After children reach one year of age, accidental injuries are the largest cause of death in the United States (National Center for Health Statistics (NCHS) Vital Statistics System, 2001; National Safety Council, 2001). Therefore, reducing injuries when working with this age group is a major concern. A longitudinal study of more than 1,200 children followed from birth through first grade found that children who spend more time in child care have a slightly reduced risk of injury compared with children spending more time in their own homes (Schwebel, Brezausek, & Belsky, 2006). Additionally, the majority of injuries (87%) that do occur in child care are minor. Only 1% are considered severe. However, because so many children in the United States are in child care, there are still a large number of children accidentally injured in these settings each year. For example, in one year, 31,000 children, 4 years old and younger were treated in U.S. hospital emergency rooms as a result of injuries sustained in child care. At least 56 children died in child care during the 1990s (U.S. Consumer Product Safety Commission, 1999). The majority of deaths were due to suffocation from nursery equipment or soft bedding. Most injuries (74%) in early childhood settings are due to playground accidents.

It is important to be continually alert for safety dangers in the environment. A large-scale national study conducted by the U.S. Consumer Product Safety Commission (CPSC) found that two-thirds of the childcare settings they examined had at least one safety hazard. The CPSC warns that there is a potential for children being injured, even seriously hurt, in these environments. The study looked at cribs, safety gates, window blind cords, drawstrings in children’s clothing, recalled children’s products, and ground coverings (U.S. Consumer Product Safety Commission, 1999). Listed below are some of the most important environmental concerns in keeping children safe:

  • All materials should meet the standards of the Consumer Product Safety Commission (CPSC).
  • To protect against falls, stairways, windows, and elevated surfaces should meet the American Society for Testing and Materials (ASTM).
  • Children should be protected from electrical outlets with specially designed outlets or safety caps.
  • Electrical cords should not be within reach of children.
  • Emergency phone numbers need to be posted near each telephone (poison control, fire department, emergency contact numbers for parents and others, and the child’s doctor).
  • Make sure there are adequate fall surfaces under both indoor and outdoor equipment and that toys are not left in fall zones. Continually examine the environment for tripping hazards.
  • To prevent poisoning, make sure all cleaning supplies and medications are in locked cupboards, there are no poisonous plants on the premises, and that children do not have access to purses or offices where adults might store personal medication.
  • Toys need to be safe by being age and developmentally appropriate for the group. For example, all toys for infants and toddlers or children who are still mouthing toys need to be choke resistant. They also need to be lead free and nontoxic. Finally, one must examine toys to make sure that they cannot lead to strangulation.
  • Buckets and tubs containing water need to be closely supervised and emptied when not in use since small amounts of water can be a drowning hazard for young children.
  • All equipment, including railings on stairs, need to be examined for possible strangulation risk. Window blind cords and drawstrings on children’s clothing can also create safety issues.
  • A daily safety check and maintenance is critical to keep equipment and the child’s environment safe.
  • Children need to be safe from other children who are aggressive. See Chapter for more information on this subject.

Even if the environment meets safety guidelines, supervision is critical in ensuring child safety. The majority of injuries (60%) that occur in early childhood settings are due to child behavior rather than environmental causes (Alkon et al., 1999); for example, a child tripping and falling, colliding with objects, or one child pushing another as they go down a set of stairs. Most states have established child/staff ratios to assist in providing adequate supervision. It is critical that programs maintain these ratios. In addition, it is important that adults actively monitor children. Many programs require staff to maintain visual contact with children as they play. Low classroom dividers can help children to feel a sense of privacy, while still allowing adults to adequately supervise children.

Although severe injuries are rare in early childhood settings, it is important to be alert to and to immediately correct safety dangers. It is also important to assure children remain safe through adequate supervision.