention and management of outpatient pediatric burns. Journal of Craniofacial Surgery. 2008;19(4):1034–1039.

Toddlers’ reach: 8–10 inches Keep handles turned to back
Kitchen Toddlers’ reach: 8–10 inches Keep handles turned to back Use back burners Toddlers are very curious and can reach things that to an adult may seem to be out of their reach. Even children as young as 11 or 12 months can sometimes reach 8–10 inches up onto the countertop where food is being prepared. Food preparers should make sure the pot handles face toward the back of the stove and use only back burners when possible. Source CFOC Standard – Hot liquids and foods. (

Hot Liquids and Food Out of reach Against wall As far back as possible
Avoid Edge of surface Tablecloth Child’s level Hot liquids and foods should not be placed on a surface at a child’s level, at the edge of a table or counter, or on a tablecloth that could be yanked down. Instead, place items as close to the wall or as far back on a table as possible. Sources Quinlan KP, Robinson M, Gottlieb LJ. Protecting children from fires and burns. Pediatric Annals. 2010;39(11):709–713. ( CFOC Standard – Hot liquids and foods. (

2,400 children injured each year Most are under age 6
Electrical Outlets 2,400 children injured each year Most are under age 6 At child’s eye level Insert objects into outlet Some 2,400 children are injured each year by putting objects into the slots of electrical outlets. Most of these injuries happen to children younger than age 6. Source CFOC Standard – Safety covers and shock protection devices for electrical outlets. (

Outlet Safety Options Tamper-Resistant Electrical Outlet Safety Cover
Safety Plugs Tamper-Resistant Electrical Outlets These types of outlets look like standard wall outlets, but they have a spring-loaded cover inside that can only be opened when the same pressure is placed on both of the slots at the same time, like when putting in an electrical plug. This prevents children from sticking objects like hairpins, keys, and paperclips into the slots. Facilities that do not have tamper-resistant electrical outlets should have safety covers that are attached to the electrical outlet by a screw or other means to prevent easy removal by a child. These covers are best for outlets where the center does not plan to unplug the appliance. Safety plugs should NOT be used because they can be easily removed by children, who may choke on them. Note to presenter: Licensing for centers in many states allow the use of safety plugs. Please be prepared for questions from staff from these centers on this device. Source CFOC Standard – Safety covers and shock protection devices for electrical outlets. (

Should not be used, if possible Children = no access Avoid
Extension Cords Should not be used, if possible Children = no access Avoid Across hallways Under rugs and carpet Near water source Behind wall hangings Frayed or overloaded Using extension cords in early care and education settings is not a good idea; however, if they have to be used, the center should buy a cord that has been tested for safety in a nationally recognized testing lab. Children should not be able to reach, pull, or play with extension cords, even if they are only going to be there for a short period of time. If children put a metal object into the extension cord socket, they can get an electrical shock. Extension cords should not be put through doorways, under rugs or carpeting, behind wall hangings, or across any areas where there is water nearby. Also, the cord should not be frayed or have too many things plugged into it. Source CFOC Standard – Extension cords. (

Childhood sunburn = skin cancer risk
Sun Exposure Childhood sunburn = skin cancer risk Limit sun exposure between 10am and 2pm Play in the shade! Skin cancer, even in young people, is increasing. Younger children are more likely to get sunburn because their skin is not fully developed and can be damaged even as early as the first summer of life. Children cannot be outside without being in the sun, but they need to be protected from getting too much sun. People who had very bad sunburns when they were children are more likely to get skin cancer later in life. The first step to prevent the chances of getting sunburn and skin cancer is to protect children early on in their life from getting too much sun and teach them how to be safe in the sun. The amount of time children are out in the sun should be limited, especially between 10am and 2pm when the sun is the strongest. Sources Paller AS, Hawk JLM, Honig P, Giam YC, Hoath S, Mack MC, Stamatas GN. New insights about infant and toddler skin: Implications for sun protection. Pediatrics. 2011:28(1). ( American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education. Caring for Our Children: National Health and Safety Performance Standards—Guidelines for Early Care and Education Programs ( CFOC Standard – Shading of play area. ( Environmental Protection Agency. Sunwise Kids. 2014:Chapter 6. ( healthychildren.org, American Academy of Pediatrics. Safety and Prevention: Sun Safety (

Protective clothing and wide brimmed hat Over 6 months
Sunscreen Infants under 6 months NO direct sunlight Protective clothing and wide brimmed hat Over 6 months All exposed areas 15 to 30 minutes before exposure Reapply every 2 hours Infants younger than 6 months should be kept OUT of direct sunlight. Find shade under a tree, umbrella, or the stroller canopy. Infants younger than 6 months should also wear clothes that cover up and protect the skin from the sun and should wear bathing suits with swimming shirts during water play. When outside, infants should wear hats. If a hat isn’t available, providers should keep these infants in the shade or under an umbrella to avoid the sun. Rules for Applying Sunscreen Applying sunscreen can give a false sense of security. Infants should not be in direct sunlight, even if sunscreen has been applied: Use enough sunscreen to cover all exposed areas, especially the face, nose, ears, feet, hands, and even backs of the knees. Rub it in well. Put sunscreen on 15 to 30 minutes before going outdoors. It needs time to absorb into the skin. Use sunscreen any time you or the children in your care are outside. Remember that you can get sunburn even on cloudy days because up to 80% of the sun's UV rays can get through the clouds. Also, UV rays can bounce back from water, sand, snow, and concrete, so make sure you protect yourself with sunscreen. Put more sunscreen on every 2 hours and after swimming, sweating, or drying off with a towel. Because most people use too little sunscreen, make sure to apply a good amount. If there are signs of sunburn, cover and remove from sun, treat according to first aid training, call parents immediately, and document. Follow the medication administration requirements for your program and state licensing regarding sunscreen. Sources Healthychildren.org, American Academy of Pediatrics. Sun Safety: Information for Parents About Sunburn and Sunscreen ( American Academy of Pediatrics. Fun in the Sun: Keep Your Family Safe CFOC Standard – Sun safety including sunscreen. (

Check temperature of equipment surfaces
On the Playground Check temperature of equipment surfaces Keep metal equipment in shade Burn injuries that happen on the playground are from contact with hot objects. Hot playground equipment increases the risk of thermal burns. Hot play surfaces can cause burns on children: Do a quick check of the play surfaces to be sure equipment is at a safe temperature before letting children to play on them. If possible, put metal equipment (such as slides) in the shade to reduce the heat on play surfaces. Sources Consumer Product Safety Commission. Burn Safety Awareness Profile. ( CFOC Standard – Shading of play area (

Fire Escape How much time do you have to safely get out of a building once the smoke or fire alarm sounds? 30 seconds 2 minutes 5 minutes 10 minutes Activity Quiz

Fire Escape How much time do you have to safely get out of a building once the smoke or fire alarm sounds? 30 seconds 2 minutes 5 minutes 10 minutes You have 2 minutes to safely get out of a burning building once the smoke or fire alarm sounds.

85% of fire-related deaths are from home fires Fire spreads rapidly
~ 2 minutes to escape Death: Smoke inhalation Eighty-five percent of all fire-related deaths are from home fires, which spread quickly and can leave families as few as 2 minutes to get out of the house after an alarm sounds. There is no time to grab anything from the house before escaping. The reality is that in about 2 minutes toxic gas and fumes will fill the space you’re in and leave you with no "good air." Most people will inhale the smoke before suffering any burns from the fire. Have a home or center fire escape plan. Guidelines on how to create a plan are available from the National Fire Protection Association. Sources Safe Kids Worldwide. Fire Safety Tips ( National Fire Protection Association –

Follow approved routes Attendance sheet Children with special needs
Fire Drills Fire drills Practice monthly Record them Follow approved routes Attendance sheet Children with special needs Evacuation cribs The center or home should have a list of scheduled emergency drills/exercises (eg, monthly), both for natural disasters and human-generated events. Fire drills should be conducted monthly. Keep a log of fire drills. All drills/exercises should be recorded. The center’s fire evacuation procedure should be approved and certified in writing by a fire inspector and by a local fire department for large and small family homes. This can be done during an annual onsite visit so the drill can be observed and the center inspected for fire safety dangers. Bring daily attendance roster to the drill to count and account for children. Take into account children with special needs (eg, wheelchair, walkers) when practicing fire drills. Cribs that are designed to be used as evacuation cribs can be used to remove infants from the center, but only if rolling is possible on the evacuation route(s). IMPORTANT: Remember to count and recount the number of children you are responsible for to make sure they are all there. Sources CFOC Standard Emergency and Evacuation Drills/Exercises Policy. ( CFOC Standard Evacuation and Shelter-in-Place Drill Record. ( National Resource Center for Health and Safety in Child Care and Early Education. Caring for Children with Special Health Care Needs. (

Fireplaces and wood burners
Fires Space heaters Fireplaces and wood burners Extension cords and other types of electrical cords Cooking What is the leading cause of home fires and home fire injuries? Activity Quiz

Fireplaces and wood burners
Fires Space heaters Fireplaces and wood burners Extension cords and other types of electrical cords Cooking What is the leading cause of home fires and home fire injuries? All of these choices are causes of fires and are safety issues that will be addressed during this presentation. Response D, cooking, is the leading cause of home fires and home fire injuries. Source Safe Kids Worldwide. Burns and Fire Safety Fact Sheet (

Fireplace and wood stove Children = no access Barriers and screen
Heating Equipment Fireplace and wood stove Children = no access Barriers and screen Doors Can reach 1300ºF Stay hot for 1 hour + Serious burn: Less than 1 second Fireplaces have surfaces hot enough to cause burns. Children should be kept away from fireplaces because their clothing can easily catch on fire. Children should be kept away from a hot surface because they can be burned simply by touching it. A protective safety screen over the front opening of a fireplace will keep the sparks away and will not allow the child to get near an open flame: Make sure that a screen or other barrier is in front of the fireplace opening. Be aware that fireplace doors stay hot for 1 hour after the fire is extinguished. Source CFOC Standard – Fireplaces, fireplace inserts, and wood/corn pellet stoves. (

Candles and space heaters Consider policy
Fire and Burn Risk Matches and lighters Children = no access Not childproof Candles and space heaters Consider policy Children should not be near matches and lighters. Many fires start by children playing with matches or lighters. Space heaters and candles are a common cause of fire and burns. To prevent burns and fires, space heaters and candles must be out of the reach of children. Children can start fires by putting material that can catch on fire near space heaters or the open flames of a candle. A child playing with a candle is one of the biggest causes of candle fires. Consider adding a policy of using safer alternatives to candles or space heaters for use in the early learning setting. Sources CFOC Standard – Portable electric space heaters. ( CFOC Standard – Inaccessibility to matches, candles, and lighters (

Cut risk of dying in half Install smoke alarms Every level
Inside and outside bedrooms Make and practice fire escape plan Test monthly Working smoke alarms cut risk of dying in half. It takes only 2–3 minutes for smoke to fill an entire house. Children should know the sound of the fire/smoke alarm and what to do if they hear it: Install smoke alarms on every level and inside and outside bedrooms. Make and practice a fire escape plan which should include a safe meeting place. Sources Safe Kids Worldwide. Fire Safety Tips ( Safe Kids Worldwide. Burns and Fire Safety Fact Sheet ( National Fire Protection Association. Smoke Alarms ( CFOC Standard Smoke detection systems and smoke alarms (

First Aid: Burn Injuries
As quickly as possible Cool burn with cool water Cover with dry cloth or gauze Call parents No butter, grease, or powder No ice Obtain a medical assessment if warranted. Medical care should be immediate. First aid to the burned child: Cool the burn area as quickly as possible. Cool by holding the burn under running cool water or soaking the burn in cool water. Do this until the burned area is cool and the pain has gotten better. Do not use ice on a burn because it may not heal as quickly. Also, do not rub a burn; it can increase blistering. Cool any burned clothing right away by soaking with water, then take off any clothing from the burned area unless it is stuck to the skin. In that case, cut away as much clothing as you can. If the injured area is not oozing, cover the burn with a sterile gauze pad or a clean, dry cloth. If the burn is oozing, cover it lightly with sterile gauze if available and seek medical attention right away. If sterile gauze is not available, cover burns with a clean sheet or towel. Do not put butter, grease, or powder on a burn. These “home remedies” may make the injury worse. Sources CFOC Standard – Response to fire and burns. ( Healthychildren.org, American Academy of Pediatrics. Treating and Preventing Burns (

Firefighters are our friends Crawl low under smoke
Teaching Kids Firefighters are our friends Crawl low under smoke Stop, drop, and roll Tools not toys What’s hot and what’s not Smoke alarm Recognize sound and respond Children should be taught that firefighters help people in their neighborhood and that they are safe strangers. Children should have a chance to meet a firefighter in their basic uniform and have the firefighter talk to them about and show them how they put on all of their protective clothing. The firefighter should do this slowly to allow the children to feel comfortable. Kids who are scared of firefighters in their full protective clothing may run away from them in an emergency. This exercise helps children feel less scared if/when they see them in their uniform in a real emergency. “Crawl low under smoke and go.” It’s important for kids to understand that the “good” air stays low to the ground. So if there is smoke, they should crawl low to get out and stay out. “Stop, drop, and roll.” Kids can practice what to do if their clothes catch fire. Teaching children that some things are tools and some are toys. This is especially true when it comes to matches and lighters. From the time that children can speak they should understand the word “hot.” Teaching children to know what things are hot and what things are not hot in their homes and in other settings is important. Teach kids that the smoke alarm is like your nose. It is always smelling the air. But as soon as it smells “bad” air, it makes a loud noise that tells us to get out. Make sure the children know what the smoke/fire alarm sounds like so they know that when they hear it they have to get out and stay out. Look for local and national programs like the National Fire Protection Association Learn Not to Burn Program. Many programs are available for free. Contact your local fire department for assistance or recommendations on available programs.

Children: Spot dangers Visit fire station Books Involve parents
Reinforce Lessons Fire drills Sunscreen Children: Spot dangers Visit fire station Books Involve parents In-person meeting Homework Handouts Make your fire safety plan and practice it regularly. Your local fire department may be willing to watch one of your fire drills and give you suggestions for making it better. This would be a great chance for them to talk to the children, too! Teach children and families about why children need sunscreen and how it helps prevent sunburn. Ask children to look around them to see whether they can spot anything that needs to be made safe. You may be surprised what they see at their level that could be dangerous and changed to prevent an injury. Visit a fire station. Let the children meet firefighters and see the trucks and safety gear up close. This helps them see the firefighters as helpers and that they are friends. Read stories about fire and burn safety. (Note to presenter: Ask participants if they have any favorite books to read in the classroom.) Share information about health and safety with providers/teachers and parents/guardians. This is important so children get the messages from both places. This can be done in the center, or information can be sent home. Give children activities to do at home with their parents/caregivers to learn about safety and what they can do to be safe. Send information home about what parents can look for in their homes that may not be safe and ideas about how they can make their home safer. Ask whether there are other things participants can do to involve parents.

Local Resources Hospital American Red Cross Fire and police Physicians
Ask your local professionals for advice. Make sure that staff knows how to act on the written emergency and disaster plans.

Deaths and injuries from fires and burns are absolutely preventable
Summary Deaths and injuries from fires and burns are absolutely preventable Children are more likely than adults to get injured Childproofing is only a layer of protection Teach children and families and model safe behaviors Use community resources Summarize the important points from the presentation. Include items participants mentioned during discussions. Ask whether there are any final questions or comments. Share your contact information (if appropriate) and the URL where participants can find the PowerPoint slides and resources used during the presentation.

Safe Kids Worldwide (http://www.safekids.org/)
Online Resources Safe Kids Worldwide ( American Burn Association ( National Fire Protection Association ( US Fire Administration ( The following is a list of general sources for the information provided in this presentation: American Burn Association National Burn Repository Report of Data from 2004–2013, Version ( Safe Kids Worldwide. Burns and Fire Safety Fact Sheet ( Safe Kids Worldwide. Fire Safety Tips ( O’Brien SP, Billmire DA. Prevention and management of outpatient pediatric burns. Journal of Craniofacial Surgery. 2008;19(4):1034–1039. Quinlan KP, Robinson M, Gottliev LJ. Protecting children from fires and burns. Pediatric Annals. 2010;39(11):709–713. ( Committee on Injury and Poison Prevention. Reducing the number of deaths and injuries from residential fires. Pediatrics. 2000;105(6):1355–1357. ( Injury Free Coalition for Kids: ( Presenters can use these resources to gather background and in-depth information on this topic: Safe Kids Worldwide ( American Burn Association ( efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention. National Fire Protection Association ( publishes, and disseminates more than 300 consensus codes and standards intended to minimize the possibility and effects of fire and other risks. US Fire Administration ( national leadership to foster a solid foundation for fire and emergency services stakeholders in prevention, preparedness, and response.

Transportation Safety: In and Around Cars
Keeping Children Safe From Injuries in Early Care and Education Settings Transportation Safety: In and Around Cars Next, I’ll provide some highlights about Transportation Safety.

State how long a child should remain rear-facing
Learning Objectives State how long a child should remain rear-facing State how tall a child should be before transitioning to seat belt Explain how tightly a car seat should be installed Know when harness is properly secured on a child State 2 key points to teach children about pedestrian safety List steps to prevent children from being left in vehicles The objectives for his module include being able to: State how long a child should remain rear-facing in a vehicle State how tall a child should be before transitioning to a seat belt Explain how tight a car seat should be installed in a vehicle Know when the harness is properly secured on a child State at least 2 key points to teach children about pedestrian safety List ways to prevent children from being left in vehicles

Crashes: Leading cause of death in this age group
Children: In Cars Crashes: Leading cause of death in this age group Deaths: 450 classrooms (12 and younger) per year 1 in 3 were not buckled up Motor Vehicle Crashes Motor vehicle crashes are a leading cause of death and disability among children in the United States. More than 9,000 children ages 12 and younger have died in crashes in the past decade; that is nearly 450 classrooms full of children. One in three children who died in crashes in 2011 were not buckled up. Source CDC Report “Child Passenger Safety: Get the Facts.” (

Facilities transporting children or with cars in driveway
Children: In Cars Low rates of appropriate restraint use in the child care settings have been reported. Facilities transporting children or with cars in driveway Know best practices in transporting kids safely Liability issues Motor Vehicle Crashes For early care and education facilities that transport or in-home child cares with potential exposure to vehicles, this is an in-care issue. Centers that transport need to be knowledgeable about and compliant with best practices in transporting kids in the proper child restraints for both safety and liability reasons. All early care and education providers have a crucial and special opportunity to model best practices and educate parents with respect to kids and cars, a major cause of death and injury to kids of this age. Source Brixey, S. “Booster Seat Use in an Inner-City Day Care Center Population.” Traffic Injury Prevention

Heatstroke: Leading cause of noncrash, vehicle-related deaths
Children: In Cars Heatstroke: Leading cause of noncrash, vehicle-related deaths Death every 8 days In 2014 30 deaths: Heatstroke (suspected) Ages 1 month–5 years Heatstroke Babies and young children can sometimes sleep so peacefully that we forget they are even there. It can also be tempting to leave a baby alone in a car while we quickly run into the store. The problem is that leaving a child alone in a car can lead to serious injury or death from heatstroke. Young children are particularly at risk, because their bodies heat up three to five times faster than an adult’s body. These tragedies are completely preventable. Heatstroke is the leading cause of noncrash, vehicle-related deaths for children. On average, every 8 days a child dies from heatstroke in a vehicle. In 2014, Thirty children, ranging in age from 1 month to 5 years, died from heatstroke or suspected heatstroke while left in cars. Source Kids Safe Worldwide. Heatstroke (

Different laws in each state Know your state’s laws
Children in Cars: Laws Different laws in each state Know your state’s laws May not reflect “gold standard” of safety American Academy of Pediatrics: Follow best practice guidelines All 50 states and the District of Columbia have laws about child passenger safety. The age at which seat belts can be used instead of child restraints differs among the states. Participants need to be aware of the laws in their specific states. HOWEVER, it should be noted that state laws are not always consistent with best practices. Although we recognize that laws differ across the country, the information that is presented in this lesson is based on the “gold standard” of safety—best or safest practice guidelines—and is consistent with guidelines established by the American Academy of Pediatrics (AAP). Sources Map image ( Car seat laws by state ( Source: CDC

Transportation Policies (1)
Policies should address: Use of car safety seats, seat belts, and booster seats Drop-off and pick-up plans Vehicle check for children Vehicle selection for safe transport Backup arrangements for emergencies Written policies should address the safe transport of children by vehicle to or from the facility, including field trips, home pick-ups and drop-offs, and special outings. The transportation policy should include: Use of seat belts and car safety seats, including booster seats Drop-off and pick-up plans Procedures to ensure that no child is left in the vehicle at the end of the trip or left unsupervised outside or inside the vehicle during loading and unloading Vehicle selection to safely transport children, based on vehicle design and condition Backup arrangements for emergencies Use of passenger vans. Policies and procedures must account for the management of these risks. Source CFOC Standard Transportation Policy for Centers and Large Family Homes. (

Transportation Policies: (2)
Vehicle operation and maintenance Driver selection, training, & supervision/licensing Child/staff ratio during transport Accessible first aid kit, emergency ID, contact and health information Communication plan: driver and facility Maximum travel time for children Other policies to include are . . . Operation and maintenance of vehicles Driver selection, training, supervision, and licensing Child/staff ratio during transport Accessible first aid kit, emergency ID/contact and health information for passengers, and cell phone or two-way radio Permitted and prohibited activities during transport Plan for communication between the driver and the child care facility staff Maximum travel time for children (no more than 45 minutes in 1 trip) Use of passenger vans. Policies and procedures must account for the management of these risks. Source CFOC Standard Transportation Policy for Centers and Large Family Homes. (

Car Seats, Boosters, and Belts
Correct use saves lives and prevents injury Misuse and nonuse: Leading factor in death and injury Safety restraints are effective in reducing death and injury when they are used properly. Misuse and nonuse remain the leading factors in preventable motor vehicle deaths and injuries.

4 Phases of Child Passenger Safety
There are four phases of child passenger safety restraints: Rear-facing car seat Forward-facing car seat Booster seat Seat belt Child Passenger Safety Every transition is a reduction in safety. Many parents report confusion about when to move from one phase to the next. And transitioning too soon can be catastrophic for a child in a crash. Sources Child Passenger Safety guidelines: Parents Central – Car seat by child’s age and size: Source: CDC

Phase 1: Rear-Facing Car Seats
Until age 2 OR reach height/weight limit of seat Check labels 5 times safer Best support: Head, neck, and spine Prevent head from being thrown away from body Infants and toddlers should ride in rear-facing car seats until they are age 2 or reach the height or weight limits for their seat based on information provided by the manufacturer. Children are 5 times safer when riding rear-facing. Rear-facing seats give the best support to the child's head, neck, and spine and prevent the child's head from being thrown away from the body in the event of a car crash. Consider how careful we are in supporting the head and neck of an infant. Infant and toddler heads are MUCH larger than their necks. This puts tremendous stress on the immature and weak neck: Adult head = 6% of total body weight Infant head = 25% of total body weight Infants and toddlers are not small adults. Young children are especially at risk for head and spinal cord injuries because their bones are not yet hardened and ligaments are still developing. Sources Healthychildren.org, American Academy of Pediatrics. Car Seats: Information for Families ( BeSafe. Scandinavian Safety: Independent Studies of Real Traffic Accidents Carried out by Volvo and Folksam. (

Why Rear-Facing? Source: University of Michigan Show video.
Source: University of Michigan

Phase 2: Forward-Facing Car Seats
Use until height/weight limit is reached Check labels Always in the back seat Once children are at least 2 years old or have outgrown the weight and height limits of their rear-facing car seat, they should be transitioned to forward-facing car seats with a harness. Children should ride in forward-facing child safety seats with a harness until they reach the upper height or weight limit for the seat. All car seats should be placed only in the back seat of the vehicle. Source Healthychildren.org, American Academy of Pediatrics. Car Seats: Information for Families (

Refer to car seat and vehicle manuals Seat belt OR latch (not both)
1. Car Seat Into Vehicle Refer to car seat and vehicle manuals Seat belt OR latch (not both) Less than 1 inch of movement To be sure you are securing the seat correctly, always refer to the manuals for the car seat and vehicle. Use the seat belt or latch to secure the car seat; never use both. Make sure the seat belt or latch is secured with less than 1 inch of movement.

Harness snug: Pinch test Chest clip: Armpits Proper harness slots
2. Child Into Seat Refer to manual Harness snug: Pinch test Chest clip: Armpits Proper harness slots Always refer to the car seat and vehicle manuals for installation instructions. The harness should be snug. Perform a pinch test to be sure the harness is fitted properly. The pinch test is when you try to pinch the harness near the point of contact on the child’s shoulder/collar bone. If you can pinch the webbing, that indicates slack. The harness is tight enough when your fingers slip off. Be sure the chest clip is positioned at the child’s armpits. Use proper harness slots (refer to manual). Rear-facing seat is different from forward-facing seat. Source Safe Kids USA Car Seat Tips. (

Age and Abdominal Injury
This figure shows the percentage of children correctly or optimally (OPT) restrained (left-hand y axis) by age and the percentage of children with an abdominal injury (right-hand y axis) by age. Optimal restraint is the lowest typically among children ages 4 to 8 because of their intermediate size – they are often too large for their car seats but too short for seat belts alone, without use of a booster seat. Seat belts are designed for adults, not children. Booster seats are needed to make sure seat belts fit properly across the younger child’s body. Children using incorrect restraints were 3.5 times as likely to sustain an abdominal injury than optimally restrained children. Source Nance ML, Lutz N, Arbogast KB, Cornejo RA, Kallan MJ, Winston FK, Durbin DR. Optimal restraint reduces the risk of abdominal injuries in children involved in motor vehicle crashes. Ann Surg Jan;239(1): ( Nance ML, Lutz N, Arbogast KB, Cornejo RA, Kallan MJ, Winston FK, Durbin DR. Department of Surgery, Children's Hospital of Philadelphia

Activity Quiz Most children can use a vehicle seat belt (without needing a booster seat) once they are how tall? 3 feet 10 inches 3 feet 6 inches 4 feet 4 feet 9 inches Directions for Activity Quizzes For all of the activity quizzes, present the question and ask participants what they think the correct answer is. As you read each response, have participants raise their hands if they think that response is the correct answer. After participants have responded, discuss the important points of the topic.

Activity Quiz Most children can use a vehicle seat belt (without needing a booster seat) once they are how tall? 3 feet 10 inches 3 feet 6 inches 4 feet 4 feet 9 inches Activity Quiz Children no longer need to use a booster seat once seat belts fit them properly. Seat belts fit properly when the lap belt lays across the upper thighs (not the stomach) and the shoulder belt lays across the chest (not the neck). HOWEVER – the recommended height for proper seat belt fit is 4 feet 9 inches tall (57 inches). Almost ALL children in the typical early learning age group (less than six years of age) who are too big for a front-facing car seat, will still be below this recommended height, so they all should be in a booster seat. For example, even very tall boys or girls (95 percentile for height) would typically be below 57 inches tall. It is important that all early care and education facilities have a policy (for their best possible protection) that states children under this height should be in a booster seat and buckled in the back seat.

Until 4 feet 9 inches: ages 8–12
Phase 3: Booster Seat Raises child for proper belt fit Lap and shoulder belt Across hips and shoulder (hard bones) Away from belly and neck (soft tissue) Until 4 feet 9 inches: ages 8–12 A booster seat should be used when the child has outgrown a forward-facing child safety seat but is still too small to safely use the vehicle seat belts. A booster seat raises the child up so that the vehicle’s lap and shoulder belts are properly positioned across the child’s hips and chest (hard bones) and away from the belly and neck (soft tissue). Most laws indicate an age and/or weight along with a height. It is important to note that proper belt fit is the BEST indicator that it is safe to transition to a seat belt. Height tends to be the best indicator for proper belt fit. All vehicles are different. Some children may fit in a seat belt in one vehicle but not another. Source Safe Kids Worldwide. (

No Booster vs Booster Source: University of Michigan
Show the video Child Passenger Safety available at This video shows a 6-year-old with and without a booster seat, side by side. Source: University of Michigan

Fits low across the hips Shoulder belt across shoulder
Seat Belt Placement Proper placement Below hip bones Fits low across the hips Shoulder belt across shoulder If the vehicle seat belt is at the child’s belly rather than below the hip bones, the child could suffer damage to internal organs and/or a spinal injury if a crash occurs. Do not place the shoulder belt under the child’s arm or behind the child’s back. This eliminates any upper body restraint and places the child at significant risk of death or injury. The lap belt should fit low across the hips. The shoulder belt should fit across the shoulder. Source Partners for Child Passenger Safety Study. Improper Versus Proper Positioning of a Lap Belt ( Source: Partners for Child Passenger Safety Study

Activity Quiz All children should ride in the back seat until they are ___ years old. 8 10 13 15 Activity Quiz

Activity Quiz All children should ride in the back seat until they are ___ years old. 8 10 13 15 Most children can fit properly into a vehicle seat belt when they are 13 years old. All children younger than age 13 should ride in the back seat. When riding in a vehicle, all children need to be properly restrained.

Seat belt too soon: 4 times more likely to suffer serious head injury
Phase 4: Seat Belt Designed for adults Seat belt too soon: 4 times more likely to suffer serious head injury 9 out of 10 parents: Transition too soon Lifelong use Seat belts are designed for adults, not children. Most children are not big enough to safely use a seat belt alone until they are between ages 8 and 12. Children between ages 2 and 5 use seat belts too soon. These children are 4 times more likely to suffer a serious head injury in a crash than those restrained in child safety seats or booster seats. Source Safe Kids Worldwide. (

Must pass seat belt test In all positions In all vehicles
Seat Belt Alone Must pass seat belt test In all positions In all vehicles The majority of children in early learning and preschool settings should be in a car seat or a booster seat. Children need to pass the seat belt fit test before transitioning into use of a seat belt alone. However, they should be: Tall enough to sit without slouching Able to keep their back against the vehicle seat Able to keep their knees naturally bent over the edge of the vehicle seat Able to keep their feet flat on the floor Each vehicle and each seating position varies. The depth of the seat cushion and the anchor points for the seat belt contribute to proper belt fit. A child may pass the test in one seating position in one vehicle, but not in another vehicle or position. Source The Car Seat Lady. The 5-Step-Test. (

Parents move to seat belt too soon
Educate Parents Parents move to seat belt too soon 4–8-year-olds: Increased risk of injury Focus on FIT not age 5-step test Fit differs in each vehicle According to a Safe Kids Worldwide study (September 2014), 9 out of 10 parents move their child from a booster seat to a seat belt before their child is big enough. Children ages 4 to 8 are at an increased risk of injury because of improper restraint. It is important to educate parents on the importance of transition; they should focus on body fit rather on age. The 5-step test: Know information to relay to parents to encourage them to keep children in booster (or put them back in!) until they can fit into the vehicle safely. Source Safe Kids Worldwide Booster Seat Study, (

Children with Special Needs
Access to resources for safe transportation. Not exempt from state laws for seat belt use. Develop policy for special transportation needs. Collaboration of parents, physicians and child care providers (MEDICAL HOME) Facilities should have transportation policies for children with special needs requiring special transportation needs. Special needs children will need access to proper resources for safe transportation. They should not be exempt from state's laws for seat belt use. Parents, physicians and providers - collaborate for special transportation needs – IMPORTANCE OF A MEDICAL HOME. Sources AMERICAN ACADEMY OF PEDIATRICS Committee on Injury and Poison Prevention: Transporting Children With Special Health Care Needs. (Pediatrics Oct;104 (4): ) American Academy of Pediatrics: Committee on Injury and Poison Prevention. School bus transportation of children with special health care needs (Pediatrics. 2001 Aug;108(2):516-8)

Children with Special Needs - Resources
National Center for the Safe Transportation of Children with Special Needs ( Automotive Safety Program Source

Children and Heatstroke Risk
Children and risk Overheat 35 times faster than adults Unable to communicate Can’t get out of car seat Can’t open car doors Child “forgotten” in vehicle Heatstroke Heatstroke or hyperthermia is the leading cause of NON-crash, vehicle-related deaths for children and can occur if a child is left unattended in a vehicle. No child of any age should be left unattended in a vehicle for any amount of time. On average, a child dies every 8 days from heatstroke in a vehicle. Child deaths have occurred in early care and education settings when children were mistakenly left in vehicles or a family member unintentionally forgot about the child in a vehicle. Children are at higher risk of heatstroke or hyperthermia because: Children’s bodies overheat 3 to 5 times faster than adults. Children cannot communicate or open car doors. Children don’t have the ability to escape from their car seat and/or vehicle. A review of 636 media reports of child heatstroke deaths from 1998 to 2014 indicates that 53% of heatstroke deaths among children in vehicles occurred when a child was “forgotten” by a parent or caregiver, 29% of deaths occurred when a child gained access to an unattended vehicle, and 17% occurred when a child was intentionally left in a vehicle. Heatstroke deaths have been recorded in 11 months of the year in 46 states. Source Safe Kids Worldwide. (

Activity Quiz How long does it take for a vehicle to heat up to a deadly temperature on an 80 degree summer day? 10 minutes 20 minutes 1 hour 2 hours Activity Quiz

Activity Quiz How long does it take for a vehicle to heat up to a deadly temperature on an 80 degree summer day? 10 minutes 20 minutes 1 hour 2 hours Activity Quiz Within 10 minutes, the inside temperature of a vehicle can be up to 20 degrees hotter than the outside temperature. After 30 minutes the vehicle’s temperature can be up to 34 degrees hotter.

Simulation Video Show the video A Simulation of Rapid and Extreme Car Heating from Direct Sunlight that shows how fast a vehicle heats up.

Prevention: ACT for early learning providers
Avoid Heatstroke Never leave child alone in vehicle Keep vehicle locked Create Reminders Signs or checklist in vehicle Confirm head count Take Action Check backseat & confirm headcount “Look before you lock” Reduce the number of deaths from heatstroke by remembering to ACT. A: Avoid heatstroke-related injury and death by never leaving a child alone in a car, not even for a minute. And make sure to keep the car locked when you’re not in it so children can’t get in on their own. C: Create reminders by making a checklist that a driver can mark off at the end of the day or by posting a sign in the vehicle. T: Take action. Always check the backseat (especially if transporting infants or nonverbal children who may be sleeping) – “Look before you lock”. After transporting children always confirm everyone is accounted for with a head count. Source Adapted from : Safe Kids Worldwide. A Simulation of Rapid and Extreme Car Heating from Direct Sunlight. (

Safety: Transportation
Facilities providing transportation – must have written policies Drivers – minimize distractions (no texting, music, radio/CD’s) Post sign in vehicle Phones only for emergencies and when vehicle is stopped. All early care and education facilities providing transportation should have written policies for transportation safety and drivers, including qualifications, competence, and training of transportation staff; policies can be adapted from the Caring for Our Children Standards. The driver should not play the radio or music or use ear phones to listen to music or other distracting sounds while children are in the vehicles operated by the facility. In each vehicle from a center, a sign should be posted stating “NO RADIOS, EAR PHONES, TEXTING” The use of portable telephones or other devices to send or receive text messages, check , etc. should be prohibited at all times while the vehicle is in motion or on an active road or highway. These devices should be used only when the vehicle is stopped and in emergency situations. Source Adapted from CFOC Standards: : Qualifications for Drivers : Interior Temperature of Vehicles : Distractions While Driving : Competence and Training of Transportation Staff

Plan: Drop-Off and Pick-Up
Parents/guardians and staff Curb or off-street Supervised Confirm children are clear of vehicle Keep attendance and time records The facility should have a plan for safe, supervised drop-off and pick-up points and pedestrian crosswalks in the vicinity of the early care and education facility and communicate this plan to staff, parents, and guardians. Drop-off and pick-up should occur only at the curb or at an off-street location protected from traffic. The facility should ensure that a staff member or adult parent or guardian supervises the process of dropping off and picking up children. The facility should ensure that the adult who supervises drop-off and loading can see that children are clear of the perimeter of all vehicles before any vehicle moves. The staff member responsible for observing drop-off and pick-up must keep an accurate attendance and time record of all children being picked up and dropped off. Source CFOC Standard – Transportation policies for centers and large family homes. (

No playing in or around them Trapped: Honk horn
Teach Kids: In Cars Always buckle up Be a good passenger Cars: Off limits No playing in or around them Trapped: Honk horn Missing child? Search vehicles! Discuss things participants suggest and how to teach these concepts to children: Always buckle up in the car, no matter how short the trip. Teach children how to be a good passenger and understand how to reduce distractions for the driver. What does it mean to be a good passenger? What kinds of things might distract the driver? Cars are off limits when not in use or without a grown up. If children become trapped they should honk the horn if they can reach it. If a child is missing, search vehicles! Young children often cannot unlock or open the vehicle door from the inside and can easily become trapped.

Local Safe Kids Coalition Car seat checks Local fire and police
Community Partners Local Safe Kids Coalition Car seat checks Local fire and police Community pediatricians Some ideas of community partners include: Safe Kids Worldwide Find a car seat inspection event across the country where certified technicians can make sure your car seat is properly installed. Schedule of local events. Visit Contact local fire department and police station Contact community pediatricians

Summary Motor vehicle crashes: A leading cause of death and disability among children in the United States Children should ride rear-facing until age 2 or reach the height/weight limit of the car seat Use car seat and vehicle manuals Check for tight car seat installation: Less than 1 inch of movement

Summary Snug harness: No pinch or slack Children should stay in a booster seat until they are approximately 4 feet 9 inches, unless seat belt fits properly Teach children safety in and around cars Prevent vehicle heatstroke: Head count, keys out of reach, and arrival plan policy

Resources American Academy of Pediatrics: Safe Kids Worldwide—A global organization dedicated to preventing injuries in children: Centers for Disease Control and Prevention: Children’s Safety Network (CSN)—A national resource center for the prevention of childhood injuries and violence:

Playground Safety The next topic is playground safety, a very important topic for early care and education providers when it comes to keeping children safe during play time. Children spend a lot of outdoor time on the playground, and while injuries on the playground are very common, they are also predictable and preventable. Sources ASTM International’s Safe Playground Equipment: Caring for Our Children: Centers for Disease Control and Prevention: Consumer Product Safety Commission: National Program for Playground Safety: National Recreation and Park Association’s Certified Playground Safety Inspectors: Safe Kids Worldwide: US Play Coalition:

Identify the #1 cause of playground injuries
Learning Objectives Identify the #1 cause of playground injuries Understand the importance of active supervision Understand the dos and don'ts for playground surfaces Identify at least 1 place to get more information about playground safety The learning objectives for this module are to be able to: Identify the #1 cause of playground injuries Understand the importance of active supervision to reduce injuries (especially around monkey bars, swings, and slides) Understand the dos and don’ts for playground surfaces and explain why Identify at least 1 place to get more information about playground safety

200,000 children injured yearly #1 cause of injury: FALLS
Playground Injuries 200,000 children injured yearly #1 cause of injury: FALLS Half of injuries = lack of proper supervision Children and risk: Developmental variations Test skills & abilities Unaware of dangers Every year, 200,000 children will go to an emergency room for a playground injury. Falls are the most common cause of playground injury (79%): Almost half of playground injuries happen because no adult is watching the children Children are at different developmental stages, both physically and emotionally Children are curious and like to test their skills and abilities, especially around playground equipment Young children do not have the ability to judge what is safe or not safe and may not realize that it’s dangerous to run in front of a swing where they could be hit Sources Tinsworth D, McDonald J. Special Study: Injuries and Deaths Associated with Children’s Playground Equipment Washington, DC: Consumer Product Safety Commission. ( Hashikawa AN, Newton MF, Cunningham RM, Stevens MW. Unintentional injuries in child care centers in the United States: A systematic review. Journal of Child Health Care Mar;19(1): doi: / Epub 2013 Oct 3. American Academy of Orthopaedic Surgeons. Playground Safety Guide ( Safe Kids Worldwide. Safe Kids Coalitions in the United States (

Common Playground Injuries
Let’s take a closer look at the some playground injuries based on data for preschool and elementary school children. Over a third of these injuries are in children between 0-5 years of age Bone fractures and bruises/cuts are the most common injury among children Among reported incidents with known ages, the 0-4 age group accounts for 54% of the data Other common injuries include: Lacerations (17%) Strains/sprains (12%) Internal/organ damage (5%) Concussions (2%) Other (3%) Sources Consumer Product Safety Commission. National Electronic Injury Surveillance System Database. May ( Safe Kids Worldwide. Safe Kids Coalitions in the United States (

Common Playground Equipment
When it comes to the type of equipment that is most likely to cause an injury, monkey bars, swings, and slides are at the top of the list. It’s important to let early care and education workers know where children are most likely to get hurt so they can provide additional supervision and focus in those areas. For monkey bars, lowering the bar should be considered, if it’s an option. Note to Presenter: The Consumer Product Safety Commission (CPSC) public Playground Safety Handbook is a great free resource with specific recommendations, especially if the audience has specific questions; however, this amount of detail is not recommended to include in the presentation routinely. Some examples: Monkey bars: For toddlers, the maximum fall height for free standing and composite climbing structures should be 32 inches (pg. 25). Free-standing arch and flexible climbers: Not recommended for toddlers and preschool children (pg. 27). Horizontal (overhead) ladders: Four-year-olds are generally the youngest children able to use upper body devices like these; therefore, horizontal ladders should not be used on playgrounds intended for toddlers and 3-year-olds. (pg. 28) Sources National Program for Playground Safety. Injuries ( The CPSC public Playground Safety Handbook (

Certified Playground Safety Inspectors (CPSIs)
Training: National Recreation and Park Association (NRPA) Locate a CPSI at Looking for hazards = preventing injuries New playground installs Yearly inspections Certified Playground Safety Inspectors (CPSIs) must attend a training and get certified from the National Recreation and Park Association in association with the National Playground Safety Institute. You can locate a CPSI at Because CPSIs’ training is beyond that of most early care and education providers, getting a professional inspection to find playground dangers before a child is injured is worth it. Child care health consultants are health professionals with experience helping early care and education settings develop their best practices. Sometimes your child care health consultant has completed the NPSI training and are certified CPSIs. If not, check the NPSI Web site for an inspector. CPSIs should do an inspection of new playground installs. Playgrounds that are already in place should be inspected at least once a year by a CPSI or local regulatory agency and when there are changes to the equipment. It is important to emphasize that early care and education providers are not expected to have the knowledge level of a CPSI and should use local resources, including local parks and recreation departments or other local regulatory agencies, for assistance with playground safety concerns. These local experts will also be familiar with any local or state requirements. For example, programs can learn from the inspectors what hazards to look for that may cause injury, such as surfacing materials shifting or part of the play structure becoming loose that may create a pinching hazard after repetitive use; these are things that programs can add to their daily inspection checklists. Also remember to budget for playground inspections and necessary repairs. Source CFOC Standard – Play equipment requirements. (

Play Space and Equipment
All areas visible at all times No access to standing water Shade Accessible to all Properly spaced and arranged Equipment: Separate play areas Appropriate for age Playgrounds should be laid out to allow caregivers to keep track of children as they move throughout the playground environment. Visual barriers should be minimized as much as possible. Early care and education providers should position themselves so that they can see the children at play and the children can see the teacher. Position yourself near high use or potentially dangerous areas, such as swings. Locate play areas away from standing water or other areas with water (eg, swimming pool without a fence, ditches, ponds, or canals). Provide shade for metal equipment (especially slides) and play space. Children should have shaded areas outside where they can play, not just on playgrounds. Trees, buildings and other structures are good choices for shaded areas. Shade also prevents sunburn or burning from hot ground surfaces. Time children’s outdoor play to avoid (or at least limit) the most intense sun exposure, which is between 10am and 4pm. Provide play equipment that is accessible to all (Americans with Disabilities Act). Injuries from falls are more likely to occur when equipment spacing is inadequate. All equipment should be arranged so that children playing on one piece of equipment will not interfere with children playing on or running to another piece of equipment. All equipment should be arranged to facilitate proper supervision by sight and sound. Collisions between children utilizing different pieces of equipment occur more often when equipment is inappropriately placed. When it comes to playground equipment, it is not a one size fits all for every child. Play structures are not only designed differently for different ages, but for different developmental skills at these ages. Size and height of the equipment are important to reducing injuries. Separate play areas for children in different age groups is very important. There are differences in the physical development and abilities among children and possible injuries are very predictable (younger children on bigger equipment are likely to get hurt). Younger and smaller children should be on equipment that is for their size and easy to play on. Equipment for older children should be away from where the smaller children play because there may be things the younger children will not be able to do. All fixed play equipment should have a minimum of six feet use zone (clearance space) from walkways, buildings, and other structures that are not used as part of play activities. For fixed play equipment only used by children six months to twenty-three months of age, a minimum three-foot use zone is required. For playgrounds intended to serve children of all ages, the layout of pathways and the landscaping of the playground should show the distinct areas for the different age groups. The areas should be separated at least by a buffer zone, which could be an area with shrubs or benches. This separation and buffer zone will reduce the chance of injury from older, more active children running through areas filled with younger children with generally slower movement and reaction times. (Note: We know that best practice would be to have a fully accessible playground with shade. Not all early care and education providers are able to provide shade or a fully ADA playground, therefore, this should be discussed as to how to provide an acceptable level of both.) Sources CFOC Standard – Visibility of outdoor play area. ( CFOC Standard – Location of play areas near bodies of water. ( CFOC Standard – Shading of play area. ( CFOC Standard – Size and location of outdoor play area. ( CFOC Standard Arrangement of play equipment. ( CFOC Standard Use Zones and Clearance Requirements. ( Consumer Products Safety Commission. Public Playground Safety Handbook (page 6). (

Goal: keep child in the space Prevent getting over, under, or through
Secured Space Goal: keep child in the space Prevent getting over, under, or through Design: discourage climbing Layer of protection Self-closing/self-latching Fences help protect and keep children in an area where they can be watched by an adult. They can prevent a child from leaving outdoor play areas and help keep children safe from injuries. Even though fences are not childproof, they do make the area safer for children who may walk away from the group. The fence and gate should be built so that it’s not easy for children to climb (fence posts on outside of fence). Early care and education programs and providers need to know and comply with local codes, if applicable, regarding fence height. Teachers should not rely on fences to keep children safe and need to actively supervise the children at all times. Gates should have latches that close and lock by themselves. The latches should be high enough so children cannot reach and open them. Source CFOC Standard – Enclosures for outdoor play areas. (

Trampolines/Mini Trampolines
American Academy of Pediatrics does NOT recommend use Not playground equipment Injuries are very common Insurance coverage may be denied The AAP, the American Academy of Orthopedic Surgeons, and the Consumer Product Safety Commission, DO NOT recommend using trampolines, including mini trampolines, for children. Trampolines are not playground equipment and injuries on trampolines are very common. Children 5 years and younger appear to be at increased risk of fractures and dislocations from trampoline-related injuries. Enclosures and padding have not been shown to decrease the number of injuries. There have been times when insurance companies have refused to give or to continue insurance to the family child care providers or early care and education center where a trampoline was found. (Note: Trampolines are regulated in many states by licensing requirements. Early care and education providers should be familiar with their licensing requirements, know the dangers, and that they are not recommended.) Sources CFOC Standard – Trampolines. ( Safe Kids Worldwide. Playground Safety Tips ( American Academy of Pediatrics. (

Play Area Inspection Daily and monthly safety checks file and document
Equipment: Anchored No missing or broken pieces, sharp edges, parts sticking out No signs of wear and tear Surface: No tripping dangers Proper coverage Daily safety checks should be conducted to identify any new potential hazards, which should be addressed immediately. Broken equipment/toys should be removed until it can be repaired or replaced. Checking the equipment every month to make sure it’s safe will give you the chance to see if there’s anything that needs to be fixed. A staff member can be assigned to check all the playground equipment to make sure it’s safe for the children. Staff members should also look at the equipment when the children are playing on it to find any issues and get them fixed as soon as possible. These observations should be documented and filed. When inspecting playground equipment, here are some things to look for to help ensure a safe play area for children: Equipment should be attached to the ground and anchored so it doesn’t tip, turn over, slide, or move in any way. None of the pieces of equipment should have sharp edges, pieces that stick out, or weak areas that could break. Sharp pieces could cause children to get scratches, cuts, bumps or bruises. All openings in pieces of play equipment should be designed too large for a child’s head to get stuck in and too small for a child’s body to fit into, in order to prevent entrapment and strangulation. Any parts that stick out and may catch a child’s clothing are prohibited. Other smaller openings may cause entrapment of a child’s fingers. A CPSI can help identify these dangers. The wood, metal, or plastic should be in good shape : No gaps, holes, cracks, broken or missing parts, rust, chipping or peeling paint, cracks or splinters, or rough surfaces. The surfacing area should be inspected for hazards that may include rocks, tree stumps or roots, uneven ground, or concrete anchoring that was under the surface but is now showing. Surfacing should also be inspected for proper coverage, which we will cover next. Safety Checklist The National Program for Playground Safety has developed a report card to evaluate the safety of an early care and education playground. Sources CFOC Standard – Inspection of indoor and outdoor play areas and equipment. ( CFOC Standard – Installation of play equipment. ( CFOC Standard – Material defects and edges on play equipment. ( CFOC Standard Entrapment of Hazards of Play Equipment. ( Safe Kids Worldwide. Playground Safety Tips ( National Recreation and Park Association. The Dirty Dozen: 12 Playground Hazards. (

3 out of 4 playground injuries = falls Not acceptable:
Surfacing 3 out of 4 playground injuries = falls Not acceptable: Asphalt, cement, dirt, and grass Shock-absorbing: Stationary Loose fill The kind of surfacing on a playground is important to prevent injuries because falls are the number one cause of playground injuries. Equipment that can be climbed on should not be near hard surfaces like asphalt, concrete, dirt, grass, or floors covered by carpet or gym mats because it is not safe for climbing equipment. All pieces of playground equipment should be placed over and surrounded by a shock-absorbing (softer) surface. This material may be either attached to the ground or loose-fill type. Check your state licensing regulations, as some states have specific requirements for surfacing. Surfacing does not prevent all injuries, but can help to make them less severe. Follow playground manufacturer’s recommendations regarding installation, maintenance, and replacement of equipment as well as the type and depth of surface materials selected. Loose-fill materials will degrade and compress over time so will need to be refilled regularly and maintained. Loose-fill does not provide access for wheel chairs. Source CFOC Standard – Prohibited surfaces for placing climbing equipment. (

Stationary: Shock Absorbing
Rubber mats Tiles Poured-in-place Optional Discussion What are the pros and cons of the listed shock-absorbing surfaces? PROS Meets the ADA standards for children with disabilities Minimum maintenance and care Allows for creative design of the area Provides fall height protection Softer on the feet when standing for a long period of time CONS Rubbery surface can cause shoes to stick, resulting in tripping Can cause “rug burn” type abrasions

Loose-Fill Material: Shock Absorbing
Wood chips, mulch, and sand: Caution: choking hazards Maintenance Depth: at least 12 inches Area: at least 6 feet in all directions Swings: 2 times height of top bar Shock-absorbing loose-fill surfaces (those that are softer and make falls less painful) include wood chips or mulch, pea gravel, and sand. However, when sand gets wet it is less shock absorbing, and gets very hard when temperatures drop below freezing. Some surface materials are not considered safe for infants and toddlers because of choking hazards (eg, pea gravel and wood chip nuggets) Wood chips, mulch, and other loose materials that are used to make the ground softer should be checked often to make sure that it is deep enough and has not moved. This is very important for under swings and at the end of slides. Wood chips or mulch should be put back into place or added if there are bare spaces, so that it is equal on all playground areas. Pea gravel is another material option, but it is a choking hazard for children under the age of 3. Loose playground surface material should be at least 12 inches deep and go out from the playground equipment 6 feet in all directions, sometimes even farther. For bigger equipment, like swings, the material will have to go out 2 times farther than the height of the bar that holds the swings in front and back of the swing. For example, it the swing bar is 10 feet high, the material should go 20 feet out from the swings in all directions. Optional Discussion What are the pros and cons of the listed shock-absorbing surfaces? Sources CFOC Standard – Inspection of play area surfacing. ( CFOC Appendix Z – Depth required for shock-absorbing surfacing materials for use under play equipment (reprinted from CPSC Public Playground Safety Handbook). (

Inspect areas before use Plants Remove unknown plants
Outdoor hazards Insects Inspect areas before use Plants Remove unknown plants Children should not eat berries, mushrooms, or other vegetation Sun Weather conditions INSECTS Facilities should prevent pest infestations by ensuring sanitary conditions. This can be done by eliminating pest breeding areas, filling in cracks and crevices; holes in walls, floors, ceilings and water leads; repairing water damage; and removing clutter and rubbish on the premises. Facilities should avoid the use of sprays and other pesticide formulations. Pesticide Use: If physical intervention fails to prevent pest infestations, facility managers should ensure that targeted (rather than broadcast) applications of pesticides are made, beginning with the products that pose the least exposure hazard first, and always using a pesticide applicator who has the licenses or certifications required by state and local laws. Child care staff should ask to see the license of the pest management professional and should be certain that the individual who applies the toxic chemicals has personally been trained and preferably, individually licensed (ie, not working in the capacity of a technician being supervised by a licensed pest management professional). Integrated Pest Management is a way to control pests in the least toxic way. A curriculum is available for early education and child care programs through the California Child Care Health Program – Notification should be given to parents/guardians and staff before using pesticides, to determine if any child or staff member is sensitive to the product. A member of the child care staff should directly observe the application to be sure that toxic chemicals are not applied on surfaces with which children or staff may come in contact. PLANTS Poisonous or potentially harmful plants are prohibited in any part of a child care facility that is accessible to children. All plants not known to be nontoxic should be identified and checked by name with the local poison center ( ) to determine safe use. All outdoor plants and their leaves, fruit, and stems should be considered potentially toxic. Cuttings, trimmings, and leaves from potentially harmful plants must be disposed of safely so children do not have access to them. For toxic, frequently ingested products and plants, see the American Academy of Pediatrics’ (AAP) Handbook of Common Poisonings in Children. ( SUN Younger children are more likely to get sunburn because their skin is not fully developed and can be damaged even as early as the first summer of life. ( Children cannot be outside without being in the sun, but they need to be protected from getting too much sun. People who had very bad sunburns when they were children are more likely to get skin cancer later in life. The first step to prevent the chances of getting skin cancer is to protect children early on in their life from getting too much sun and teach them how to be safe in the sun. The amount of time children are out in the sun should be limited, especially during the hours of 10am and 4pm when the sun is the strongest. Children should be protected from the sun with sunscreen and hats, as well as by shaded areas on the playground. WEATHER CONDITIONS Supervising adults should check the air quality index (AQI) each day and use the information to determine whether all or only certain children should be allowed to play outdoors. Children need protection from air pollution. Air pollution can contribute to acute asthma attacks in sensitive children. Warm temps are likely to increase the need for access to water to keep active children hydrated. Children need protection from adverse weather and its effects. Wind chill conditions at or below minus 15oF as well as heat index at or above 90oF, as defined by the National Weather Service, pose significant risks for children. Children have greater surface area to body mass ratio than adults. Therefore, children do not adapt to extremes of temperature as effectively as adults when exposed. Sources CFOC Standard Playing Outdoors. ( CFOC Standard Protection from Air Pollution While Children Are Outside. ( Environmental Protection Agency. Sunwise Kids. 2014: Chapter 6. ( healthychildren.org, American Academy of Pediatrics. Safety and Prevention: Sun Safety (

No substitute for supervision
Active supervision No substitute for supervision Half of injuries = lack of proper supervision More active = more supervision Making the playground area safe for children is important, but cannot replace the safety and security of having adult supervision. Almost half of playground-related injuries are due to improper supervision. Children are more active in the outdoor learning/play areas than they are inside and need to be watched more carefully outside. Discussion Discuss the need to have a supervision strategy so that all children are being observed by at least one designated adult at all times. Keep in mind that because monkey bars, swings, and slides are the most likely to cause injuries, more supervision in these areas is needed. Sources CFOC Standard 2.2 – Supervision and Discipline. ( Safe Kids Worldwide. Playground Safety Tips (

Six Active Supervision Strategies
Set Up the Environment Keep small spaces clutter-free Clear play space for big spaces Now we are going to review the six active supervision strategies that will keep children safe on the playground. These strategies are from the National Center on Early Childhood Health and Wellness at the Office of Head Start. 1. Set up the environment Staff set up the environment so that they can supervise children at all times. Choose equipment that is age and developmentally appropriate; set up all areas to they are visible to supervising adults (ie, no “blind spots”).

Six Active Supervision Strategies
2. Position Staff Always be able to see and hear children at all times Make sure there are clear paths to where children are playing 2. Position Staff Early care and education staff should: Make sure they can see the children at play and the children can see them at all times. Carefully plan where they will position themselves in the environment to prevent children from harm. Place themselves so that they can see and hear all of the children on the playground. Make sure there are always clear paths to where children are playing so they can react quickly when necessary. Stay close to children who may need additional support.

Active Supervision Strategies
3. Scan and Count Continually scan environment Regularly count children (name to face) Same caregiver/child ratio indoors and outdoors 3. Scan and Count Caregivers/teachers should regularly count children (name to face and whenever leaving one area and arriving at another), going indoors or outdoors, to confirm that each child is safe at all times. Also, they must be able to state (and account for) the number of children in their care at all times. The ratio of caregivers/teachers to the number of children should be the same indoors as it is outdoors. They continually scan the entire environment to know where everyone is and what they are doing. They count the children frequently. This is especially important during transitions, when children are moving from one location to another.

Listen For sounds or absence of sounds 4. Listen Specific sounds or the absence of sounds may signify reason for concern. Staff who are listening closely to children immediately identify signs of potential danger. Programs that think systemically implement additional strategies to safeguard children.

5. Anticipate Child’s Behavior Know each child’s interests and skills Know when child might wander or get upset 5. Anticipate Children’s Behavior Staff use what they know about each child’s individual interests and skills to predict what he/she will do. They create challenges that children are ready for and support them in succeeding. But they also recognize when children might wander, get upset, or take a dangerous risk. Information from the daily health check (eg, illness, allergies, lack of sleep or food, etc.) informs staff’s observations and helps them anticipate children’s behavior. Staff who know what to expect are better able to protect children from harm. Discussion Discuss the need to have a supervision strategy so that all children are being observed by at least one designated adult at all times. Sources Safe Kids Worldwide. Playground Safety Tips ( National Centers on Health: 6 Strategies to keep children safe – active supervision – National Center on Early Childhood Health and Wellness Tip sheet ( Poster ( Additional Materials (

Engage and Redirect Offer support to children Get involved if needed 6. Engage and Redirect Staff use active supervision skills to know when to offer children support. Staff wait until children are unable to solve problems on their own to get involved. They may offer different levels of assistance or redirection depending on each individual child’s needs. Discussion Discuss the need to have a supervision strategy so that all children are being observed by at least one designated adult at all times. Sources Safe Kids Worldwide. Playground Safety Tips ( National Centers on Health: 6 Strategies to keep children safe – active supervision – National Center on Early Childhood Health and Wellness Tip sheet ( Poster ( Additional Materials (

Playground Rules No shoving, pushing or crowding Swing: Sit
One at a time Keep clear (people and things) Slide: Feet first Down, not up Children should learn the rules on the playground to help prevent injuries. Early care and education providers need to have clear rules for the playground, teach and reteach these rules to the children they care for, and always enforce the rules. General rules include no pushing, shoving, or crowding. Rules for playing on the swing: Children should always sit. This prevents falls to the ground. Only 1 child should be on the swing at a time. Children should not be near children who are swinging on the swings because they can get hurt. It is important to show children how far back and forward swings move when in use. Children need to be reminded that that when swings are in use, they move. They do not stay in the same position. Therefore they need to keep their heads up and a safe distance as to not make contact with the swinger. Area around the swings should be kept clear of movable hazards like trikes, toys, rocks and groups of children. Rules for playing on a slide: Feet first. This could prevent a possible head injury. One at a time. More than one child on the slide can cause injury. Always go down the slide, never up. If someone is going down the slide while someone is coming up, injuries can happen. Source More for Kids. Playground Injuries: Statistics and Prevention (

Strangulation Hazards
Avoid: Scarves Clothes with drawstrings Bike helmet straps Another safety issue that caregivers need to be aware of is strangulation. Caregivers need to make sure children are not wearing clothing or other items that could be dangerous on the playground. For example: No scarves (unless they are worn for customary or religious reasons) or clothing with drawstrings that are longer than 3 inches outside the garment. Remove bike helmets. Parents and caregivers may think that bike helmets help protect a child’s head if he or she falls; however, straps can get caught in equipment. Helmets should not be worn when they are playing on the playground. CFOC Standard – Strangulation Hazards. (

Falls - #1 cause of injury Check equipment Teach children safe play
Summary Falls - #1 cause of injury Check equipment Teach children safe play Document injuries Use active supervision Install shock absorbing surfaces Use local resources/experts Help participants remember the main points of the session by reviewing the summary and answering any remaining questions. Falls are the most common cause of playground injuries. Fractures, bruises, and abrasions are the most common injuries. The safest surfaces for playgrounds are surfaces that help absorb the impact of a child falling. Adult supervision is key to keeping children safe from injury at the playground. Lack of supervision is associated with nearly half of all playground injuries. Make sure all adults who are supervising children on the playground know how to effectively supervise children and know which children they are to watch. Monthly safety checks of all equipment provide an opportunity to notice wear and tear that require maintenance. Safety checks help prevent an injury before it has a chance to happen. Children need rules to play safely. Teach children these rules and consistently enforce them. All injuries should be documented. Look for patterns, investigate causes, and implement preventive measures. Local resources are available to help you. Locate a local Certified Playground Safety Inspector in your area, your community’s parks and recreation department, the local Safe Kids Coalition, and other community groups.

Consumer Product Safety Commission: www.cpsc.gov or www.recalls.gov
Resources Early Childhood Learning and Knowledge Center (ECLKC): Administration for Children and Families. Health and Human Services Consumer Product Safety Commission: or ASTM International: Injury Free Coalition for Kids: Caring for Our Children, 3rd edition: Early Childhood Learning and Knowledge Center - safety and injury prevention resources for children in Head Start programs The Consumer Product Safety Commission offers a free subscription service for product recall notices. The ASTM International is an international standards organization that develops and publishes voluntary consensus technical standards for a wide range of materials, products, systems, and services. The Injury Free Coalition for Kids is one of the most effective injury prevention programs for children. Caring For Our Children provides the standards that early education and child care settings should be following and implementing in their centers.

National Recreation and Park Association (www.nrpa.org)
Resources National Recreation and Park Association ( Certified Playground Safety Inspector Safe Kids Worldwide: Coalitions across the United States National Program for Playground Safety: Online safety courses available A Certified Playground Safety Inspector can be used for guidance in assisting with outdoor play areas. To locate a local inspector, check the National Recreation and Park Association registry. Safe Kids Worldwide has coalitions across the United States that advocate for the prevention of injuries to children. Visit the Web site to find a local group. The National Program for Playground Safety has several interactive online courses covering a variety of topics on developing and maintaining safe and appropriate outdoor play environments for children.

Medication Safety and Poison Prevention
Keeping Children Safe From Injuries in Early Care and Education Settings Medication Safety and Poison Prevention The next topic I’ll review today is medication safety and poison prevention.

Learning Objectives Explain why children are at risk for medication poisonings Identify ways to prevent poisonings in early care and education settings Learn what to do when a poisoning has occurred or is suspected in early education and child care settings The learning objectives for this module are to be able to: Explain why children are at risk for medication poisonings Identify ways to prevent poisonings in early care and education settings Learn what to do when a poisoning has occurred or is suspected in early care and education settings

Medication Administration Training
Today’s presentation is focused on medication safety Check state regulations around medication administration requirements for early care and education providers Medication Administration trainings are available Please note: This presentation is focused on medication safety and avoiding poisonings and is not a training for medication administration. You should check your state’s regulations around medication administration and take an accredited Safe Medication Administration training program. At the end of this presentation, I will show you where you can find a program that was developed by the AAP. The reauthorization of the Child Care and Development Block Grant requires states to certify that they have established health and safety requirements applicable to early care and education providers in 10 substantive areas, including medication administration.

How Busy Is Poison Control?
Of the 1.34 MILLION calls made to Poison Control Centers for children, what percentage were medicine related? 10% 29% 33% 49% Directions for Activity Quizzes For all of the activity quizzes, present the question and ask participants what they think the correct answer is. As you read each response, have participants raise their hands if they think that response is the correct answer. After participants have responded, discuss the important points of the topic.

How Busy Are Poison Control Centers?
10% 29% 33% 49% According to Safe Kids Worldwide, medications are the leading cause of poisoning among children. The majority of medication poisoning happens with young children (younger than age 6), and more often in 1- and 2-year-olds. In 2013, Poison Control Centers answered more than 1.34 million calls for children younger than age 19 from parents, family members, and health care providers. Many of these calls were for children getting into medicine, getting too much medicine, or being given the wrong kind of medicine. In fact, in 2013, nearly half of the calls to Poison Control Centers about children were related to medicine. Sources Safe Kids Worldwide. Medicine Safety for Children: An In-Depth Look at Calls to Poison Centers ( National Capital Poison Center. Poison Control. ( Safe Kids Worldwide. (

Poisonings in the Emergency Department
On average, how many young children are treated in the emergency department every day? 10 50 100 >150 Activity Quiz

Medication Safety 10 50 100 >150
Every day in the United States, approximately 165 young children—or about 4 school busloads of children—are seen in emergency rooms after getting into medications. Every year, more than 64,000 children go to an emergency room for medication poisoning. That’s 1 child every 8 minutes. Source Safe Kids Worldwide. Keeping Kids Safe Around Medicine. (

Greater than 50% of calls for poisonings were for what age group?
The Facts: Who Greater than 50% of calls for poisonings were for what age group? 0–12 months 1–2 years 3–4 years 4–5 years Activity Quiz

High Risk: What Age? 0–12 months 1–2 years 3–4 years 4–5 years
More than half of the emergency calls were for medication poisoning for children between the ages of 1 and 2. Source Safe Kids Worldwide. Medicine Safety for Children. (

Whose Medicine? Of the medication poisonings, what percentage of the medicine belonged to someone the child knew? 10% 20% 50% >75% Activity Quiz

Whose Medicine? 10% 20% 50% >75%
Children can get into early care and education providers’ medications, too! In 3 out of 4 emergency room visits for medicine poisoning, the child got into medicine belonging to a parent or grandparent. Keep in mind that children can get into an early care and education providers’ medications, too, so store them out of children’s reach! Later we’ll discuss strategies that early care and education providers can use for safe storage and disposal of all medications at their center. Source Safe Kids Medication Safety Report. Medicine Safety 2014 Infographic. (

Children and Medication Risk
Developmental Curious explorers Everything goes in mouth Physical Medication weight based One pill can kill Developmentally Children are curious, and they do not understand what things are dangerous. One- and two-year-olds are explorers, and it’s part of the natural development of children this age to walk alone, stand on tiptoe, climb up on furniture without an adult, and turn over containers to pour out the contents. These behaviors that can put a child at risk if medicine is left within sight on a low counter or within reach. Physically Medication in children is weight based. A safe or harmless dose for adults may be toxic or deadly to children who weigh less. ONE PILL CAN KILL!

Look-a-Like Medications
Children don’t know difference between pills and candy Provider should be familiar with look-a-like medications and packaging Young children can easily confuse medicine for candy, especially when medicine is left out on a counter or in a purse or briefcase that is left within their reach. As you can see here, these common over-the-counter medicines look like candy; and if they are left within a child’s reach can be dangerous if they are ingested. It is also important to keep products in their original containers and out of the reach of children (ideally locked up).

What Children Are Getting Into
Younger than age 1: Diaper care/rash products Ages 1‒4: Ibuprofen, vitamins, and diaper care/rash products The top medicine that children younger than age 1 got into was diaper care and diaper rash products; they were involved in 19% of the cases for children this age. Diaper rash products are meant to soothe baby’s irritated skin, but if inhaled they can cause lung damage and nausea and if swallowed they can cause vomiting and diarrhea. For children ages 1 to 4, the top medicines involved were ibuprofen (8%), multiple vitamins for children and adults (8%), and diaper care and rash products (6%). Many of these are over-the-counter products and are available without a doctor’s prescription. It’s easy to think that because over-the-counter medicines and vitamins don’t need a prescription from a doctor they are not dangerous. But that isn’t necessarily true. Medicines are designed to cause specific changes in the body, so any medicine can be dangerous if taken by the wrong person, in the wrong amount, or in the wrong way. For example, multiple vitamins can be poisonous if taken in overdose; the most serious risks come from iron or calcium tablets. Source Safe Kids Worldwide. Medicine Safety for Children: An In-Depth Look at Calls to Poison Centers, p 8, Table (

Ingestion (eating or drinking) Absorption (skin or eyes)
Methods of Poisoning Ingestion (eating or drinking) ~ 85% of poisonings Absorption (skin or eyes) Inhalation (breathing) Animal and insect bites Injection (skin puncture) Ingestion Happens by eating or drinking. Children are attracted to bright colorful packages, pills, and odd shapes. They often mistake pills and vitamins for candy. Absorption Happens when poisonous substances such as pesticides or plants come in contact with a person’s skin or eyes. The poison is absorbed through the skin or mucous membrane into the blood stream. Inhalation Happens when children breathe fumes from carbon monoxide, pesticides, certain types of art materials, or dust that may contain lead. The air is exchanged in the lungs and comes in direct contact with the blood stream. Animal and Insect Bites Can cause an allergic reaction, but they can also be very toxic and can lead to death. These include ticks, which cause Lyme disease or Rocky Mountain spotted fever, and reptiles such as rattlesnakes. (For information on infectious diseases caused by pets and pests, please see Prevention of Infectious Disease: A Curriculum for the Training of Child Care Providers.) Injection Happens when there is a puncture wound. The danger may come from the substance that was injected or from the threat of tetanus. Today, there is an extra threat of children finding needles that have been used to inject drugs. An incident like this can cause the child to be exposed to HIV, hepatitis B, or other infections.

Most Serious Household Poisons
Drain openers and toilet bowl cleaners (chemical burns) Nail glue removers (cyanide poisoning) Windshield washer solution (blindness and death) Carbon monoxide (death) Some of the most serious household poisons other than medicine include drain openers and toilet bowl cleaners that can cause chemical burns as serious as burns from fire, nail glue removers that can cause cyanide poisoning if swallowed, and windshield washer solutions that can cause blindness and death if swallowed. Carbon monoxide poisoning can happen from faulty furnaces or other heating appliances, portable generators, water heaters, clothes dryers, or cars left running in garages. At its worst, carbon monoxide can cause severe side effects or even death. Young children are especially at risk to the effects of carbon monoxide because of their smaller bodies. Children process carbon monoxide differently than adults, may be more severely affected by it, and may show signs of poisoning sooner. Symptoms of carbon monoxide poisoning include headache, nausea, and drowsiness. Sources National Capital Poison Center. Common and Dangerous Poisons: The Most Common Poisons in Children. ( Safe Kids Worldwide. Carbon Monoxide. (

Latest Trends Laundry packets Liquid nicotine Button batteries
Laundry Packets (especially in home care settings) Keep liquid laundry packets out of children’s reach and sight. Keep packets in their original container and keep the container closed. Liquid Nicotine In 2015 through July 31, the American Association of Poison Control Centers received 1,983 e-cigarette device and liquid nicotine reported exposures. Some children and toddlers who come into contact with e-cigarette devices or liquid nicotine have become very ill; some even requiring emergency room visits with nausea and vomiting being the most significant symptoms. Adults should use care to protect their skin when handling the products. The products should be kept out of sight and out of the reach of children. Button Batteries Keep coin lithium battery-controlled devices out of sight and reach of children. Remote controls, singing greeting cards, digital scales, watches, hearing aids, thermometers, children’s toys, calculators, key fobs, t-light candles, flashing holiday jewelry, and decorations contain button batteries. Keep loose batteries locked away or place a piece of duct tape over the controller to prevent small children from accessing the battery. Share this lifesaving information with caregivers, friends, family members, and sitters. It only takes a minute, and it could save a life. If you suspect a child has ingested a battery, go to the hospital immediately. Don’t induce vomiting or have the child eat or drink anything until assessed by a medical professional. Source Safe Kids Worldwide. Laundry Packets. (

Medications to Avoid Aspirin: NOT FOR CHILDREN
Cough and cold medications Side effects Don’t work in young children Honey (younger than age 1) Teething medications Homeopathic or herbal Risk: Combination medication Aspirin is not a medication routinely given to children due to a risk of developing a medical illness called Reye’s syndrome. Early care and education providers should not be using aspirin alone or in combination with other products in their centers. Cough and cold medications are widely used for children to treat upper respiratory infections and allergy symptoms. Recently, concern has been raised that there is no proven benefit and some of these products may be dangerous if not used as directed. Leading organizations such as the Consumer Healthcare Products Association and the AAP have recommended restrictions on these products for children younger than age 6. Honey Children younger than age 1 are at risk for getting a condition called botulism. Teething Medications Not recommended (benzocaine teething gels) Side effects Safer alternatives (teething rings) Homeopathic and Herbal Medications Avoid all homeopathic/herbal medications unless specifically part of a medical plan from a physician Not recommended in early care and education settings Dangerous if used incorrectly Often not regulated and untested in children with little research on side effects/drug interactions Combination Medications Many over-the-counter children’s medications contain a combination of ingredients. It is important to make sure the child isn’t receiving the same medications in 2 different products, which may result in an overdose. For example, you should NOT give an acetaminophen product PLUS a combination medication that also has acetaminophen in it. Facilities should not stock over-the-counter medications. Sources Consumer Healthcare Products Association – Cough and cold medications ( American Academy of Pediatrics – Over-the-counter cough and cold medicines ( CFOC Standard – Medications. (

Prevent/delay access: Layer of protection Re-secure after use
Child Safety Caps Prevent/delay access: Layer of protection Re-secure after use Caps are NOT childproof They are child resistant Child safety caps are designed to prevent, or at least delay, young children from opening bottles so that an adult may stop them before the bottles are opened. However, early care and education providers must correctly re-secure the caps after each and every use for them to be effective. Child-Resistant Caps Choose child-resistant caps for medicine bottles, if you can. If pill boxes or non-child-resistant caps are the only option, store these containers up high and out of sight and reach when caring for kids. Remember that child-resistant does not mean childproof, and some children will still be able to get into the bottles given enough time and persistence. Close child-resistant caps on medication bottles every time.

Used with child safety caps Layer of protection
Flow Restrictors Used with child safety caps Layer of protection Added to necks of liquid medication Limits liquid escape Flow restrictor adapters are added to the necks of liquid medicine bottles to limit the amount of liquid that can come out of the bottle, even if they are turned upside down, shaken, or squeezed. They are meant to work with current child-resistant packaging, such as child safety caps, to help keep young children from getting into medicines when adults aren’t looking. Source Centers for Disease Control and Prevention. Flow Restrictors May Help Prevent Medication Poisonings in Young Children (

Medication: Where Children Find It
The best way to prevent children from finding medications is to make sure that ALL medications are not accessible to them. As you can see by this graphic, 20% of medications that children find are from someone’s purse or bag. Remember what good climbers children can be! Parents and teachers should always put their purses, diaper bags, backpacks, and other bags out of reach of the children. Create a special place for parents to place their items when they are at the facility, even if it’s only for a short period of time. And as an early care and education provider, you need to keep your own medications up and away and secure in your purse or bag. Source Safe Kids Worldwide. Medication Safety Infographic (

Storage: Up and Away In original container In designated area
Out of reach or locked/secure (except emergency medications) Home: Empty medicine cabinets NO cubby or diaper bag Risk: Staff and guest medications Purses and diaper bags Visit for more information Always keep medications in their original container. Store medications in a safe location out of sight and reach of young children, even if another dose needs to be given in a few hours. Place medications in a designated area and out of reach or locked and secure (except emergency medications). Never leave medicine or vitamins out on a kitchen counter, even if you have to give the medicine again in a few hours. Exceptions to locked storage: Nonprescription diaper creams Nonprescription sunscreen Emergency medications (eg, epinephrine auto-injector) Emergency medications should stay close to the area and can be stored in a pouch that stays on a supervising adult if on a field trip or outing. If in a home setting, make sure all medicine cabinets in bathrooms are clear of medications. Consider products you might not think about as medicines. Most parents store medicine up and away―or at least the products they consider to be medicine. They may not consider products such as diaper rash remedies, vitamins, or eye drops to be medicine, but they actually are and need to be stored safely. Risk: Staff and Guest Medications Store staff medications safely and be sure they are not accessible to children. Ask guests/visitors to keep purses, bags, or coats that have medicine in them up and away and out of sight and reach when they are in your home or center. Think about setting up a designated safe location where parents can temporarily store their bags or purses. Do not leave medication in a child’s diaper bag or cubby. View the Storing Medication AAP TV video available at Sources Healthy Futures. Floor Plan Activity: Where to Store Medication ( Safe Kids Worldwide. Keep Kids Safe Around Medicine. (

Disposal Preferred: Return to parent Document
Do not dispose in sink or toilet Local pharmacy Community medication disposal Trash disposal (if necessary) Reasonable efforts should be made to return unused medication to the parent. Parents should sign to verify they received the returned, unused medication. How and when medications were disposed of should be noted on the medication log or the permission form. Do not dispose of medication in the sink or toilet because of water contamination. Some communities have hazardous waste disposal plans and designated medication disposal days. Some pharmacies may assist in disposal of unused medications. Disposal of medications in the trash To minimize the risk of accidental ingestion and promote safe disposal of medication if none of the other options mentioned work, the FDA states that you can also follow these simple steps to dispose of most medicines in the household trash ( Mix medicines (do not crush tablets or capsules) with an unpalatable substance such as dirt, kitty litter, or used coffee grounds; Place the mixture in a container such as a sealed plastic bag (after scratching out personal identifiable information); Throw the container in your household trash.

Permission and documentation (log) Giving medications
Policy and Procedure Permission and documentation (log) Giving medications Medication error or incident Disposal Medication policy given to ALL parents As an early care and education provider, you need to know: What procedures and forms are used for permission and documentation What procedures are followed when giving medications and which logging documents need to be completed What the procedures are in the event of a medication error or incident Unused medications should be returned to the parent/guardian for disposal A copy of the facility’s medication administration policy should be given to all parents. Programs can work with a Child Care Health Consultant and Head Start programs can work their Health Services Advisory Committee to develop policies and procedures and complete incident reviews as necessary.

Medication Administration Training
The Medication Administration in Early Education and Child Care Settings is available from the Healthy Futures Website as a free online course! One of the best ways to prevent poisoning is through an approved and accredited Safe Medication Administration Training for Early Education and Child Care. Medication Safety and Poisoning Prevention does not substitute for a thorough Medication Administration training. There is a curriculum available that was developed by the AAP, which is a free and didactic online course. It is available in English and Spanish.

Adult Supervision = #1 Prevention
ALL medication poisonings are PREVENTABLE Poisonings can occur in all settings Home Family child care settings Early care and education centers Remember that all medication poisonings are preventable They can occur in all settings

Most poisonings occur when children are unsupervised
Supervision Most poisonings occur when children are unsupervised Never turn back to child taking medication Supervision is key to the prevention of medication poisoning Children should be watched at all times when medication is being given to children Never turn your back to a child taking medication Make sure that all medications are out of reach of children

An adult always gives medicine Medicine is not candy Child-free zone
Teaching Kids An adult always gives medicine Medicine is not candy Child-free zone Cabinets: Medicine, cleaning cabinet, kitchen, and bathroom Garage Don’t share medicine Don’t know what it is? Don’t smell, taste, or touch Teach the children you care for that medicine is always given by an adult. It’s important for children to know that they should not take medicine on their own. Parents and caregivers can help make sure they are taking it correctly. Don’t refer to medicine as candy. Although saying medicine is candy may make it easier to get a child to take medicine, this may encourage them to try it on their own. It's important for staff to model safe behavior. Children learn by watching adults around them: Avoid taking your medications in front of children. Model responsible medication behavior. What kids see you doing is a much stronger message than what you tell them to do. Make sure to store medicine out of reach of children. Read drug facts and prescription labels before taking medicine and follow the recommended dose. Communicate to kids the importance of only taking medicine that is meant for them. Taking medicine that belongs to someone else or misusing medicines (even over-the-counter medicines) can cause harm. You can get poisoned by eating, drinking, touching, or smelling something that can make you sick or hurt you. Stay away from areas at home that could contain poisonous items: Medicine cabinet Cleaning cabinet Kitchen and bathroom cabinets Garage It is the adult’s responsibility to prevent children from accessing toxic products by always storing these products in a locked area. Both providers and families can purchase inexpensive cabinet locks to secure medications and cleaning products.

Role Play For preschool-age children Role play What to do when you find a pill or medicine on the floor

American Academy of Pediatrics
ALL early care and education settings should have emergency protocols in place in the event of medication poisoning. Caregivers/teachers should have emergency protocols in place in the event of an injury, poisoning, or allergic reaction.

Call: Any potential poisoning Follow and document advice
Poison Control Center Call: Any potential poisoning Follow and document advice Be prepared to give information Age and gender - Substance Estimated amount - Child’s condition Time since ingestion or exposure The Poison Control Center should be called for advice about any exposure to toxic substances or any potential poisoning emergency. Specialists will link the caregiver/teacher with their local center. The advice should be followed and documented in the facility’s files. The caregiver/teacher should be prepared for the call by having the following information for the Poison Control Center specialist: The child’s age and gender The substance involved The estimated amount taken by the child The child’s condition The time elapsed since ingestion or exposure Source CFOC Standard Use of a poison center (

Call Poison Control Center FIRST Do not try home remedies
What If? Swallowed Call Poison Control Center FIRST Do not try home remedies NEVER try to make someone throw up Eyes Rinse eyes with running water + call If a poisonous substance is swallowed by a child, call Poison Control first. Have the package of the substance close by so you can provide Poison Control with specific information. Do not give the child anything to eat or drink or try to make the child throw up. If a poisonous substance gets in a child’s eyes, rinse them with running water and then call Poison Control.

Provide fresh air right away + call
What If? Skin Remove any clothing that poison touched + rinse skin with running water + call Inhaled Provide fresh air right away + call If any poisonous substances such as household products, pesticides, or plants come in contact with a child’s skin, remove any clothing from the affected area, rinse the child’s skin with running water, and call poison control. Since the poison is absorbed through the skin or mucous membrane into the blood stream, it’s important to rinse the areas as soon as possible.

Don’t Forget the Invisible Poison
Carbon monoxide – invisible, tasteless, odorless gas Faulty furnace or heater Headache, nausea, and drowsiness Check detectors monthly, batteries yearly Alarm - go outside and call 911 The Hard Facts Carbon monoxide (CO) is a gas that you cannot see, taste, or smell. In 2009, Poison Control Centers reported more than 3,551 cases of carbon monoxide exposure in children ages 19 and younger. Carbon monoxide poisoning can result from faulty furnaces or other heating appliances, portable generators, water heaters, clothes dryers, or cars left running in garages. At its worst, carbon monoxide can cause severe side effects or even death. Young children are especially vulnerable to the effects of carbon monoxide because of their smaller bodies. Children process carbon monoxide differently than adults, may be more severely affected by it, and may show signs of poisoning sooner. Symptoms of carbon monoxide poisoning include headache, nausea, and drowsiness. Source Safe Kids Worldwide. Carbon Monoxide. (

Summary Curious children = Risk for poisoning
Never call medicine “candy” Keep medicines in original containers Keep medicines locked up Always read label Teach children to ask an adult before tasting anything : Save this number! Remember to: Know the Poison Control Center phone number: Keep medicines and household products in their original containers and in a different place than food. Always read the label and follow directions. Keep household products and medicines out of reach and/or locked up. Put them where children can’t see them or reach them. Buy products with child-resistant packaging. But remember, nothing is childproof! Never call medicine “candy.” Teach children to ask an adult before tasting anything. Poisons may look like food or drink. Have a working carbon monoxide alarm.

Resources Safe Kids Worldwide: http://www.safekids.org
Up and Away and Out of Sight: National Capital Poison Center: Quills Up, Stay Away! Online AAP Course—Medication Administration in Early Education and Child Care: The Up and Away and Out of Sight program has several free materials and resource links to help you learn more about keeping children safe by storing medicines safely. See more at Quills Up, Stay Away! is a poison awareness program featuring Spike, the porcupine puppet. The program, designed for preschool children, makes it easy and fun to teach this important topic. Quills Up includes a video and classroom activities as well as educational materials for parents/caregivers because getting parents and other adults involved is critical to poison prevention. If you have questions about poison prevention or need local poison prevention materials, such as the phone stickers, contact your Poison Control Center’s education coordinator by calling The AAP offers the online course Medication Administration in Early Education and Child Care. Visit or

Keeping Children Safe in Early Care and Education Settings
Helmet Safety The last topic I’m going to review today is on helmet safety.

Learning Objectives Understand the risks associated with use of wheeled toys by young children State when helmets should be used Explain how to check proper helmet fit State at least 2 concepts to teach children about wheeled toy safety The learning objectives for this module are to: Understand the risks associated with use of wheeled toys by young children State when helmets should be used Explain how to check proper helmet fit State at least 2 concepts to teach children about wheeled toy safety

Tricycle-Related Injuries
Among tricycle-related injuries, the ____ is the most commonly injured body part. hand knee ankle head Activity Quiz For all of the activity quizzes, present the question and ask participants what they think the correct answer is. As you read each response, have participants raise their hands if they think that response is the correct answer. After participants have responded, discuss the important points of the topic.

Tricycle-Related Injuries
Among tricycle-related injuries, the head is the most commonly injured body part. hand knee ankle head Activity Quiz The head is the most commonly injured region of the body and the most common region to endure internal damage.

Wheeled Toys Helmets: most effective safety device to prevent injury
Wheeled toys (eg, bicycles/tricycles, skates): leading cause of head injuries for children 600 children injured per day Only ½ of children wear helmets Helmets are the single most effective safety device available to reduce head injury and death from bicycle crashes and accidents related to other wheeled equipment. Wheeled activities that are not motorized include bicycles and tricycles, rollerblades, skates, and skateboards. The American Academy of Pediatrics (AAP) does not recommend skateboard use in the early learning population. For more information, visit Each month, 3 out of 4 children in the United States ride a bicycle. Approximately 55% of children don’t always wear a helmet while bicycling. Apart from cars, bicycles are tied to more childhood injuries than any other consumer product. Helmet use is the single most effective way to reduce bicycle-related fatalities. Helmets reduce the risk of head injury by at least 45%, brain injury by 33%, facial injury by 27%, and fatal injury by 29%. One study suggests that helmet use can reduce the risk of head injury by 85% and severe brain injury by 88%. More injuries are associated with non-motorized scooters among children younger than age 15 than any other toy. Source Safe Kids Worldwide at

2015 Study: Tricycle Injuries
2012: Most common cause of toy-related deaths ~5,000 tricycle-related injuries per year The head is the most frequently injured body part Most likely part to endure internal organ damage According to the Consumer Product Safety Commission, tricycles have remained the second most common cause of reported toy-related deaths among children younger than age 15 in the United States from calendar years 2005 to In 2012, tricycle accidents were the most common cause of reported toy-related deaths in children. From 2012 to 2013, a 2-year period, there were more than 9,000 tricycle-related injuries. This equates to approximately 5,000 injuries each year. An estimated 9,340 tricycle-related injuries were treated in US emergency departments from 2012 to Two-year-olds had the highest frequency of injuries (2,847). Boys accounted for 63.6% of all injuries. Children between ages 1 and 2 represented 51.9% of all injuries (4,847). Researchers estimated the total included 2,767 injuries to the head, 767 at the elbow, 1,880 accidents damaging the face, 954 hurting the mouth, and 483 harming the lower arms. On average, the injured children were approximately 3-years-old, and patients between ages 1 and 2 represented slightly more than half of the cases. Boys accounted for almost two-thirds of the accidents. An indication that safety is important even on short rides or trips that don’t extend beyond the yard or driveway is that approximately 72% of the injuries happened at home. Source Bandzar S, Vats A, Gupta S, Atallah H, Pitts SR. Tricycle injuries presenting to US emergency departments, 2012–2013. Pediatrics. October 2015;36(4). (

2015 Study: Tricycle Injuries
Most common Type: Lacerations 3 to 5-year-olds: internal organ damage Body part: Head Fracture: Elbow Lacerations were the most common type of injury. Internal organ damage was the most common type of injury in 3- to 5-year-olds. Contusions were the most common type of injury in 1- to 7-year-olds. The head was the most commonly injured region of the body and the most common region to endure internal damage. The elbows were the most commonly fractured body part. The upper extremity was more frequently fractured than the lower extremity. Source Livescience study – available at

American Academy of Pediatrics
Tricycles Age 3: Balance and coordination to ride Low to ground + big wheels = safest Supervision: Away from pools and streets Older than age 1 + riding wheeled toys = helmet In the early care and education setting, all riders should wear properly fitting helmets when riding toys (such as tricycles) and wheeled equipment (such as scooters). Approved helmets should meet the standards of the US Consumer Product Safety Commission (CPSC). The standards sticker should be located on the bike helmet. Helmets should be removed once children are no longer using wheeled riding toys or wheeled equipment. The American Academy of Pediatrics says most children don’t have the balance or coordination to ride a tricycle until approximately age 3. Tricycles that are low to the ground, with big wheels, are safest, and helmets should be worn, the AAP says. Proper supervision is advised, including keeping little cyclists away from pools and streets. This is where most deaths occur involving tricycles. Sources CFOC Standard Riding Toys with Wheels and Wheeled Equipment. ( CFOC Standard – Helmets. (

Helmet Most effective way to reduce injury
Recommended: Older than age 1 Remove after use Strangulation risk Playground equipment Climbing trees Worn incorrectly Helmets are the single most effective safety device available to reduce head injury and death from bicycle crashes and accidents related to other wheeled equipment. Helmets should be REMOVED once children are no longer using wheeled riding toys or wheeled equipment. Helmets can be a potential strangulation hazard if they are worn for other activities such as playing on playground equipment or climbing trees. Helmets can be a potential strangulation hazard if they are worn incorrectly. Babies younger than 1 year have relatively weak neck structures. Infants are just learning to sit unsupported and have not developed sufficient bone mass and muscle tone to enable them to sit with their backs straight. Having infants sitting in a slumped or curled position for prolonged periods can be dangerous. Having infants younger than 1 wear a bike helmet can strain their neck muscles and can be harmful. All children ages 1 and older should wear properly fitted and approved helmets while riding toys with wheels or using any wheeled equipment.

Wearing a Helmet A child should wear a helmet when riding any wheeled toys Bicycles Tricycles Scooters Training skates *Skateboards are NOT recommended for young children Helmets should be worn even for short trips. The AAP does NOT recommend skateboard use by young children.

Eyes No more than 2 fingers above eyebrows
Fit Test: Eyes Eyes No more than 2 fingers above eyebrows Adjust the Straps Eyes: The child should be able to see the front edge of the helmet. Sources Safe Kids Worldwide. Does Your Bicycle Helmet Fit Properly? ( Safe Kids Worldwide. Bike Helmet Fit Test. (

Ears Straps should form a V under ears
Fit Test: Ears Ears Straps should form a V under ears Adjust the Straps Ears: The sliders should be moved up to just under the ear lobes. Sources Safe Kids Worldwide. Does Your Bicycle Helmet Fit Properly? ( Safe Kids Worldwide. Bike Helmet Fit Test. (

Mouth No more than 1‒2 fingers between chin and strap (buckled)
Fit Test: Mouth Mouth No more than 1‒2 fingers between chin and strap (buckled) Adjust the Straps Mouth: The chin strap should fit snugly enough that opening the mouth widely will move the helmet. Sources Safe Kids Worldwide. Does Your Bicycle Helmet Fit Properly? ( Safe Kids Worldwide. Bike Helmet Fit Test. (

When to Replace Crashed Cracked Broken straps
Recommended by manufacturer Bike helmets should be replaced if they have been involved in a crash, the helmet is cracked, the straps are broken, the helmet can no longer be worn properly, or according to recommendations by the manufacturer.

Cleaning Brain injury vs head lice Best practice: Use own helmet
If shared: Clean between users (mild detergent) Can use surgical hats Concern regarding the spreading of head lice in sharing helmets should not override the practice of using helmets. The prevention of a potential brain injury heavily outweighs a possible case of head lice. While it is best practice for each child to have his or her own helmet, this may not be possible. If helmets need to be shared, it is recommended that the helmets be cleaned between users. Wiping the lining with a damp cloth (with mild detergent) should remove any head lice, nits, or fungal spores. Another option is to use surgical hats under the helmet.

Wheel Safety Role model Wear helmets Start habit early Stay alert
Role Model and Teach Good Behavior (Safe Kids Bike Safety Tips) Children learn by watching the adults around them! It's important for early care and education workers and parents to model safe behavior. Wear a Helmet Early care and education workers should also wear helmets when using bicycles or other wheeled equipment. A child who rides with companions wearing helmets or adults in general is more likely to wear a helmet. Start the habit of putting on a helmet when children are young so that you do not have to work to correct the behavior later in life! Stay Alert No matter where you ride, teach children to stay alert and watch for cars and trucks and for what might be ahead.

Rules of the Road: Simulating Safety
Set up pretend “roads” (chalk) and stop signs/signals: Teach kids to stay to the right Use sidewalks Cross at intersections Stop at lights and stop signs Stop: Look left, right, and left again Teach children street safety when using a bicycle. This can be done at the center or home in the driveway or parking lot using pretend roads (chalk) and play stop signs or signals. Remind children to: Make eye contact with drivers. Bikers should make sure drivers are paying attention and are going to stop before they cross the street. Ride on the right side of the road, with traffic, not against it. Stay as far to the right as possible. Use sidewalks whenever possible. Always cross at intersections. Look back and yield to traffic coming from behind before turning left. Use appropriate hand signals when turning and obey traffic signals, stopping at all stop signs and stoplights. Stop and look left, right, and left again before entering a street or crossing an intersection. Source Safety Town Model. (

Develop Policies and Know Local Resources
Use best practices Work with local experts Pediatrician Safe Kids Coalition Bike shops or clubs Schools Find discounted or free helmets Use best practices to develop policies for your center. You can use the best practices presented in this module to develop policies. You can work with a pediatrician, Head Start health manager, or a child care health consultant if you need help or have questions. Work with local experts. Take advantage of discounted or free helmets for your center. Visit Helmets.org, which has information on free helmets (

Prevent future injuries: Review past reports Look for patterns
Document All Injuries Prevent future injuries: Review past reports Look for patterns Figure out the causes All playground injuries should be documented (as with any injury) using the Child Injury Report Form for Indoor and Outdoor Injuries. This form can be found in Appendix DD of Caring for Our Children or you can use the injury report form required by your state licensing entity or your program. For Head Start Programs: You can also use the CFOC Incident Report Form, Appendix CC, which sometimes works better for early care and education programs, as it has language that aligns with injuries in early care and education programs. Injury reports are important because they can be used to look for patterns of injuries and figure out the causes, so that the same injuries don‘t happen over and over again. Sources CFOC Appendix CC – Incident Report Form. ( CFOC Appendix DD – Child Injury Report Form for Indoor and Outdoor Injuries. (

Summary Wheeled toys: Leading cause of head injury
Helmet use with any wheeled equipment Helmet fit: Eyes, ears, mouth Role model and teach children about helmet safety Source CFOC Standard – Riding toys with wheels and wheeled equipment. (

Resources American Academy of Pediatrics: Safe Kids Worldwide—A global organization dedicated to preventing injuries in children: Centers for Disease Control and Prevention: Children’s Safety Network (CSN)—A national resource center for the prevention of childhood injuries and violence: Consumer Product Safety Commission:

Resources Safe Kids Worldwide – Healthy Children – Centers for Disease Control and Prevention The primary resources used to develop the content for all of the safety and injury prevention modules are: Safe Kids Worldwide Healthy Children, AAP’s public Web site Centers for Disease Control and Prevention

Acknowledgments This curriculum has been developed by the American Academy of Pediatrics (AAP). The authors and contributors are expert authorities in the field of pediatrics. The recommendations in this curriculum do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Listing of resources does not imply an endorsement by the AAP. The AAP is not responsible for the content of resources mentioned in this curriculum. Website addresses are as current as possible but may change at any time. Support for the Heathy Futures curricula has been provided through funding from Johnson & Johnson Consumer Inc.

Acknowledgments Project Advisor Andrew N. Hashikawa, MD, MS, FAAP – AAP Early Childhood Champion (Michigan) University of Michigan Injury Center (Assistant Professor) Curriculum Content Consultant Amy Teddy – Child Safety & Injury Prevention Expert (University of Michigan) Steering Committee Danette Glassy, MD, FAAP AAP Council on Early Childhood Member Nancy Topping-Tailby, MSW, LICSW National Center on Early Childhood Health & Wellness Susan Pollack, MD, FAAP AAP Committee, Section, Council Reviewers Council on Early Childhood Council on Injury, Violence, and Poison Prevention Disaster Preparedness Advisory Council

Copyright Information
Copyright©2016 American Academy of Pediatrics. All rights reserved. Specific permission is granted to duplicate this curriculum for distribution to child care providers for educational, noncommercial purposes.

Keeping Children Safe in Early Care and Education Settings

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