While adults have the sense of judgement to avoid dangerous situations, children are defenceless and can do nothing to prevent themselves from getting injured. The responsibility of protecting our children lies with us. Children feel secure because they trust us for their protection. Are we giving them a false sense of security because we fail to identify the possible dangers they may encounter in the environment?

Up to 10% of the children who come to the Children's Emergency for treatment at the Children's Hospital everyday are seen for childhood injuries. A smaller but significant number of children die each year from serious accidents like road traffic accidents, falls from heights and drownings. We have to strive to understand our children better to ensure that they grow up in a safe and secure environment.

The World From A Child's Perspective

Children are not small adults. A safe environment for an adult may not be safe for a child. Many hidden injury hazards may not be apparent from a child's viewpoint. Unless we can see things from a child's perspective, the common sense that comes with prevention of childhood injuries may not come easily.

While an infant is totally unable to look after himself and therefore avoids accidents, the toddler gradually has to look after himself as he grows older. Many parents and caregivers have no idea of the developmental capability of their children. For instance, they never expected that their 6-month-old infant would be capable of rolling over and falling when left unattended on a bed without the cot side up.

However, there is also a need to balance between over protection and allowing complete independence. This fine balance constantly changes as the child grows. Over protection will cause the child to remain dependent on his parents and grow up to be timid and insecure. They may also never learn caution and rebel against over-protection. This may make them even more accident-prone.

The infant needs your full protection. The crib, an apparently safe place for your baby, may be dangerous if you fail to identify the injury hazards. Soft toys and pillows look cute and attractive, but may pose a suffocation hazard to the newborn who has not learnt to lift up his head from the pillow. Musical mobile crib toys may cause strangulation when the infant's neck gets caught by the strings. The sarong cradle used in many local homes has been known to cause serious head injuries despite being the source of comfort for many babies.

The toddler usually still requires heavy supervision to prevent him from getting hurt. He begins to understand the meaning of "No", "Don't touch" and "Be careful, you will fall". However, frequent repetition of such advice may fall on deaf ears. Discipline may be necessary. Sometimes, allowing certain mildly uncomfortable experiences will allow the child to understand the consequences of touching a hot object, or suffering a bump from a minor fall.

At this age too, toddlers learn by imitating adults. If your toddler sees you taking your medicine pills, he may think you are taking sweets, and may resolve to try some himself. The lighter, which his father uses to light up his cigarette, looks like an interesting gadget to try out. He may also decide to try imitating the maid in climbing onto a chair to clean the windows.

Children at this age are inquisitive and like to explore and experiment. Attractive ornaments may invite the toddler to climb up to reach them. Even innocent electric points look exciting and may prompt the child to poke a pencil in to see what comes out of the holes. Leaving your toddler unattended in the bath to answer the phone will encourage him to go ahead to jump into the bath first to play with the toy ducky. Children have sustained scalds from the hot bath water, or even drowned in the shallow bath water in this way.

At this age, the toddler's sense of balance is still not fully developed, and stairs may pose a potential danger. To prevent accidental falls, a safety gate at the foot of the staircase may be essential. A gate at the top of the stairs is controversial. Children may be tempted to climb over and sustain a more serious injury than a simple fall down the stairs.

Being short has its disadvantages
The child's short stature at this age also prevents him from seeing the whole picture. Dangerous objects may actually appear rather innocuous from his perspective. From his height, the handle of a cooking pot of boiling hot soup may seem like a sturdy bar to hold on to. The toddler may decide to play hide and seek with the tablecloth, not being aware of the hot teapot on the tabletop.

On the other hand, the child's short stature also makes many things look inviting simply because they are placed at a low level. Many children are seen in hospital Accident & Emergency Departments throughout the island for accidental ingestions of common household chemicals like bleach, kerosene and insecticides. Such accidents occur because these are commonly kept at ground level near the kitchen sink, within easy reach of the toddlers. Some of these dangerous chemicals look even more inviting because they are kept in Ribena or orange juice bottles!

Medications like oral contraceptive, iron supplements and aspirin carelessly left on the dressing or bedside table will be within easy reach of the toddler and invite him to try out some of these "sweets". Small objects like buttons, coins and toys with small parts, when left on a low table or shelf, would obviously invite a young child to try and see if he can fit something into his ear or nose, or taste to see if they are sweets. Numerous choking episodes have been known to occur in similar scenarios.

Pre-schoolers would usually have gained a better level of understanding and judgement. However, they still continue to live in a magical world of make believe. Play is their reality and they are serious about it. They also maintain the same level of childhood curiosity of wanting to explore and discover. They are also slowly gaining confidence in learning to be independent.

Make believe world
Children in this age group are still very vulnerable to childhood injuries. Their fascination with Christmas tree decoration lights have led to accidental electrocutions. Those left alone in the house have been know to set the entire flat on fire, or found dead at the bottom of a block of flats because they thought they could fly like Superman. Many caregivers frequently under-estimate the imagination of their children, as well as the convincing effects the mass media may have on their children. It is important to ensure that all your windows are secured with grills, and that there are no chairs or tables placed near the windows which will enable your child to climb up to the windows.

The games children play at this age are still largely based on "make-believe". A child in an exciting game of "Hide and Seek" may think, " What better and more secure a place to hide than the refrigerator?" Children have been known to suffocate when they are trapped in large electrical appliances like refrigerators and washing machines.

At the playground
Playground injuries are also common in this age group. They commonly sustain upper arm fractures or head injuries from falls off the monkey bar, or the slides and obstacles. The young child can also run into the way of a swing and suffer serious head injuries. This is because children at this age are still not good in assessing dangerous situations. The excitement and fun of games in the playground overrides any caution they may have for their own safety.

Playground activities should therefore be closely supervised at this age because children will not be able to identify the potential dangers in a playground when they are engrossed in their play. It is essential for the caregiver to ensure that the playground equipment are well maintained, and that there are no potholes in the ground before allowing their young children to play in it.

Drowning
Deaths from drowning occur commonly in this age group as well. Again, the reason is because pre-schoolers are not able to assess potentially dangerous situations accurately. Common incidents include caregivers leaving their children to play unsupervised near the condominium swimming pools or at the beach. Children have been known to fall into the pools accidentally because the poolsides are constructed flush with the ground. An inflated lilo floating out to the sea, or airwings becoming deflated, are potential dangers we must look out for when we supervise young children at the pool or the beach.

Children must never be allowed unsupervised at the pool or at the beach. They should also be taught that the swimming pool can be dangerous and deep, despite the fact that on the surface, it appears calm and shallow.

Select proper toys
Injuries from improper selection of toys also occur commonly in this pre-school age group. Caregivers should exercise discretion in selecting toys for their children. What toy a child demands to have may not actually be suitable for his age and mental development. Bows and arrows, airguns and catapults may cause the loss of an eye. If the child is left to play unsupervised, riding a tricycle may give him injuries if he loses control when riding over a hill or hitting a pothole.

Practise road safety
A child at this age will not hesitate to run onto the road for a ball. Remember that from the child's point of view, he may not be able to see an on-coming car, especially if there are other road obstructions blocking their view. Neither can he judge accurately the speed of approaching vehicles. Always hold onto your child securely while on the pavement.

Conclusion

Many of these precautionary advice may sound like common sense. However, many children suffer injuries because their caregivers overlooked the potential dangerous hazards in the environment. One reason is that we fail to understand that the environment from a child's perspective looks deceivingly safe and secure.

It is our responsibility to identify the potential injury hazards in our children's environment. Childhood injuries are preventable if we exercise more caution.