On a quiet Monday evening last month, a two-year-old boy died in a bedroom in his own home in north Spokane County. He wasn't playing with a gun or poking a fork into an electrical outlet, and he wasn't without supervision. His teenage sister was watching him, but she wasn't feeling well and it was getting late. She fell asleep while watching TV, and when she woke up a couple of hours later, the boy was dead. The Sheriff's report says the boy accidentally hung himself while he was playing with a strap, similar to a purse strap, that was dangling from a hook in a bedroom.
Chances are this boy will not be the only Spokane toddler to unintentionally lose his or her life this year. Actually, unintentional injuries are the leading cause of death for children 14 and younger, and the National Safe Kids Campaign estimates that 5,686 children died in 2000 because of accidents -- 37 percent of which happened in or around the home.
"That is true, most injuries happen right at home," says Ana Matthews, Safe Kids' local coordinator. "Many parents have this image of child abduction and stranger violence being the biggest danger to their children, and there is a risk for that we should take very seriously, but most injuries happen at home."
Safe Kids surveys show that children living in poverty are disproportionately affected by unintentional injuries -- often because they live in more hazardous environments such as substandard housing, in close proximity to busy streets and with inadequate childcare or supervision.
But all new parents, especially with their first child, face the challenge of adjusting to the child's increasing mobility. Until babies begin to crawl, they're fairly stationary and there's a limit to how much trouble they can get into on their own.
"Parents must make sure their home is safe. Check the whole house from top to bottom," says Matthews. "Get a good parenting handbook from the library, or get a list out of a parenting magazine and follow that as you go through room by room."
And you can never be too careful.
"The number one danger areas are falls, motor vehicles, poisoning, burns, choking and drowning," says Matthews. "The thing is, most injuries are preventable. That's why we refrain from calling these incidents 'accidents'. Calling it accidents leaves the impression that it was somehow beyond your control, but most serious injuries to children are preventable -- it's important to always keep that in mind."
Look Ma, No Hands... -- The No. 1 reason children visit the emergency room is falls. Not only are toddlers just learning to keep their balance on two feet, but they also have a tendency to climb and crawl onto anything within their reach.
Check furniture in the toddler's room and around the house. A simple brace mounted to the top of a bookcase or dresser will keep the furniture from tipping over and hurting a climbing toddler. Stairs pose a huge threat as well. Use baby gates to keep the smallest members of the household off stairs altogether. Moving the same gate around might be a cheap solution, but many gates become rickety from being moved too much. And always follow the manufacturer's instructions when you install them.
Outside, it's especially riding toys that get toddlers in trouble. The little ones most often hurt their heads and faces, eyes, mouths and ears when they fall off a toy.
"Helmets for toddlers are a must -- we can't say that often enough," says Matthews. "Get them to wear helmets on their tri-cycles from a very early age, and they'll get used to them from the start."
Same goes for ski helmets, but even the best helmet isn't worth anything if it isn't worn correctly. "I just get goose-bumps when I see kids riding with helmets where the chinstrap isn't tied," says Matthews, adding that "infants should not wear helmets. Their little heads are not steady enough. They can't withstand it."
Another source of many falls is baby walkers. These wheeled contraptions were especially popular in the '80s and early '90s, and though Matthews says many studies have shown they don't benefit the child's development, many parents still use them.
"They are very dangerous. They can go down stairs and they can tip over on top of the baby. That's a huge concern," says Matthews. "I believe 80 percent of the infants who get hurt in walkers were being supervised at the time of the injury. They can move so fast across the floor in just a second, that many injuries happen with an adult right there in the room."
On the Road -- Riding in a car is always somewhat dangerous, but if you are younger than two years old it's especially risky. There are dozens of car seats available on the market, but even the best seat doesn't help much if it's not installed correctly or if the child riding in it isn't strapped in.
"When the child is between one and 20 pounds, it must be riding in a rear-facing car seat. After 20 pounds, until 40 pounds, it can be a forward-facing car seat with a harness, and then a booster seat," says Matthews. "With the youngest children [under two years old], motor vehicle death is number one, most often because the child isn't correctly restrained in the vehicle."
The Spokane Regional Health District holds regular car seat clinics, where technicians help install the seats and show parents how to use the many different harnesses correctly.
Car seats can be expensive, but community organizations and police and fire departments often organize car seat giveaway events, just as parents often share car seats with friends and family as their own children outgrows them.
If you are using a secondhand car seat or one of an older model, it's important to check and see that it hasn't been recalled and otherwise fulfills today's standards.
"Drivers should of course always stay at a proper speed and not be tired," advises Matthews. "That would prevent a lot of car accidents in the first place."
Burning Curiosity -- Children under the age of five are nearly three times as likely as the rest of us to die in a house fire. Not only do children get scared to the point of paralysis in the event of a fire, but they also often try to hide in closets and under beds to get away from the flames. But instead of escaping, they can end up trapped.
"One of the biggest things is that small children won't know what to do. Parents and babysitters must know what the fire escape plan is," says Jan Doherty, public education officer for the Spokane Fire District. "Sometimes parents are fearful as to what can happen to an infant sleeping upstairs. They don't want to talk about what could happen if there's a fire because it's very scary to talk about. That fear becomes a block, but it's much better to find out what to do, to think ahead."
Every family should have a fire escape plan and practice getting out of the home as fast as possible. Every fire escape plan should include a meeting spot outside, away from the home, garages or any other outbuildings.
And remember that small children not only are less mobile, but also very often won't be able to follow instructions during a fire emergency.
"With infants, simply have a sturdy bag to carry the infant in, maybe on a rope so you can lower the child out the window if you have to," says Doherty. "Make sure there are two ways out of every room, and teach toddlers that they can't hide from a fire. Talk to them about it, even if it scares you."
Smoke detectors are a must, and batteries should be tested once a month -- if they are regular nine-volt batteries, they should be changed at least once a year -- for instance, when watches are set to daylight savings time.
"Some people don't realize that smoke detectors don't last forever. Most should be changed after about 10 years," says Doherty. "Some detectors have a lithium battery in them that lasts about as long as the detector, and they are only about $10."
To prevent smaller fire emergencies on a day-to-day basis, matches and lighters should be kept out of reach and out of sight.
"I'd prefer to see them under lock," says Doherty. "And teach your children to tell a grown-up if they see matches lying around. They should understand that matches and lighters are completely hands-off."
It's a misconception that small children can't start big fires.
"The saying actually goes the other way: the smaller the child the bigger the fire," says Doherty. "Often the fire has burned a lot before the child reacts or before anyone else finds out."
To prevent fires, Doherty says it's a good idea to have a kid-free zone around the stove in the kitchen, and always to turn handles of pots and pans toward the wall. Don't forget to set the water heater temperature at 120 degrees to prevent scalding of little hands and feet clamoring around in a bathtub. And never leave children unsupervised around fireplaces or barbecue grills.
If your child does get burned, remember the Rule of Palm. "Seek medical attention if the burn is very deep, or the size of the palm of the person who has been burned," says Doherty. "So a relatively small burn on young child is a serious burn because the child is so little."
The best immediate first aid is still to immerse the burned area in cool water, and hold it there for 10-15 minutes.
Bang! - You're Dead -- According to Safe Kids, 80 children ages 14 and younger died from unintentional shootings in the home in 2001 (the most recent year for which data is provided). Of these children, nearly 90 percent were between five and 14. This makes the unintentional firearm injury death rate among children of this age group nine times higher than in the 25 other industrialized countries -- combined. The same year, nearly 1,400 children in the same age group were treated in hospital emergency rooms for unintentional firearm injuries, and more than 8,000 children ages 14 and younger were treated for pellet and BB gun-related injuries.
These numbers make it very clear that children and guns don't mix very well, but this is also an area where a few simple preventive measures go a long way.
To encourage gun owners to keep their weapons out of the hands of children, some states have adopted access-prevention laws, which hold adults criminally liable if a child gets shot by their gun. But Washington isn't one of them.
"What we do have is a reckless endangerment law," says Cpl. Dave Reagan, spokesman for the Spokane County Sheriff's Department. "If you recklessly create conditions and someone gets hurt, then you can be held liable. And it's illegal for children under the age of 14 to possess a firearm."
As far as Reagan knows, there are no laws on the books for firearm storage either.
"When it comes to safety, I think, even a locked cabinet is not a guarantee," says Reagan. "Parents need to be aware that kids are naturally curious. Even if they are told not to touch the guns, they may still do it -- for instance, if friends who haven't been around guns encourage them to show them the gun."
Keeping firearms locked up in place and bullets or magazines locked up in another is a good safety precaution. Reagan says few children are hurt by unintentional gunshots in his jurisdiction.
"In Spokane County, we don't have very many incidents where children are hurt with guns," he explains. "Maybe it's because so many people around here hunt. Many children grow up with firearms in the house around here -- you know, long guns like rifles and shotguns -- because their family hunts. Youngsters who hunt have had some formal training and a safety course, or maybe family members have shown them gun safety."
If there are guns in your household, talk to your children about them. "Children are naturally very curious, and maybe parents can satisfy some of the curiosity by showing them what the gun is," says Reagan, adding that small children, of course, don't understand the impact a gunshot can have on.
Is there an age at which children are too weak to pull a trigger?
"I don't think so. Most triggers are less than four pounds of pull. That's easily accomplished, even by small children," says Reagan. "And there are many cheap firearms, you know the 'Saturday Night Specials,' that can be fired just by being dropped because they are poorly made. I have kept guns in my house for 20 years, and I was always much more concerned that my kids would get into them than that anyone would get in the front door of my house and get me."
Still, many keep weapons for personal protection near beds or in desk drawers where kids can easily get to them -- you may think you have hidden your gun, but Reagan says he can almost guarantee you that your kids know exactly where it's at.
"At least keep it in a locked nightstand," Reagan advises. "It doesn't take many moments to slide a key in there and get the gun out -- even if you have to get the bullets or the magazine out of the closet afterward. It can be done."
Publication date: 03/13/03