Underrated areas of child safety

Some areas of child safety are overhyped given how rare they are, like shootings and stranger abduction. This is my overview of some areas I think are worth taking more steps.

Car accidents, while in the car

Cars are the thing most likely to kill most children. (Recent statistics showing that guns are the top risk for US children is true for boys in their late teens, not other children.)

Big gains:

Safer driving: Treat driving as a risky activity. Minimize driving while impaired by texting, substances, sleep deprivation, etc.

Use seatbelts: For children in particular, the biggest gain is from using child restraints (car seats or seatbelts) at all. 10% of the child rides and 34% of the child deaths are while unrestrained (source). 

Back seat: The back seat is safer for kids; crash tests indicate kids 12 and under are about half as likely to get injured in the back seat. Around age 13 the benefit is no longer statistically significant. Our kids are on the small side, so we’ll likely keep them in the back longer.

Less important:

I had thought keeping kids rear-facing was important, but it’s actually less key than I thought. There’s some theoretical reason to think rear-facing is safer, but there’s not a lot of real-world data. The main study showing it was much safer failed to replicate and was retracted.

• Kids are physically flexible, and ours haven’t minded having their legs bent. Here are US and UK recommendations for rear-facing seats for preschoolers.
• With three kids in the backseat of a compact car, the main downside of a rear-facing child is that it’s very tempting for the youngest to kick her sisters when bored. I let her sit forward on long trips to reduce this.

The standard recommendation is to remove a child’s coat before strapping them into a carseat, but there’s no data on how much difference this makes. Winter is long where we live, and we try to have straps snug but don’t typically remove coats. 

Car accidents, while a pedestrian

Pedestrian injuries are less common than passenger injuries, but of course it will depend how much your child is a pedestrian vs a passenger.

The biggest gains are from infrastructure changes like slower speed limits and traffic calming measures. But among things that are under a family’s control:

More supervision. I feel conflicted on this one because current US and UK norms reduce children’s mobility in an unprecedented way. But common advice seems to be to assume that children under about 8 aren’t cognitively ready to cross streets reliably.

Training children. There’s moderate evidence that training programs reduce risky behaviors. My guess is parents can do better by training their specific children.

• Training toddlers to wait for an adult to hold their hand before stepping into the street
• Teaching toddlers to show me where they stop at the edge of the sidewalk
• Training against dashing out into roads after an object: we practiced rolling balls and tricycles into the road and yelling for an adult instead of running after it.
• Crossing at intersections rather than mid-block
• Not crossing between parked cars. 
• Looking left-right-left (or the equivalent in your country).
• Not crossing while distracted. Especially relevant once kids have smartwatches or phones.
• Practice in less-risky areas first; in our case we have the kids practice crossing the bike path near us, and then very quiet streets.
• Training older kids to cross streets independently.
• Choose less-busy routes and intersections for kids to get to their destination. 
• Don’t assume sidewalks are safe for scooters or bikes. When you’re moving fast on a sidewalk, there’s no time to look for cars backing out of driveways. I’ve seen kids scooter from sidewalk to street without realizing how unpredictable this is to cars (and because wheels make you faster, a driver has less time to stop.)
• When getting out of a parked car into a street, Jeff has taught the kids to stay “in the shadow of the door” rather than going beyond the outermost part of the car. Here the green area is the “shadow of the door”. Then they can walk around the back of the car to the sidewalk.
  

• If parked cars are blocking visibility, it’s not enough to look from the side of an intersection Jeff taught about checking for cars both at the corner, and also when you get to the “car line” and can see fully into the street. Here I’ve drawn the “car line” in pink.

As a parent observing your child’s particular behaviors, you can tailor training to what they need. We didn’t set a specific age when our kids could cross streets alone; they were different ages when they demonstrated they could do it competently. One kid practiced more and had better focus, and she was reliable sooner.

Backup cameras

It might be worth installing a backup camera in older cars. In writing this post I read about “driveway backovers”, typically of toddlers who move unpredictably in a driveway or parking lot. We have an older car with no backup camera, and live in an area with a lot of children using the sidewalks. The actual camera is cheap, but installation is a pain.

Drowning

Drowning is the top cause of death for children age 1-4. I keep seeing the claim that most child drownings happen during a lapse of supervision for a few minutes, often when a child is supposed to be inside the house but goes to explore a backyard pool. There doesn’t seem to be a good source for that claim, but it seems likely to me.

Our four-year-old nearly drowned last summer in a fountain we thought was too shallow to be dangerous. On a different family vacation, her cousin ended up underwater within view of about 5 adults; no one person thought they were responsible for watching him. Drowning is quick and silent, not splashy.

Big gains

• Perimeter fences around pools. Not just around the yard; you don’t want a child to be able to walk from the house straight to the pool. 
• Life jackets on open water.

Less clear benefit

Other layers of protection. None of these show up as a big win in the statistics, but it seems to me it’s worth layering multiple types of risk reduction.

Learning to swim

We finally got serious about swim lessons this year. It was hard to find spots in lessons near us, so I hired a teacher to do lessons during family swim time at a nearby pool. Writeup from another parent who did it himself. Work on “water competency” and not only swimming:

• Ability to pull yourself up over the pool edge 
• When you fall in the water, turn around and go back to the edge (rather than floundering forward)
• Ability to hold breath underwater and get yourself to the surface
• Floating or treading water 

Close supervision

The statistics don’t point to supervision as a big gain, because so many drownings happen while an adult is supposedly supervising. I don’t take this as a reason to give up on supervision, but I think it points to the level of attention needed. I do expect there’s a real gain in having a designated adult truly watching the kids, not multitasking or on their phone. I trust some of the adults in our extended family to give this their full attention, but not most of them.

Life jackets
I also think wearing life jackets while playing near the water may be worth it, as another layer of risk reduction. We have our kids wear these while playing at the beach when we’re not giving our full attention to all 3 kids.

Concussions

Concussions sometimes basically resolve within a few weeks. Other times, especially if repeated, they carry lasting health burdens in pain, cognition, and behavior.

Biggest gains 

• Bike helmets. They seem to reduce the risk of head and brain injuries by about 75% in both children and adults (source).
• Avoid re-injury during the weeks after a concussion. The highest-risk time for a concussion is while you’re recovering from another concussion; you’re both more likely to get one (because you’re less coordinated) and the effects are worse. If my child got a concussion, I’d keep them far away from activities where they were likely to get another until they had fully recovered.

A lot of childhood concussions happen while doing physical play, like playing on playgrounds, riding bikes, and playing sports. Everyday physical play still seems clearly worth it to me.  

Sports vary. The highest risk per hour is below. This shows rates of concussion per 1000 athlete exposures (practice or competition). Competitions carry higher risk than practice. Source

Even within the same sport, girls/women are more likely to get concussions, despite safety rules like a ban on body checking in girls’ ice hockey.

Other things I’d be cautious about:

• Trampolines
• Horseback riding
• Downhill skiing – Jeff loved it as a kid, but the thrill wore off after he realized how badly you could get hurt. I know multiple people from work who’ve needed to take significant time off because of skiing injuries.

For things with high per-hour rates of injury, I’m inclined to let kids try it occasionally if they really want to. Lily says riding a horse was “the best thing that ever happened.”

We use helmets for more activities than most families:

• Biking, skating, scootering
• Roller skating and ice skating
• Rock scrambling, if we remember
• Sledding if there are obstacles like trees where we’re going (Jeff on sledding with obstacles). Also, use steerable sleds on hills with obstacles, rather than round sleds where you can easily end up backwards.

We’ve also tried to reduce concussion risk in our house. A family member got a concussion at Jeff’s dad’s house from standing up underneath a cabinet, which now has padding attached. It’s not cute, but I’ve staple-gunned a yoga mat to the bottom and edge of a loft bed that was head-bonking height.

Sexual abuse by known people

Sexual abuse by a stranger is rare. Sexual abuse by family, neighbors, or caregivers is sadly not that rare. More in this Preventing child sexual abuse.

Poisoning

Most random things your child puts in their mouth aren’t going to be that dangerous, and most calls to poison control basically tell you to wait it out.

A basic step is putting dangerous things on high shelves. At least in our house, cabinets with child latches don’t get closed 100% of the time. I trust high shelves to be more toddler-proof, assuming the child isn’t truly determined to reach the item.

The most common source of serious poisonings in young children is pain medications, especially acetaminophen.

Kids like spray bottles; I’d keep cleaning sprays out of reach if you wouldn’t want a young child spraying themselves or their siblings in the face with it.

Pills and gummies look like candy. Vitamins with iron are a common source of poisoning, especially if the child likes the taste of their vitamins. Pill organizers are easy for a child to open. Keep them out of sight / out of reach, including at the houses of older relatives or when grandparents are staying with you.

Among cleaning products, dishwasher pods and laundry pods are especially candy-like. I’d keep those up high or use something less appealing.

More on training kids

Compared to other parents, we do more training than is typical.

• Training staying in an area.
• Making sure that breaking the rules doesn’t get them when they want; if they cross a street unsafely, they have to go back and do it right. Crossing unsafely shouldn’t just yield getting to your destination sooner. Going back makes this salient in a way that adult lectures don’t.
• Teaching not falling off high ledges

Postscript: weirdly, while I was working on this post, one of my kids randomly fell off her bed and got a concussion. She’s ok now. Sometimes you just get bad luck.