Accidents in Children
Causes, Prevention, and Nursing Management
A comprehensive guide for nursing students to understand, prevent, and manage common pediatric accidents.
Table of Contents
1. Introduction to Pediatric Accidents
Accidents remain the leading cause of death, disability, and hospitalization among children worldwide.
Accidents in children refer to unintentional injuries that occur due to various causes in the pediatric population (0-18 years). These injuries can range from minor to severe and sometimes fatal outcomes. Understanding the patterns, causes, and prevention strategies is crucial for healthcare professionals, especially nurses who play a vital role in both prevention and management.
Why Focus on Children?
- Children have unique anatomical and physiological characteristics that affect injury patterns
- Developmental stages influence risk exposure and injury potential
- Child supervision requirements vary by age and environment
- Most childhood accidents are preventable with proper interventions
- Early education can establish lifelong safety habits
Core Concepts
- Unintentional injury vs. abuse (differentiation required)
- Risk assessment based on age, development, and environment
- Anticipatory guidance as a preventive approach
- Primary, secondary, and tertiary prevention strategies
- Integrated approach involving healthcare, family, and community
The Impact of Pediatric Accidents
Physical Impact
- Temporary or permanent disability
- Developmental delays
- Chronic pain
- Long-term medical needs
Psychological Impact
- Post-traumatic stress
- Anxiety and fear
- Behavioral changes
- Impact on self-esteem
Socioeconomic Impact
- Healthcare costs
- Parental work absences
- Educational disruptions
- Long-term care requirements
2. Epidemiology & Statistics
Each year about 100 children are killed and 254,000 are injured as a result of bicycle-related accidents. Drowning is the leading cause of unintentional injury-related death among children ages 1 to 4.
Key Statistics
| Age Group | Leading Cause of Injury | Statistical Highlights |
|---|---|---|
| Infants (<1 year) | Falls, Suffocation, Drowning | Falls account for over 50% of non-fatal injuries; suffocation is the leading cause of accident-related deaths |
| Toddlers (1-3 years) | Drowning, Burns, Poisoning, Falls | Drowning is the #1 cause of death; poisonings peak at age 2 due to oral exploration |
| Preschoolers (3-5 years) | Falls, Burns, Drowning | Falls from playground equipment increase; burns often associated with kitchen accidents |
| School-Age (6-12 years) | Falls, Traffic/Bicycle, Sports Injuries | Traffic and sports injuries increase as independence grows |
| Adolescents (13-18 years) | Traffic Accidents, Sports Injuries, Drowning | Motor vehicle accidents become the leading cause of death; risk-taking behavior increases |
Global Perspective
- Globally, more than 1,600 children and adolescents die daily from preventable injuries
- Road traffic injuries account for approximately 23.7% of all child accident fatalities
- Drowning accounts for about 20% of child accidental deaths globally
- Falls (13%) and fire-related incidents follow as leading causes
- Low and middle-income countries have disproportionately higher rates
Risk Factors
- Age: Developmental stage directly impacts risk profile
- Sex: Boys typically have higher injury rates than girls
- Socioeconomic status: Lower income associated with higher risk
- Supervision: Inadequate supervision increases accident risk
- Environment: Home safety measures, neighborhood design impact risk
- Behavior: Impulsivity, risk-taking tendencies affect injury patterns
Common Types of Accidents by Frequency
Falls (44%)
Motor Vehicle/Traffic (23%)
Burns (15%)
Poisoning (10%)
Drowning (8%)
3. Developmental Considerations in Pediatric Accidents
Understanding developmental stages is critical for anticipating potential accident risks and implementing appropriate preventive measures.
| Developmental Stage | Key Milestones | Accident Risks | Prevention Focus |
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| Infants (0-12 months) |
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| Toddlers (1-3 years) |
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| Preschoolers (3-5 years) |
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| School-Age (6-12 years) |
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| Adolescents (13-18 years) |
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Physiological Considerations
- Head-to-body proportion: Children have larger heads relative to bodies, affecting fall injuries and center of gravity
- Skin thickness: Thinner skin in children leads to deeper, more severe burns
- Airway anatomy: Narrower airways increase choking risk and respiratory compromise
- Thermoregulation: Less effective temperature regulation increases hypothermia risk in drowning
- Bone development: Growing bones may fracture differently than adult bones
- Metabolic rate: Higher metabolic rate affects toxin absorption in poisoning cases
Cognitive Development Impact
- Sensorimotor stage (0-2 years): Learning through sensory experiences and motor actions increases mouthing objects
- Preoperational stage (2-7 years): Egocentric thinking limits understanding of others’ perspectives, affecting traffic safety
- Concrete operational (7-11 years): Beginning logical thinking but may struggle with abstract concepts like “danger”
- Formal operational (11+ years): Abstract thinking develops but risk assessment skills still immature
- Executive function: Gradual development affects impulse control, decision-making in risky situations
The Developmental-Risk Connection
Understanding the connection between development and risk is fundamental to effective prevention. Each new skill a child acquires (rolling, crawling, walking, climbing, etc.) brings new potential dangers. Prevention strategies must evolve alongside the child’s development.
4. Falls in Children
Falls are the leading cause of non-fatal injuries in children, accounting for approximately 44% of all injury-related emergency department visits.
Common Types of Falls by Age
Infants:
- Falls from furniture (beds, changing tables, sofas)
- Falls from baby equipment (infant seats, high chairs)
- Falls while being carried
- Falls from car seats placed on elevated surfaces
Toddlers/Preschoolers:
- Falls from windows and balconies
- Falls down stairs
- Falls from shopping carts
- Falls from playground equipment
- Falls from tricycles and other ride-on toys
School-Age Children:
- Falls from playground equipment (higher heights)
- Falls during sports activities
- Falls from bicycles
- Falls from trees
- Falls during recreational activities
Adolescents:
- Sports-related falls
- Falls from heights during risk-taking activities
- Falls during recreational activities (skateboarding)
- Falls during work activities
Common Injuries from Falls
Head Injuries
- Concussions
- Contusions
- Skull fractures
- Intracranial hemorrhage
Fractures
- Wrist/forearm fractures
- Clavicle fractures
- Femur/tibia fractures
- Growth plate injuries
Soft Tissue
- Sprains and strains
- Contusions
- Lacerations
- Abrasions
Internal
- Abdominal trauma
- Spleen/liver injuries
- Thoracic injuries
- Pneumothorax
Prevention Strategies for Falls
Home Environment Modifications
- Install window guards or stops (limiting opening to 4 inches)
- Use stair gates at the top and bottom of stairs
- Secure furniture to walls to prevent tipping
- Use non-slip mats in bathtubs and showers
- Install guardrails on elevated beds for young children
- Keep floors clear of tripping hazards
- Ensure adequate lighting in all areas
- Use door knob covers for balcony access
Supervision and Behavioral Strategies
- Always maintain physical contact when infants are on elevated surfaces
- Never leave young children unattended on beds, sofas, or changing tables
- Teach children safe behavior on stairs and playground equipment
- Enforce rules about appropriate places for climbing
- Supervise playground activities based on age and ability
- Assess playground equipment for safety before use
- Remove tripping hazards from pathways
- Establish clear rules about balcony and window safety
Fall Risk Assessment in Healthcare Settings
Pediatric-specific fall risk assessment tools like the Humpty Dumpty Falls Scale help identify children at high risk for falls in healthcare settings.
Nursing Management of Fall Injuries
Assessment
- Primary survey (ABCDE approach)
- Neurological assessment including GCS
- Evaluate for signs of head injury
- Assess for fractures/deformities
- Document mechanism of injury, height of fall
- Assess for internal injuries
- Pain assessment using age-appropriate scales
Interventions
- Stabilize spine if indicated
- Monitor vital signs and neurological status
- Immobilize suspected fractures
- Apply RICE protocol for sprains/strains
- Administer analgesics as prescribed
- Clean and dress wounds
- Neurological checks for head injuries
- Provide age-appropriate comfort measures
Education
- Injury-specific home care instructions
- Signs/symptoms requiring medical attention
- Fall prevention strategies based on age
- Environmental modification recommendations
- Proper use of assistive devices if needed
- Follow-up care instructions
- Activity restrictions as appropriate
FALLS Prevention Mnemonic
F – Furniture secured and floor hazards removed
A – Age-appropriate supervision at all times
L – Limit access to heights and dangerous areas
L – Lighting adequate in all areas
S – Safety equipment used consistently (gates, rails)
5. Drowning
Drowning is a leading cause of death in children ages 1-4 years and remains a significant risk throughout childhood and adolescence.
Key Concepts in Drowning
Definition
Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. Outcomes are classified as: death, morbidity, or no morbidity.
Types of Water Bodies Associated with Drowning
- Infants and Toddlers: Bathtubs, buckets, toilets, swimming pools
- Preschoolers: Swimming pools, hot tubs, natural bodies of water
- School-Age: Lakes, rivers, oceans, swimming pools
- Adolescents: Open water (lakes, rivers, oceans), often associated with risk-taking behaviors
Pathophysiology
- Initial panic and struggle
- Breath-holding (voluntary apnea)
- Aspiration of water
- Laryngospasm (may occur)
- Hypoxemia and acidosis
- Cardiac arrest (if rescue/resuscitation delayed)
Risk Factors
- Male gender (higher risk-taking behavior)
- Lack of barriers around water sources
- Inadequate supervision
- Inability to swim
- Failure to wear personal flotation devices
- Alcohol use (adolescents and caregivers)
- Seizure disorders
- Developmental disabilities
Important Statistics
- Drowning is the leading cause of injury-related death in children ages 1-4
- A child can drown in as little as 20-60 seconds
- Drowning can occur in as little as 1-2 inches of water
- For every child who dies from drowning, another 8 receive emergency care for non-fatal submersion
- 50% of children who survive drowning may suffer permanent neurological disability
Prevention Strategies for Drowning
Supervision
- Maintain constant visual supervision
- Designate a dedicated “water watcher”
- Avoid distractions (phones, reading)
- Practice “touch supervision” for young children
- Never leave children alone near water
Barriers
- Install 4-sided pool fencing (at least 4 feet high)
- Use self-closing, self-latching gates
- Pool alarms and pool covers
- Secure bathroom doors with locks
- Store buckets empty and upside down
Skills
- Formal swimming lessons starting at age 1+
- Water safety education for children
- CPR training for all caregivers
- Teaching children to never swim alone
- Learning safe rescue techniques
Equipment
- Properly fitted life jackets near water
- Coast Guard-approved flotation devices
- Rescue equipment accessible
- Cell phone for emergency calls
- Avoid reliance on inflatable toys/aids
Nursing Management of Drowning
| Phase | Assessment | Interventions |
|---|---|---|
| Initial/Emergency |
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| Acute Care |
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| Recovery/Discharge |
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The “ABC & D” of Drowning Prevention
A
Adult Supervision
Constant, vigilant supervision by a focused adult whenever children are in or near water
B
Barriers
Physical barriers between children and water (fences, gates, covers) to prevent unauthorized access
C
Classes
Swimming classes for children and CPR training for caregivers to develop critical water safety skills
D
Devices
Proper use of life jackets and rescue equipment when in or around water bodies
6. Burns
Burns are a leading cause of accidental injury in children, with scalds being the most common type among young children.
Types of Burns in Children
Thermal Burns
- Scalds: Most common in children under 5 (hot liquids, steam)
- Contact burns: Touching hot objects (irons, stoves, heaters)
- Flame burns: Direct contact with fire (more common in older children)
Chemical Burns
- Household cleaners and chemicals
- Battery fluid (especially button batteries)
- Pool chemicals
Electrical Burns
- Exposed electrical cords
- Electrical outlets
- Electrical appliances in water
Other Types
- Friction burns
- Sunburns
- Radiation burns (rare in children)
Burn Classification
Burn Depth
- Superficial (First-degree): Involves epidermis only; red, painful, no blisters
- Partial-thickness (Second-degree):
- Superficial: Involves epidermis and upper dermis; red, painful, blisters
- Deep: Extends into deeper dermis; mottled appearance, decreased sensation
- Full-thickness (Third-degree): Destroys all skin layers; leathery, painless, dry
- Fourth-degree: Extends beyond skin into fat, muscle, bone
Burn Extent – The Rule of Nines (Pediatric Modification)
The percentage of total body surface area (TBSA) affected varies by age:
| Body Part | Infant | Child | Adolescent |
|---|---|---|---|
| Head | 18% | 13% | 9% |
| Neck | 2% | 2% | 2% |
| Anterior Trunk | 18% | 18% | 18% |
| Posterior Trunk | 18% | 18% | 18% |
| Each Arm | 9% | 9% | 9% |
| Each Leg | 13% | 16% | 18% |
| Genitalia | 1% | 1% | 1% |
Note: “Palm method” can be used for smaller burns – child’s palm = approximately 1% of TBSA
Prevention Strategies for Burns
Kitchen Safety
- Keep children out of kitchen during cooking
- Use back burners and turn pot handles inward
- Set hot food/drinks away from edges of counters
- Never hold a child while cooking or handling hot items
- Test food temperature before serving to children
- Establish a “kid-free zone” around stove (3 feet)
- Use oven mitts consistently
Bathroom Safety
- Set water heater temperature to 120°F (49°C) or lower
- Always test bath water temperature before placing child in bath
- Never leave children unattended in bathtub
- Turn cold water on first, off last
- Install anti-scald devices on faucets
- Teach children about hot water dangers
- Secure hot styling tools (curling irons, straighteners)
General Home Safety
- Install smoke detectors on every level
- Create and practice fire escape plans
- Keep matches/lighters locked away
- Cover electrical outlets
- Check for frayed electrical cords
- Install barriers around fireplaces, heaters
- Store chemicals in original containers
- Apply sunscreen regularly
- Use protective clothing for sun exposure
Nursing Management of Burns
Assessment
- Initial Assessment:
- Primary survey (ABCDE approach)
- Assess for signs of airway involvement (facial burns, singed nasal hair, carbonaceous sputum)
- Check for associated injuries
- Burn Assessment:
- Determine mechanism of injury
- Assess burn depth (superficial, partial-thickness, full-thickness)
- Calculate TBSA affected using pediatric modifications of Rule of Nines
- Identify high-risk areas (face, hands, feet, genitalia, joints)
- Pain Assessment:
- Use age-appropriate pain scales
- Assess both background and procedural pain
- Fluid Status Assessment:
- Monitor vital signs for signs of hypovolemia
- Track intake and output
- Assess for capillary refill, peripheral pulses
Interventions
- Immediate Care:
- Remove clothing and jewelry from burned area
- Cool burn with cool running water for 20 minutes (for thermal burns seen within 3 hours)
- Do NOT apply ice, butter, toothpaste, or other home remedies
- Cover with clean, dry dressing
- Ongoing Management:
- Maintain airway patency
- Administer fluid resuscitation as ordered
- Provide pain management
- Implement wound care as prescribed
- Monitor for and prevent infection
- Maintain body temperature
- Psychosocial Support:
- Provide age-appropriate explanations
- Prepare child for procedures
- Support family coping
- Address potential psychological impact
- Rehabilitation Considerations:
- Position to prevent contractures
- Early mobilization as appropriate
- Splinting as needed
- Coordinate with physical/occupational therapy
The “6 C’s” of Burn Care Management
C1 & C2
Clothing & Cooling
Remove clothing from burned area; cool burn with clean, cool (not cold) running water for 20 minutes
C3 & C4
Cleaning & Chemoprophylaxis
Gently clean the burn with mild soap and water; apply appropriate antimicrobial dressings as prescribed
C5 & C6
Covering & Comforting
Cover with sterile, non-stick dressing; provide appropriate pain management and emotional support
7. Poisoning
Poisoning is a leading cause of unintentional injury in children, particularly in those under 6 years of age. Exploration and inability to recognize dangers puts young children at particular risk.
Common Poisoning Agents by Age
Infants and Toddlers (0-3 years):
- Household cleaning products
- Medications (particularly those without child-resistant packaging)
- Personal care products
- Batteries (especially button batteries)
- Plants (household and garden)
- Pesticides and insecticides
Preschool and Early School Age (4-9 years):
- Medications (often mistaken for candy)
- Art supplies (some paints, glues)
- Alcohol (in unattended drinks)
- Essential oils and cosmetics
- Vitamins (especially those with iron)
Older Children and Adolescents (10-18 years):
- Intentional ingestion of medications (over-the-counter and prescription)
- Alcohol
- Recreational drugs
- Chemical inhalants
- Plant toxins (experimentation)
Routes of Exposure
Ingestion
- Most common route in children
- Typically involves substances placed in mouth during exploration
- May involve multiple agents
- Amount ingested often unknown
Inhalation
- Gases and volatile compounds
- Carbon monoxide
- Aerosols and sprays
- Chemical fumes
- Vaping products
Dermal/Ocular
- Chemical splashes
- Pesticides
- Hydrocarbons
- Corrosive substances
Parenteral
- Insect stings
- Snake bites
- Animal bites with venom
- Injection (rare in young children)
Risk Factors
- Developmental: Oral exploration, curiosity, inability to recognize danger
- Environmental: Accessible toxic substances, improper storage
- Product-related: Attractive packaging, lack of child-resistant containers
- Supervision: Inadequate supervision, distracted caregivers
- Behavioral: Risk-taking behaviors (adolescents)
Prevention Strategies for Poisoning
Safe Storage
- Store all medications, chemicals, and cleaning products up high and out of reach
- Use child-resistant packaging and containers
- Install childproof locks on cabinets containing hazardous substances
- Keep products in their original containers with labels intact
- Store chemicals and food products separately
- Dispose of unused medications properly
- Store purses and bags containing medications out of reach
Supervision & Education
- Maintain active supervision of young children
- Teach children about poison dangers at an early age
- Never refer to medicine as “candy”
- Teach children to ask before putting anything in their mouths
- Educate teenagers about medication and substance dangers
- Instruct children about potential plant toxicity
- Teach proper use of household chemicals
Emergency Preparedness
- Post Poison Control Center number (1-800-222-1222 in the US) near all phones
- Program poison control number into cell phones
- Keep activated charcoal on hand if recommended by healthcare provider
- Know basics of first aid for poisoning
- Keep potential antidotes accessible as recommended
- Maintain list of child’s medications and allergies
- Know location of nearest emergency department
Nursing Management of Poisoning
Immediate Nursing Response
| Step | Actions |
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| 1. Assessment |
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| 2. Stabilization |
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| 3. Decontamination |
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| 4. Antidote Administration |
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| 5. Ongoing Monitoring |
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Follow-up Care
- Continue monitoring for delayed effects
- Provide symptom management
- Support hydration and nutrition
- Assess for psychological impact
- Document exposure details thoroughly
- Prepare for potential transfer to specialized facility
- Coordinate with poison control center for guidance
Discharge Planning & Education
- Provide comprehensive poisoning prevention education
- Address specific storage issues related to the incident
- Educate about proper medication administration
- Provide information on poison control resources
- Assess need for home safety evaluation
- Schedule appropriate follow-up
- Refer to community resources as needed
- Consider child protective services if indicated
POISON Prevention Mnemonic
P – Proper storage in original containers with safety caps
O – Out of reach and locked away from children
I – Identify poisonous plants and remove from home
S – Supervise children closely, especially toddlers
O – Obtain and post poison control number
N – Never call medicine “candy”
! – !mmediately clean up spills and properly dispose of unused medications
8. Traffic & Motor Vehicle Accidents
Motor vehicle crashes are the leading cause of death for children over 4 years of age and a major cause of disability. The proper use of child restraints is the most effective strategy to prevent injury or death.
Types of Traffic-Related Injuries
Motor Vehicle Occupant Injuries
- Unrestrained or improperly restrained children
- Premature transition to seat belts
- Front seat positioning before appropriate age
- Airbag-related injuries
- Ejection from vehicle
Pedestrian Injuries
- “Dart-out” incidents (child suddenly enters roadway)
- Mid-block crossings without supervision
- Driveway/parking lot backover incidents
- Walking along roadway edges
- Low visibility (dusk, dawn, dark clothing)
Bicycle Injuries
- Head injuries (absence of helmet use)
- Collisions with motor vehicles
- Falls from bicycles
- Improper bicycle size or maintenance
- Lack of visibility to drivers
Other Vehicle-Related Injuries
- All-terrain vehicle (ATV) accidents
- Recreational vehicle injuries
- Skateboard and scooter injuries
- Golf cart accidents
Common Injury Patterns
Head & Neck
- Traumatic brain injuries
- Skull fractures
- Cervical spine injuries
- Facial trauma
Thoracic
- Rib fractures
- Pulmonary contusions
- Pneumothorax
- Cardiac contusion
Abdominal
- Liver/spleen lacerations
- Bowel perforation
- Kidney injuries
- Seat belt injuries
Extremities
- Fractures
- Joint dislocations
- Growth plate injuries
- Soft tissue trauma
Age-Specific Considerations
- Infants: Fragile neck structures, proportionally larger head
- Toddlers/Preschoolers: Limited understanding of danger, impulsivity
- School-Age: Increasing independence, still developing traffic awareness
- Adolescents: Risk-taking behavior, peer influence, potential for driving
Prevention Strategies for Traffic Injuries
Child Passenger Safety
- Rear-facing seats: Birth to 2+ years or until reaching maximum height/weight limit
- Forward-facing seats with harness: 2+ years until outgrowing (typically 4-7 years)
- Booster seats: When outgrown forward-facing seat until seat belt fits properly (typically 8-12 years)
- Seat belts: When child passes the “5-step test” (typically 4’9″ tall, 8-12 years)
- All children under 13 years should ride in back seat
- Never place rear-facing seat in front of active airbag
- Ensure proper installation and harness fit
- Replace car seats involved in moderate/severe crashes
Pedestrian & Bicycle Safety
- Pedestrian:
- Teach and model safe street crossing
- Supervise young children near roads
- Use designated crosswalks
- Wear bright/reflective clothing
- Make eye contact with drivers
- Bicycle:
- Always wear properly fitted helmets
- Follow rules of the road
- Use bike lanes when available
- Wear bright clothing and use lights
- Ensure proper bicycle size and maintenance
Other Vehicle Safety
- ATV Safety:
- No children under 16 on adult ATVs
- Always wear helmet and protective gear
- No passengers unless designed for two
- Formal safety training before operation
- Teen Driving:
- Graduated driver licensing programs
- Limit passengers and night driving
- Zero tolerance for alcohol/drugs
- No cell phone use while driving
- Parent-teen driving agreements
Nursing Management of Traffic Injuries
Initial Assessment & Stabilization
- Follow trauma assessment protocols (ABCDE approach)
- Immobilize cervical spine until cleared
- Assess for multiple trauma (high-energy impacts)
- Initiate appropriate trauma team activation
- Establish IV access
- Fluid resuscitation as needed
- Assess for occult injuries (children may not verbalize pain)
- Use pediatric assessment tools and equipment
Ongoing Management
- Monitor vital signs and neurological status
- Pain assessment and management
- Frequent reassessment for evolving injuries
- Monitor for signs of internal bleeding
- Prevent hypothermia (children cool quickly)
- Minimize anxiety through age-appropriate communication
- Prepare for diagnostic imaging
- Documentation of mechanism of injury, restraint use
- Involve child life specialists when available
Discharge Planning & Education
- Age-appropriate injury prevention education
- Car seat/booster seat evaluation and education
- Connect with child passenger safety technicians
- Provide helmet fitting information for bicycle safety
- Discuss pedestrian safety guidelines
- Refer to community safety resources
- Schedule appropriate follow-up care
- Assess need for rehabilitation services
- Evaluate for post-traumatic stress symptoms
SAFE RIDE Mnemonic for Child Passenger Safety
S – Seat selection appropriate for age/size
A – Anchors and tethers properly secured
F – Fit harness snugly (no more than 1 finger between harness and child)
E – Every ride, every time
R – Rear-facing as long as possible
I – Installation checked by certified technician
D – Don’t transition too soon to next stage
E – Expiration date checked on all car seats
9. Choking & Suffocation
Suffocation is the leading cause of unintentional injury death in infants under 1 year of age. Children under 4 years are at the highest risk for choking on food and small objects.
Types of Breathing Emergencies
Choking (Foreign Body Airway Obstruction)
- Food items: Hot dogs, grapes, nuts, popcorn, candy, gum
- Non-food items: Coins, marbles, button batteries, small toys, balloon pieces
- Signs of choking:
- Inability to speak, cry or make sounds
- Difficulty breathing
- Weak, ineffective cough
- High-pitched sounds while inhaling
- Cyanosis (bluish color to skin)
- Panic and distress
Suffocation
- Mechanical asphyxia: External compression of chest/abdomen preventing breathing
- Overlay: When a person or larger object compresses child during sleep
- Entrapment: Body wedged in a position that restricts breathing
- Rebreathing: Breathing in carbon dioxide-rich air (plastic bags, enclosed spaces)
- Environmental: Entrapment in refrigerators, trunks, toy chests
Strangulation
- Ligature strangulation: Cord, rope, or string around neck
- Hanging: Suspension by neck (clothing caught on objects, window blind cords)
- Entanglement: Clothing, drawstrings, necklaces caught in equipment
- Positional: Neck positioned to restrict blood flow/airway (between crib slats)
Age-Specific Risks
Infants (0-12 months)
- Highest risk for suffocation in unsafe sleep environments
- Inability to move away from dangerous situations
- Limited head control and weak neck muscles
- Exploring objects with mouth
- Common scenarios:
- Soft bedding, pillows, plush toys in sleep area
- Wedging between mattress and wall/furniture
- Co-sleeping with adults or siblings
- Covering face with blankets
Toddlers (1-3 years)
- Highest risk for choking on food and small objects
- Mobility without safety awareness
- Oral exploration of objects
- Inability to chew food properly
- Common scenarios:
- Choking on small toys, food items
- Entanglement in cords (blinds, curtains, electrical)
- Entrapment in small spaces
- Access to small objects (coins, button batteries)
Older Children (4+ years)
- Risk shifts to more activity-related incidents
- Playing with/misusing ropes or cords
- Recreational activities (playground entanglements)
- Sports-related incidents
- Misuse of toys or equipment
Prevention Strategies
Choking Prevention
- Food Safety:
- Cut food into small pieces (< ½ inch) for young children
- Avoid high-risk foods for children under 4 (hot dogs, grapes, nuts, popcorn, hard candy)
- Have children sit while eating
- Supervise mealtimes
- Toy Safety:
- Follow age recommendations on toys
- Use small part testers (if it fits in a toilet paper tube, it’s too small)
- Regularly check for broken toys with small parts
- Keep small objects out of reach
- Be cautious with button batteries and magnets
Suffocation Prevention
- Safe Sleep:
- Place infants on backs to sleep (ABC – Alone, on Back, in Crib)
- Use firm mattress with fitted sheet only
- No pillows, blankets, bumpers, or toys in crib
- Room-sharing without bed-sharing
- Avoid overheating
- Environmental Safety:
- Keep plastic bags away from children
- Ensure toy chest lids stay open or have safe-closing mechanisms
- Secure heavy furniture to walls
- Remove access to abandoned appliances
- Monitor children in sand or dirt play
Strangulation Prevention
- Cord Safety:
- Use cordless window coverings or cord cleats
- Keep cords out of reach
- Remove drawstrings from children’s clothing
- Secure electrical cords
- Structural Safety:
- Ensure proper spacing between crib slats (< 2⅜ inches)
- Check for gaps that could trap head but allow body to pass
- Supervise playground use
- Remove necklaces, headphones, and helmets during play
- Avoid placing cribs near windows with cords