Health and Safety, Birth to 2 Years

This topic advises parents and other caregivers on ways to help prevent illness and accidental injuries in babies and young children. It is not able or meant to cover every risk that faces a child. However, the topic addresses many of the most common hazards so you can help minimize the risk of infections and injuries and identify areas and situations that can be dangerous for a child up to 2 years of age.

Why are health and safety important for babies and young children?

Children age 2 and younger are not yet able to understand and recognize many dangers that threaten their physical safety. Parents must take measures to keep babies and young children safe from everyday hazards both inside and outside of the home.

Also, infants and young children are continually exposed to a variety of germs. Children age 2 and younger have immature immune systems, which makes them vulnerable to bacterial and viral infections. They also are at greater risk of developing complications from these infections. You can help limit your child's exposure to germs by practicing good hygiene.

What are the most common safety hazards?

Car accidents and drowning are the leading causes of injury and death for children age 2 and younger.^{1, 2} Other common injuries include:

• Burns.
• Choking or strangulation.
• Falls, such as from playground equipment, stairs, or furniture.
• Poisoning.
• Gunshot wounds.
• Pet bites.

How can I protect my child from illness?

Many illnesses can be prevented by avoiding close contact with people who are sick, frequently washing your child's hands, regularly washing and disinfecting toys and surfaces, and ensuring that your child's immunizations are current.

You can help protect your child from food-borne illness by preparing, serving, and storing food safely. For example, keep meat separate from other foods and cook it to the recommended internal temperature, refrigerate leftover foods promptly, and be selective about restaurants where you eat.

What kinds of equipment can be hazardous?

Any equipment you purchase for your child should meet all safety standards and be in good condition. Car seats, cribs, strollers, playpens, and high chairs are all frequently used by infants and toddlers up to age 2. If you purchase or are given used equipment, make sure it meets current safety standards and has not had any safety recalls. (You can check recall information online or by calling the U.S. Consumer Product Safety Commission. For contact information, see the Other Places to Get Help section of this topic). Also, inspect items for worn or broken parts.

Supervise your child closely while using equipment shared by the public, such as shopping carts or restaurant high chairs, which may meet only very minimal safety standards. Also, cleaning the surfaces of shared equipment with disposable wipes can help you prevent your child from being exposed to viruses and bacteria.

How can my stress level affect my child's safety?

Most injuries to children occur when parents are tired, hungry, emotionally drained, or are having relationship difficulties. Other common causes of family stress include changes in daily routines, moving to a new house, or expecting another child.

Having and protecting a child is an immense responsibility and can be extremely stressful for some parents. It is important to take care of yourself and to recognize your limits.

Frequently Asked Questions

The immune systems of babies and young children up to 24 months of age are still developing. This makes them especially prone to getting sick after being exposed to viruses and bacteria. Exposure to common pathogens can occur from person-to-person contact and improperly prepared food. Good hygiene practices can help you to protect your child from exposure to these germs.

Safe food preparation

You can help protect your child from getting sick by paying attention to safe food practices.

• Prepare food safely. You can help reduce the chances that your child will become ill from food poisoning by washing your hands, keeping kitchen areas clean, and preparing foods properly.
• Shop safely. Raw meats, seafood, and eggs can contaminate other foods they touch. Keep these items wrapped in plastic and away from fresh foods in your shopping cart. Look closely at all items, and don't buy those that have signs of spoilage or damage.
• Cook foods safely. Meats and foods that have been in contact with raw meat need to be cooked thoroughly to prevent the growth of bacteria. The specific temperature varies by type of food.
• Store foods safely. Keep food temperatures at safe levels to prevent bacterial growth that can cause illness. Also take special care when storing breast milk or formula for bottle-feedings. Bacteria grow quickly in warm breast milk or formula that is left at room temperature. After bottle-feeding your baby, immediately discard the milk or formula that is left in the bottle. Promptly refrigerate fresh breast milk or formula if it is not needed right away. Also, clean and disinfect all bottles before each use.
• Follow labels on food packaging. Look for expiration dates on perishable foods before you buy or eat them. Also, follow any cooking guidelines provided, such as temperature and cooking time.
• Ensure that the restaurants where you eat handle food safely.

For more information, see the topic Food Poisoning and Safe Food Handling.

Protect against the spread of illness and germs

Germs spread easily from person to person. Cold and flu viruses usually affect the most people during the colder months, although they can develop at any time of the year. Babies and young children have an increased risk of developing secondary bacterial infections from these illnesses. Take extra care to help protect your child against infections.

• Get your child immunized. Immunizations, also called vaccinations, help protect your child from diseases. Immunizations begin at birth and are scheduled throughout adolescence. For more information, see the topic Immunizations.
• Be aware of the higher risk of germs in public areas. Avoid exposing your child to a large crowd if he or she has been ill recently or has an otherwise weakened immune system, especially when a contagious illness is going around. Also, it may be helpful to have disposable wipes and a hand sanitizer available to clean hands and to wipe off shopping carts or other shared items in public places.
• Avoid close contact with others who are obviously sick. Also, if your child is ill, avoid contact with other children until the contagious period is over. Talk to your doctor if you are unsure about how long your child is likely to be contagious.
• Wash hands frequently, including after every diaper change. Keeping your hands clean is an obvious, but often overlooked, way to prevent the spread of germs. Also wash your baby's hands after he or she has a bowel movement, because a baby can touch his or her messy bottom without your being aware of it.
• Wash and disinfect surfaces and toys. Areas where germs collect, such as the kitchen and bathroom, also should be kept clean and frequently disinfected.
• Teach good hygiene habits early, especially if your child is frequently around many children, such as at day care. For example, teach your child to cover his or her mouth when coughing or sneezing, preferably using a tissue so germs do not get on the hands. Also show your child how to wipe his or her nose with tissues. Babies and young children may not understand your instructions, but repetition will help them remember these concepts as they grow.
• Consider flu shots for your child. The inactivated flu vaccine (flu shot) is recommended once a year for:
  • All children 6 months through 59 months of age (4 years, 11 months). (Children 9 years of age and younger who are getting the shot for the first time should get 2 doses, given at least one month apart.)
  • Children 5 years and older with certain medical conditions (such as asthma, chronic heart or lung disorders, or an impaired immune system).
  • Close contacts, including household contacts and out-of-home caregivers, of children 59 months of age and younger and of children older than 59 months who are at high risk for complications of the flu. Healthy people ages 2 through 49 years can usually get the nasal spray form of the vaccine, called FluMist. Pregnant women can get the flu shot but not FluMist. For the latest flu vaccine recommendations from the U.S. Centers for Disease Control and Prevention (CDC), see their Influenza (Flu) Web site at www.cdc.gov/flu/protect/keyfacts.htm. Also, for more information, see the topic Influenza.

Visit the doctor regularly

Make sure to schedule well-child visits, during which a health professional gives your child a physical exam. Your health professional will ask you about your child's development and whether you have any concerns.

Immunizations are also given at well-child visits. Immunizations provide important protection for your child against harmful diseases. The standard immunization schedule outlines the recommended vaccinations and the ages at which they should be given.

From birth to age 2, children depend on parents and caregivers for their safety. Safety issues change and increase rapidly in number as newborns grow into toddlers. It is important to consider your child's physical and mental development when evaluating current and future hazards.

Although close supervision is important, it is not realistic to think that you can watch your child's every move. In addition, constantly hovering over your child can limit his or her experiences and confidence. Balancing supervision with safety precautions will help prevent accidents and injuries, as well as allow your child to explore and discover.

Taking the time to research and adopt safe habits can help to prevent common accidents and injuries that can occur around the house.

Use safe baby products

In the United States, safety standards for children's equipment, furniture, clothing, and other items are set by the Consumer Product Safety Commission (CPSC). Although most new items you purchase will likely meet these standards, older and used items may not. Equipment that has been used before, such as a baby carrier, may not be safe. These items may have wear and tear that affects how they function. The CPSC may also have recalled some items because of reported hazards.

Check that all the products your baby uses meet current standards. The following list provides safety information for items frequently used by children up to age 2:

• Cribs should meet all current safety standards, such as having less than 2.4 in. (6.1 cm) of space between slats. Lower the mattress and remove mobiles, large stuffed toys, and bumpers from the crib as your baby grows.
• Baby walkers should not be used, according to recommendations from the American Academy of Pediatrics (AAP). If you decide to allow your child to use a walker, the AAP recommends using only those labeled "ASTM F977-96," which ensures that they meet international safety standards.¹
• Playpens should have spaces in the mesh material that do not exceed 0.25 in. (0.6 cm) across; wooden slats should measure less than 2.4 in. (6.1 cm) apart.¹ Be careful about the toys you put in the playpen. As your children grow, they can get tangled in mobiles or may use larger toys as steps to boost them out of the enclosure.
• High chairs should have a wide, stable base. Do not use booster seats that attach to the table. Always take time to make sure the high chair is locked in the upright position before use. Use the safety straps, and supervise your child at all times while he or she is in the high chair.
• Changing tables should have a railing on all sides that is 2 in. (5.1 cm) high. A slightly indented changing surface is also recommended. Always use the safety strap and keep one hand on your child. Have diapers and other items handy, but keep them out of your child's reach.

To help you keep track of important safety features, use the nursery equipment safety checklist(What is a PDF document?).

For more information about equipment standards from the CPSC, see the Other Places to Get Help section of this topic.

Safe sleeping and sudden infant death syndrome (SIDS)

Sudden infant death syndrome is one of the most common causes of death for babies between the ages of 1 and 12 months. Most babies who die of SIDS are between 2 and 4 months old. Although SIDS cannot be predicted or completely prevented, placing your baby to sleep on his or her back can help prevent this tragedy. For more information, see the topic Sudden Infant Death Syndrome (SIDS).

Preventing falls

You can prevent many falling accidents by using common sense and appropriate equipment that meets all safety standards. Recognize new hazards that your baby will encounter as he or she learns to scoot, crawl, and walk.

• As soon as your baby can walk, lock doors to all dangerous areas.
• Use sliding gates at both ends of stairs. Do not use accordion-style gates, because a child's head could get caught. Look for a gate with openings no bigger than 2.4 in. (6.1 cm).
• Install window guards.
• Do not allow children to climb on high furniture.
• Avoid using baby walkers.
• Be careful when using equipment such as high chairs and changing tables. Always use the safety straps, and keep a close eye on your child.

Choking

Help prevent your child from choking by offering the right kinds of foods and keeping an eye out for choking hazards.

• Learn to recognize the signs of choking so you can react quickly. For example, a child who is choking can't talk, cry, breathe, or cough.
• Know how to select and prepare foods. For example, choose soft foods that can be cut up into small pieces, such as cooked carrots. Avoid round, firm foods such as hot dogs, grapes, nuts, and raisins.
• Establish certain areas for eating, such as the kitchen table or dining room. Teach your child to sit down while he or she is eating and to chew carefully; do not force a child to eat when he or she is not hungry. These practices will also help your child to develop lifelong healthy eating habits.
• Be aware that young children can choke on small objects. Generally, objects smaller than 1.3 in. (3.3 cm) in diameter and 2.3 in. (5.8 cm) long are choking hazards. Examples include coins, buttons, and bottle caps. Keep these items out of your child's reach.
• Do not allow your child to eat while he or she is walking, running, playing, or riding in a car.
• Never leave rubber bands or deflated balloons around the house where children can reach them.
• Do not allow young children to chew gum or eat hard candy.

Strangulation and suffocation

A young child can strangle from a variety of household items. Protect your child by minimizing these hazards:¹

• Keep cords for blinds and drapes out of your child's reach. Attach cords to mounts that hold them taut, and wrap them around wall brackets.
• Cords with loops should be cut and given safety tassels instead.
• Never use accordion-style gates. A baby or young child may trap his or her head in the gate and may strangle.
• Make sure that furniture does not have cutout portions or other areas that can trap your child's head.

Suffocation is another danger for young children. Teach your child about suffocation and the importance of a safe play area. Pay attention to possible suffocation dangers, such as:

• Trunks of cars. Keep rear fold-down seats closed so children are not able to climb into the trunk from inside the car. Also, always lock car doors, and keep the keys out of your child's sight and reach.
• Refrigerators and freezers, even those that are not in use. If you are storing an old refrigerator or freezer, remove the door.
• Plastic sacks. Do not let your child play with plastic sacks, and keep them out of his or her reach. Many children like to play with sacks and put them over their heads.

Poisoning

To prevent poisoning, identify household cleaners and other chemicals, plants, medicines, makeup, perfumes, and any other products that can harm a child who eats or inhales them. It is critical to properly store these items out of reach of young children. If you have a possible poisoning emergency, call 1-800-222-1222 and you will be automatically transferred to the poison control center closest to you. For more information, see the topic Poisoning.

Lead poisoning is another cause for concern in young children who may chew on contaminated paint flakes, painted objects, or toys. House paint is no longer made with lead, but older homes may still have it on walls and other surfaces. Have your home tested if you are unsure whether lead-based paint was used. In 2007, the U.S. Consumer Product Safety Commission (CPSC) found high lead content in many children’s toys and jewelry made in other countries. For a complete list of recalled products, see the CPSC Web site at www.cpsc.gov. Also see the topic Lead Poisoning for more information.

Prevent carbon monoxide poisoning by frequently monitoring levels of carbon monoxide in your home and taking precautionary measures, such as having your home's heater checked each year. Carbon monoxide (CO) is a colorless, odorless, and tasteless gas produced from burning fuels such as natural gas, gasoline, fuel oil, or wood (for example, in indoor heating systems, car engines, cooking appliances, or fires). High carbon monoxide levels quickly affect young children because of their small size. For more information, see the topic Carbon Monoxide Poisoning.

Fire hazards

Prevent household fires by keeping and maintaining smoke detectors and planning and practicing escape routes.

Burns

Burns are caused by heat, electricity, chemicals, radiation, or friction. Protect your child from burn injuries by identifying dangers in your home and taking measures to remove or block your child's access to them.

• Heat burns can be prevented by keeping your child away from fire, steam, hot water, and other hot liquids and objects. Do not heat bottled formula or breast milk in the microwave, because hot spots in the liquid can burn a baby's mouth and throat. Consider buying flame-resistant pajamas for your child.
• Electrical burns can be prevented by keeping electrical cords out of your child's reach and using safety covers on all electrical outlets. During electrical storms, keep your child indoors and away from windows.
• Chemical burns can be prevented by keeping all chemicals out of children's reach. Acid, such as from batteries, and alkaline products, such as drain cleaners, are especially dangerous.
• Sunburns (radiation burns) can permanently damage a child's skin. Children younger than 6 months should stay out of the sun entirely. Keep young children out of the sun, or have them use sun-protection measures while they are outdoors.
• Friction burns are usually minor injuries. Rough play or falls may cause these burns in babies or young children.
• Enjoy fireworks from a distance. Almost half of those injured from fireworks are children 14 years of age and younger.³ Children can also get burns from using and being around firecrackers and sparklers. Sparklers have been shown to be most dangerous for children under 5 years of age.³

Guns and other weapons

Gun and firearm safety measures should be established for all households and especially those where children live or visit. All guns and firearms should be kept in a locked area, unloaded, and out of reach of children. Also store knives (even kitchen knives), swords, and other weapons safely out of reach.

Pets

Pets are found in many households. Children who live in homes without pets are likely to encounter animals in other environments. Many injuries can be avoided by teaching children how to properly interact with pets. Also, pet owners who train and keep their animals healthy are less likely to have problems when children are around.

• Teach your child how to interact with pets. Explain that animals can hurt you when they are scared, hurt, eating, or protecting their babies. Teach your child to speak quietly and move slowly around animals and to watch for animal body language that can help your child know when to stay away.
• Train and prepare your pet to behave around children. A well-trained and obedient pet is less likely to harm a child.

Drowning

Drowning is second only to automobile accidents as a leading cause of death in children younger than 5 years. Never leave your child alone near water. Also, follow drowning prevention recommendations from the National Safety Council, the Consumer Product Safety Commission, and the American Academy of Pediatrics.

• Supervise all baths at all times. Always stay within an arm's reach of your child, and never leave your child alone in the tub—even with an older sibling.
• Control access to water in your home. Keep large bodies of water, such as a pond or a pool, fenced. Empty all buckets and coolers when they are not in use. Keep toilet lids down, and secure them with safety latches.
• Keep pool areas safe. When visiting public or private pools, keep your child within arm's reach. If you have your own pool, make sure to follow all your local safety codes. These usually are available from your city's planning department.
• Keep children away from irrigation canals. Do not let your child play in or near irrigation canals.

In addition to these precautions, learn first aid and CPR (cardiopulmonary resuscitation). It can make the difference between life and death.

You cannot protect your child from every danger he or she can possibly encounter outside the home. However, you can take reasonable precautions and teach your child basic safety rules. This general training can help prepare your child for a variety of situations he or she may face.

Prevent accidents by using safe equipment, teaching safety awareness, and closely supervising your child.

• Always use a car seat. Car accidents are the leading cause of death and injury in young children.⁴ Many injuries and deaths can be avoided by using proper child restraints. For every ride in an automobile, make sure your child is securely strapped into a properly installed car seat that meets all current safety standards. Because state regulations vary and may not include important factors to keep your child as safe as possible, make sure to follow basic guidelines established by the American Academy of Pediatrics (AAP). Until your baby is at least 1 year of age and weighs at least 20 lb (9.1 kg), use an infant car seat that reclines and faces the rear. After that, use a forward-facing seat until your child weighs 40 lb (18.1 kg). Some infant seats can be converted into toddler seats. For pictures of car seats, see the National Highway Traffic Safety Administration Web site at www.nhtsa.dot.gov/people/injury/childps/AreYouUsing/images/UsingScr.pdf.
• Never leave your child alone in a car. Heat inside a car could cause long-lasting injury or death in just minutes. A young child's body temperature can go up 3 to 5 times faster than that of an adult. Keeping the car windows down will not protect your child in hot or warm weather. Other injuries could also occur from a child getting stuck in the trunk or setting the car in motion.
• Help your child become "street smart." Teach your child the basic rules about the dangers of cars and streets.
• Teach proper behavior around animals. Teach your child how to interact with different types of pets and other animals that he or she may come across while outside your home.
• Begin teaching your young child swimming safety. Knowing proper behavior while in and around water can help prevent a drowning accident. If you have a swimming pool at home, take safety measures around the pool. If you live near irrigation canals, teach your child not to play in or near them.
• Keep your child safe in strollers and carts. Keep your child restrained, and watch him or her closely.
• Use insect repellents to prevent bites and stings. Also, take action to lower your child's chances of being stung by an insect by having your child wear socks, closed shoes, and clothes that fully cover his or her body when outdoors.

Before your child visits an unfamiliar home, ask the homeowner whether you need to be aware of any dangerous areas, pets, or other safety issues. In addition, it is always a good idea to see the household for yourself. Don't be afraid to voice any concerns you have about safety. You are ultimately responsible for protecting your child.

Before enrolling your child in day care, evaluate the environment and talk with care providers. Ask questions about their safety guidelines. Identify any hazards, and ask how they are handled. Inspect the food preparation area, and ask how often it is cleaned and what kinds of cleaning products are used. For more information, see the topic Choosing Child Care.

Going along for the ride

When you include your child in your activities, be sure to recognize the related safety issues. Your focus should be on your child's comfort and safety.

• Keep your child safe in strollers and carts. Use the safety straps, and follow the printed instructions. For example, signs on shopping carts usually advise you not to put a child in the area that is reserved for shopping items.
• Never leave your child alone in a car. Factors such as heat inside a car and leaving car keys within a child's reach could cause long-lasting injury or death in just minutes.
• Prevent sunburns by taking extra care, such as applying sunscreen and putting on a hat before going outdoors. In addition, be careful that your child does not develop heat exhaustion from being out in warm temperatures. Small bodies can develop these problems much more quickly than adults. Do not keep your child out in warm weather for long periods, and keep water or other drinks on hand. For more information, see the topics Sunburn and Heat-Related Illnesses.
• Monitor air pollution when planning to take your child outdoors. Children's lungs are especially sensitive to pollution. You can check your newspaper or local weather station for details about air pollution levels.
• Watch for physical signs that show it's safe to gradually include your child in your activities. When children can run or climb, it's usually a good sign that they are getting stronger and can keep their balance. Before and after these signs appear, use good judgment for your baby's comfort and safety.

Gaining confidence

Many parents wonder whether they are equipped to handle the responsibility of keeping their child safe. You will likely feel more confident if you are alert, take all the precautions you can, and know how to respond to emergencies.

• Learn first aid and cardiopulmonary resuscitation (CPR). Classes usually are offered through your local hospital or fire department.
• Read and learn about child growth and development. Knowing what to expect can help ease the fear of the unknown.
• Join a support group. Parenting organizations can help you learn new skills as well as help ease emotional issues of having a new child. Groups differ in their focus. Some target specific concerns, such as breast-feeding, while others offer parents a chance to get together with their children for playtime and visiting. Contact your local hospital or religious organization, or ask your health professional for resources in your area.

Connection between parental well-being and child safety

Taking care of yourself is a vital part of keeping your child safe. Although accidents can occur at any time, most happen during times of excess stress, such as when:¹

• Parents and children are hungry and tired, especially right after work and before dinner.
• Another baby is expected.
• There is an illness or death in the family.
• Marital problems develop.
• Major changes in your routine or environment occur. This can happen when your child's caregiver changes, when you move to a new house, or even before you go on a vacation.

Recognize the signs of stress and what situations cause it. Be extra careful during these times, and ask for help when you need it. Also, work on taking care of your personal relationships.

For more information, see the topic Stress Management.

Seeking help

All parents have times when they feel exhausted, frustrated, angry, sad, or overwhelmed. Recognize that this is a normal part of being human and being a parent. However, if these feelings become too much for you to handle alone, keep your child safe by getting help. For example, when your emotions are too much for you to handle alone, you may not have the energy or desire to watch your child as closely as you should. Some parents injure their children when their emotions cause them to shake, hit, or push a child. This can result in injury to the child such as shaken baby syndrome, which can cause permanent brain damage or even death.

Call 911 immediately if you feel you are about to injure yourself or your child.

Places to go for help include:

• A family medicine physician.
• A pediatrician.
• A physician assistant or nurse practitioner.
• A licensed mental health counselor.
• Your local hospital.
• Parenting organizations (see the Other Places to Get Help section of this topic).

For more information on physical harm to children, see the topics Shaken Baby Syndrome and Child Abuse and Neglect. For more information on handling difficult emotions, see the topics Depression, Anxiety, and Anger, Hostility, and Violent Behavior.

Online Resources

Organizations

• Animal and Human Bites
• Burns
• Carbon Monoxide Poisoning
• Child Abuse and Neglect
• Child Car Seats
• Choking Rescue Procedure (Heimlich Maneuver)
• Choosing Child Care
• Cuts
• Dehydration
• E. coli Infection
• Environmental Illness
• Food Poisoning and Safe Food Handling
• Growth and Development, Ages 1 to 12 Months
• Growth and Development, Ages 12 to 24 Months
• Growth and Development, Newborn
• Head Injury, Age 3 and Younger
• Health and Safety, Ages 2 to 5 Years
• Heat-Related Illnesses
• Immunizations
• Insect Bites and Stings and Spider Bites
• Lead Poisoning
• Playground Safety
• Poisoning
• Preventing Poisoning in Young Children
• Shaken Baby Syndrome
• Stress Management
• Sudden Infant Death Syndrome (SIDS)

Citations

1. American Academy of Pediatrics (2004). Keeping your child safe. In SP Shevlov, RE Hannemann, eds., Caring for Your Baby and Young Child: Birth to Age 5, 4th ed., pp. 423–470. New York: Bantam.

2. National Center for Injury Prevention and Control (2002, page last reviewed September 7, 2006). Water-Related Injuries: Fact Sheet. Available online: http://www.cdc.gov/ncipc/factsheets/drown.htm.

3. Centers for Disease Control and Prevention (2006). Fireworks-Related Injuries. Available online: http://www.cdc.gov/ncipc/factsheets/fworks.htm.

4. Centers for Disease Control and Prevention (2005). CDC's Unintentional Injury Activities—2004. Available online: http://www.cdc.gov/ncipc/pub-res/unintentional_activity/2004/DUIP_Activity_Rpt2004.pdf.

Other Works Consulted

• American Academy of Pediatrics (2002). Pool safety for children. The Injury Prevention Program (TIPP). Available online: http://www.aap.org/family/tipppool.htm.

• American Academy of Pediatrics (accessed 8/16/06). Car safety seats: A guide for families 2006. Available online: http://www.aap.org/family/carseatguide.htm.