Injury Prevention Outside the Home for One- to Two-Year-Olds
What can parents do to avoid playground injuries?
MARY ANN P. LIMBOS, MD, MPH: If parents are going to set up playground equipment in their backyard, they need to consider several things. Number one is the surface that is going to be under their child if they should fall off. The most absorbent surface for a child to fall on is wood chips. They need to be layered at a certain depth, usually about six inches or greater. Surfaces like dirt and grass are not as absorbent as wood chips.
The other thing is maintenance of the playground equipment itself. Parents should look to make sure there are no sharp edges that children can get scratched on and no protruding screws on other parts of the equipment that they can get pieces of their clothing caught on. They should also be careful about the height of the equipment. Children at this age should not be playing on equipment over three or four feet high.
Some playgrounds today are made out of plastic more often than metal surfaces. Are these better?
MARY ANN P. LIMBOS, MD, MPH: Yes, although we have school playgrounds that are still lagging behind because there are no resources to remodel them. I think parents should see for themselves where their kids are playing, whether it be at a park or a preschool. They should look at the surfaces and the equipment and make sure that the locations are safe for their children.
How can we keep our children safe in the car?
MARY ANN P. LIMBOS, MD, MPH: Car accidents are the leading killer of children as far as injuries. It is important to have a child in a proper restraint at this age. Between the time they are born to the time they are a year old, they should be in an infant car seat, and that infant car seat should be in the back seat of the car facing backwards.
When they become one- and two-year-olds, they need to be in toddler seats for children 20-40 pounds. Parents can also buy what is called a convertible car seat, and these car seats can be used for infants between 0-1 year of age, facing backwards. Then when the child is one year old, this car seat can be flipped to face forward, still in the back seat, and can be used until they are about 40 pounds.
What tips can you can give a parent about using car seats?
MARY ANN P. LIMBOS, MD, MPH: It should never be placed in the passenger seat in the front. One reason is the back seat is always the safest. Another reason is a lot of the newer cars have air bags in the front passenger seat, and these air bags can be very dangerous if they go off and there is a small child or car seat in the front seat. So, placement is very important.
When kids get fussy, what is a parent to do in terms of safety for both of them in the car?
MARY ANN P. LIMBOS, MD, MPH: If you need to attend to your child, you should pull over and do it, and not feel like you have to do it while you are driving. Some parents tell me they would like to put the car seat in the front seat so they can keep an eye on their child. What I tell them is, you put your child to bed at night and you are not watching them for four to six hours, and this is just a very short car ride, so they really don't need that constant supervision.
How can parents avoid injuries around water?
MARY ANN P. LIMBOS, MD, MPH: For children between one and two years of age, the biggest danger is drowning in backyard pools and spas. Parents will say, 'My child has had swimming lessons,' or 'I am only going to be gone a minute, isn't it okay to leave them unattended for just a short amount of time?' The answer is 'No.' The most important thing to prevent drowning in children this age is constant, direct supervision.
What about flotation devices?
MARY ANN P. LIMBOS, MD, MPH: That is a problem. We generally don't use flotation devices in children who are two and under. These devices are usually reserved for older kids.
What are some other important safety considerations for the 1- to 2-year-olds near water?
MARY ANN P. LIMBOS, MD, MPH: If a family with small children has a backyard pool or spa, it is important that they have a fence around the water area. Fences, in addition to adult supervision, have really been the only things that have been proven to reduce the risk of drowning. It should be a four-sided fence, and the house should not be used as one of the sides of the fence. The slats in between the fence should be no more than four inches apart, so that little bodies can't wriggle through, and the gate to the fence should be self-latching as well as self-locking.
