Every year thousands of children are injured in child care settings. Sometimes the injury is slight and with a bit of first aid and a kiss the child is up and running again. Too often, however, the child requires treatment at a hospital. And at other times, the injury is fatal.
Childhood Injuries by the Numbers
Statistics collected by the National Center for Injury Prevention and Control indicate that more than 4.2 million nonfatal injuries were recorded for children ages one to four (2001-2002). Of those, almost 42 percent or more than 1.7 million resulted from unintentional falls. In the same period, over 3,000 children in the same age group were fatally injured. Most deaths were caused by motor vehicle accidents, followed by drowning. For more information about the five leading causes of injury and death, see sidebar below.
The Packard Foundation (2000) has estimated that in 1996, unintentional childhood injuries cost society $66 billion in productivity losses, $14 billion in lifetime medical spending, and $1 billion in other resource costs. Most of these costs were associated with injuries preventable by education, environment, product changes, and legislation.
As someone who cares for children and their well-being, you are in a position to safety check your setting and play a major role in reducing child injury and death.
Safety Check #1 – Licensing Requirements
If your child care setting is licensed, the first step you can take to ensure that your environment is safe is to comply with all licensing requirements – the goal of licensing is the prevention of harm. Between annual inspections, review the checklist your licensor uses to assess your program to see for yourself if you are complying with all of the rules. If your setting is not licensed, you can ask your licensing agency for copies of the rules and checklists and use them for periodic safety checks. Your local resource and referral agency can likely help you contact a licensor in your area.
Safety Check # 2 – CPSC Hazards
The Consumer Product Safety Commission (CPSC) was established by the federal government to protect the interests of consumers. CPSC tests products and recalls those found to be unsafe, and responds to consumer complaints. CPSC also carries out research, including research focused on child care. For example, a CPSC study of licensed child care settings (1998) showed that two thirds exhibited at least one targeted safety hazard. Overall study results appear in the sidebar on page 22 along with space for you to assess whether the same hazards are present in your setting.
Safety Check # 3 – Playgrounds
CPSC’s Public Playground Safety Handbook is an invaluable source of research findings and other information for child care providers about playground safety. It also includes a public playground safety checklist and is available on the web at http://www.cpsc.gov. The safety of outdoor play spaces is of key importance given the large number of injuries resulting from falls and the fact that researchers have identified “the school (including child care) as the primary location of playground injuries” and noted that playground falls are a “leading mechanism of injury in daycare centers” (Phelan, K. et al., 2001).
Additional playground resources are available from the National Program for Playground Safety (NPPS). In 2000 and 2004 NPPS released national and state report cards on playgrounds, including playgrounds in child care settings. You can find the results from your state, as well as a safety checklist for your own setting, on the web at http://www.uni.edu/playground. This website also has information about a new publication, Child Care Assessment for Outdoor Play Environments, available from NPPS.
Safety Check # 4 – National Standards
Two important resources for learning more about preventing harm to children in child care settings are Caring for Our Children and Stepping Stones. Caring for Our Children: National Health and Safety Performance Standards for Out-of-Home Child Care Programs provides comprehensive national standards for safety in child care settings, written and reviewed by panels of experts in specific fields. Each standard is fully explained in an accompanying rationale and comments. Its companion publication, Stepping Stones to Using Caring for Our Children, includes a shorter version of a sub-set of key standards and was designed for use in child care settings.
Revised editions of Caring for Our Children (2002) and Stepping Stones (2003) are on the web, along with a checklist that you can use to compare your program with Stepping Stones. For more information, visit http://nrc.uchsc.edu.
Safety Check # 5 – 13 Key Indicators
In deciding what to include in Stepping Stones, the editors consulted a number of specialists, including Richard Fiene (2002) whose research methods were used to help determine “the most critical
standards for protecting children from harm.” After further risk factor analysis of the standards chosen for Stepping Stones, Fiene arrived at 13 indicators selected on the basis of being able to “predict” overall compliance with requirements and positive outcomes for children. Those 13 indicators, in random order, are child abuse reporting and clearances, proper immunizations, staff:child ratio and group size, director and teacher qualifications (two indicators), staff training, supervision/discipline, fire drills, administration of medication, emergency contact/plan, outdoor playground safety, inaccessibility of toxic substances, and handwashing/diapering.
Details about Fiene’s analyses are available on the web by following the links at http://nrc.uchsc.edu/regulators.htm. Bear in mind that even when your setting meets standards in certain areas, there are almost always higher benchmarks waiting to be met.
Safety Check # 6 – Safety Organizations
You can also look to safety organizations for resources and guidance on injury prevention. For example, SAFE KIDS USA is part of a worldwide organization that provides information and sponsors valuable research and education on child safety, including the National Standardized Child Passenger Safety Training Program. State SAFE KIDS coalitions have many local chapters that offer varied activities and resources. To find out more about what is available in your state, visit http://www.safekids.org.
Your state may also have an organization that focuses on reducing the incidence of sudden infant death syndrome (SIDS) and can help you safety check your child sleeping environment. For example, Tomorrow’s Child: Michigan Sudden Infant Death Syndrome (SIDS) provides resources for prevention and grieving, as well as a sample investigation form to help determine the exact cause of death. If a child dies in your setting, such a form can help you learn more about what happened. If, after completing the form, you find the death was not from SIDS but had a known cause, such as suffocation from soft bedding, you can take steps to prevent a similar tragedy in future. You will find a copy of the form developed by Tomorrow’s Child at http://www.tomorrowschildmi.org.
Safety Check # 7 – Your Own Experience
Your own close observations of your child care settings, based on your personal experience and records of injuries that have occurred in the past, are of key importance in making your setting safe for children. Whether your program is located in a center, in a building like a church that you are adapting for child care, or in your home, you know better than anyone where injuries – and near injuries – most often occur. Use your knowledge of your setting to make your own checklist. Keep a record of incidents as they occur, then review your records on a regular basis. Before long, you will begin to see patterns that will help you take action.
For example, if you notice that the children always seem to hurt themselves at one particular spot, such as where the ground slopes toward the corner of the building, you can reduce the hazard by eliminating the slope or putting up a barricade so that the children can no longer play there. Either way, by taking action, you will likely prevent more than one injury and eliminate much suffering and grief.
In the end, safety checks are about prevention. If you can prevent injury and death, you can lower statistics. You can make sure that resources are not spent on the effects of childhood injury but, more positively, on ensuring that the children in your care grow up to experience a happy and productive future.
Judith Colbert, Ph.D., is a consultant who specializes in early care and education. Much of her work focuses on child care regulation. Her most recent projects include a major study on minimizing risks to children in licensed child care settings.
Consumer Product Safety Commission
(CPSC). (1999). CPSC study of safety
hazards in child care settings. Available:
Fiene, R. (2002). 13 Indicators to quality
care: Research update. Denver, CO:
National Resource Center for Health
and Safety in Child Care. Available:
Packard Foundation. (2000, Spring-
Summer). Unintentional Injuries in
Childhood. The Future of Children.
Phelan, K. et al. (2001, July-August).
Trends and patterns of playground
injuries in United States children and
adolescents. Ambulatory Pediatrics, I,