Editing Pediatric Nursing (section)

== Safety and injury prevention ==

Unintentional injury is the leading cause of death for children beyond infancy, and the specific hazards track directly with developmental capability. Anticipatory guidance means teaching about the next stage, not the current one.

=== Infants ===

* '''Supine sleep on a firm surface''' in a crib with no pillows, bumpers, blankets, or soft toys; room-sharing without bed-sharing.
* Crib slats no more than 2 and three-eighths inches apart; mattress fitted tightly.
* '''Never leave an infant unattended on any elevated surface''', and keep one hand on the infant during a diaper change.
* '''No honey before 12 months''' (infant botulism). '''No whole cow's milk before 12 months.'''
* Introduce single-ingredient complementary foods around 6 months, one at a time for several days.
* '''Infant walkers are not recommended''' and are associated with stair falls and burns.
* Test bath and formula temperature; set the water heater to no higher than 120 degrees Fahrenheit (49 degrees Celsius). Never microwave formula or breast milk.
* Aspiration is the leading injury risk; keep small objects, latex balloons, and coins out of reach.

=== Toddlers and preschoolers ===

* '''Drowning''' is a leading cause of death in the 1 to 4 year age group. Provide touch supervision, four-sided isolation pool fencing with self-latching gates, and empty buckets and tubs immediately.
* '''Choking foods''' to avoid: whole grapes, hot dog rounds, nuts, popcorn, hard candy, raw carrots, chunks of peanut butter. Cut round foods lengthwise.
* '''Poisoning:''' store medications and chemicals locked and out of sight, keep products in original containers, and post the United States national Poison Help line, 1-800-222-1222. Do not induce vomiting and do not give syrup of ipecac.
* Turn pot handles inward; keep hot liquids and appliance cords out of reach.
* Use stair gates, window guards, and cabinet and outlet safety devices.

=== School-age children and adolescents ===

* '''Helmets''' for cycling, skating, and skiing; protective gear for sport.
* Swimming instruction and water safety rules; supervision at all ages.
* Pedestrian, bus, and bicycle traffic safety education.
* '''Firearms stored unloaded and locked, with ammunition locked separately.'''
* Adolescents: motor vehicle safety, seat belt use in every seat, no texting or impairment while driving, substance use, sexual health, social media and bullying, and screening for depression and suicidal ideation. '''Any expression of suicidal ideation is assessed directly and immediately and requires continuous observation and referral.'''

=== Car seat guidance ===

* '''Rear-facing''' car safety seat in the '''back seat''' from birth for as long as possible, at minimum until age 2 and ideally until the child reaches the highest weight or height allowed by the seat manufacturer (Durbin & Hoffman, 2018).
* Then a '''forward-facing seat with a harness''' until the seat's limits are exceeded.
* Then a '''belt-positioning booster''' until the vehicle lap and shoulder belt fits properly, usually at a height near 4 feet 9 inches and between 8 and 12 years of age.
* '''All children younger than 13 ride in the back seat.'''
* A rear-facing seat is never placed in front of an active passenger air bag.
* Harness straps should be '''at or below the shoulders when rear-facing''' and '''at or above the shoulders when forward-facing'''; the retainer clip sits at armpit level, and bulky coats are removed before buckling.