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Protecting Your Newborn: Injury Prevention for Infants

Your newborn is amazing. In the first year of life he/she will undergo a tremendous amount of growth and development, as she will go from a not very mobile and totally dependent baby to an independent-minded, exploring and crawling (maybe even walking) infant. All the while, she will be susceptible to injury or death that you, as a parent, need to recognize and prevent. Did you know that putting your baby down to sleep might expose her to potential injury? Did you know that the simple act of eating solid food might possibly injure your baby? Did you know your baby could drown in a bucket of water? It sounds ominous, but the vast majority of unintentional injuries and deaths can be prevented with a little knowledge, planning, and vigilance.

For children younger than one year of age, the leading cause of unintentional injury-related death is suffocation, followed by motor vehicle occupant injury, choking, drowning, and fire and burns. In my practice, I hear the familiar attitude of "that won’t happen to my baby" from some parents and it reminds me to be extra dutiful in reminding them what they can do to prevent problems from arising. Parents tend to under- and overestimate the abilities of their babies. They do not realize how quickly babies learn, can become mobile, start to pick up small objects, put things in their mouths, or crawl to the edge of a stairwell. When a parent sees a baby roll over for the first time, they might not realize that the baby has probably rolled over several times before someone actually saw it happen. Also, providing explanations or constantly stopping a baby from doing something will not necessarily "teach" him it is wrong. At younger than one year of age, babies’ immature cognitive abilities and natural drive for curiosity will overwhelm anything that we try to "teach."

Suffocation
Babies from zero to four months are at greatest risk for suffocation because they cannot turn their faces or lift their heads to breathe when placed down to sleep. Always place your baby on her back on a firm, snug-fitting mattress (less than two finger-widths between the mattress and the crib sides). Lying on her back is the safest position for your sleeping child. If placed face down on a soft surface, babies’ faces might sink into it and they could suffocate.

Keeping infants on their backs has been shown to decrease the incidence of sudden infant death syndrome (SIDS). On the other hand, smoking in the house has been shown to increase the risk of SIDS and should be avoided.

Poorly fitting mattresses in cribs or a regular bed put your baby at risk for the most frequent cause of suffocation: becoming wedged between the bed and mattress or wall, causing obstruction of the nose and mouth. Do not use lumpy pillows, comforters, or stuffed animals on your baby’s sleeping area. Do not place babies on the following surfaces:

• waterbeds
• soft pillows
• soft mattresses
• soft comforters
• sheepskin rugs
• mattresses covered with plastic bags

Motor Vehicle Occupancy Injuries
The first safety device your baby will most likely use is a safety seat. Injuries, even death, can be prevented with proper, consistent use of a child-safety seat. Your infant should be in this seat every time he or she is in the car. The safest place and position for infants from newborn to one year of age is in the rear, middle seat, facing backward (toward the rear window). They should stay facing backward until they are both 20 pounds and one year of age. Infants should not be placed in the front passenger seat that is equipped with an airbag, since doing so can result in serious injury if the airbag is deployed. Proper and consistent use of the child-safety seat is the only way to prevent serious injury or death if involved in a motor vehicle accident.

Choking
It is not uncommon for parents to want to put jewelry (bracelets, earrings, or necklaces) on their baby. However, jewelry, as well as small toys, pose potential choking dangers. As babies grow, they tend to explore their world by putting things into their mouths. Anything that can fit through a cardboard toilet-paper tube, or is smaller than your baby’s fist, is a choking hazard and should be kept out of your baby’s reach. Periodically, check toys for wear and tear and loose parts that can come off and be swallowed. Finally, as your baby begins to eat solid foods, the size, shape, and consistency of the food she eats may pose a danger. Any food that is round and firm can be a choking hazard. For this reason, if your baby is eating solids, cut all foods into manageable pieces and supervise your infant at mealtime. These particular foods should be avoided until four years of age:

• Popcorn
• Hot dogs
• Whole grapes
• Peanut butter
• Hard candy
• Chunks of carrots, celery, or other raw vegetables

Drowning
While a pool may come immediately to mind as a drowning hazard, more than half of drowning among infants younger than one year of age occurs in bathtubs. They can also occur in toilets, pails of water, wading pools, and spas. NEVER leave a baby alone in a bathtub or near the above-mentioned objects. Don’t answer the phone, go to get a towel (gather all necessary items for bath time ahead of time), or answer the door when giving a baby a bath. Since an infant can drown in only a few inches of water, you must make sure to completely empty water from the bathtub and empty any freestanding containers that may hold water. As your baby becomes mobile and crawls or walks, swimming pools become very dangerous. Statistics tell us that drowning in swimming pools occurs silently, that the infant was last seen in the home, was out of sight for less than five minutes, and was in the care of one or both parents at the time of the drowning. Lesson: we cannot be super-parents, and prevention is the key. For swimming pools, install a five-foot-high, four-sided fence that completely encircles the pool. Before your baby starts crawling, equip the fence with a self-closing and self-latching gate. Keep all enticing objects such as balls and rubber "floaters" out of the pool. A child may reach for them and fall into the pool. Provide one-to-one adult supervision when children are playing in the pool.

Fire and Burns
Before your baby’s birth, turn down your home’s water heater to 120 degrees from the usual 140 degrees. This temperature avoids serious scalding injuries when infants are accidentally put in hot bath water. Once born, your baby will advance in his motor skills before you know it. Never carry hot liquids near your infant or while holding him. In the kitchen, move pot handles away from the edge of the stove and do not let infants play near stoves and ranges. If your baby does get burned, immediately put the burned area under cold water until he stops crying. Then put a loose bandage over the burn and call your doctor immediately.

To protect from house fires, install smoke detectors in your house, specifically in the room where your baby sleeps. If you have two stories in your house, make sure there is one detector on each floor. For older infants, to prevent clothing from being a danger, use snug-fitting or flame-retardant clothing for sleepwear (oxygen cannot feed the fire if snug-fitting clothes are used).

Falls
Infants progress faster than we think. At birth, babies can move their arms and legs and as they get older, they can push against objects and then roll over. Never leave your baby unattended on changing tables, sofas, beds, or cribs with the side rails down. The safest place to leave your baby should be a federally approved crib or playpen with its side rails up. As your baby becomes even more mobile and crawls or walks, make sure you place gates at the tops of stairways and three steps from the bottom to prevent falls. Putting the gate on the third step allows for practice of climbing without exposing the baby to injury risk.

Window guards
One mother recounted to me how she couldn’t hear her child anymore, so she checked the entire apartment and didn’t find her. She then unfortunately realized her infant had fallen out of the unprotected window of her third-story apartment. Again, no matter how careful we may be in watching our infants, we cannot see and hear everything. Prevention is the key. Place window guards on all windows above the first floor.

Baby walkers
Finally, never use a baby walker. While they may provide some with a babysitting capacity, baby walkers not only develop the wrong muscles for walking (and thus do not accelerate a baby’s ability to walk), they greatly increase the risk for serious head injury. Infants who normally do not move very fast are suddenly accelerated in their mobility and can quickly slip out of sight and get to places where they can pull heavy objects onto themselves, tip over the walker, and fall out or down stairwells. It is a myth that they help an infant’s walking, and it is a fact that they can lead to serious head injuries.

Safety Table
Every time a child suffers an injury usually there are three things involved: the child, the environment, and the object that caused the injury. While it is difficult to change our infants’ behavior, we can alter the object and the environment. We can make it childproof and safe. For your infant younger than one year of age, here are the most common injuries, the objects involved, and what you can do right now to help prevent the injuries from happening. Parents can take steps to minimize the chances for injury.

Conclusion
In the end, we cannot be super-parents. We need to understand that injury prevention in our infants is not just a simple matter of "keeping an eye on them." We should understand that our little angels develop quickly and will interact with things in their environment on a daily basis. Prevention is ultimately preparation. Do things now so that your baby will be safe later. Don’t assume things will be OK; be proactive and make safety a priority at all times.