Injuries are the leading cause of death of children in the United States. The incidence is especially high in children under the age of five. It is imperative for pediatricians to counsel parents on injury prevention as part of their routine well baby checkups. Although some areas arise at specific developmental stages, many need to be reiterated at many different office visits. This is only a guide to areas that should be covered.

Before Hospital Discharge

1. Discussion of carseat use, position in the backseat, and danger of airbags.
2. Sleeping position- "Back to Life"
3. Mattress must be firm
4. Crib should meet federal specifications regarding separation of bars.

1. Smoke detectors and fire extinguishers should be in the home
2. Carbon Monoxide detector
3. Sun protection- avoid sun especially between 10 am -4 pm, wear a hat
4. Bathing safety- don't leave unattended, child may be slippery when you pick them up
5. Hot water should be less that 120 degrees to prevent scalding and full thickness burns

1. Don't leave child unattended on bed or changing table because they may roll over
2. Pacifiers should not be connected to cord around the neck

1. Outlet covers
2. Cords and wires should be hidden. Electrical cords are "live" and can get deep electrical burns if bitten. Also, pulling on cords can lead to pulling objects down on the child. 
3. Cords from blinds and shades should be high enough so that children can't wrap them around their neck and choke 
4. Windows should not be accessible and furniture that can be climbed on to be near a window moved. Windows should have guards and locks
5. Parents should have Syrup of Ipecac and Poison Control Center number. Medicines and chemicals should out of reach or locked in cabinets. 
6. Walkers are dangerous and shouldn't be used.
7. Remove any furniture with sharp corners.

1. First aid in case of choking instructions given, don't give small objects to infants and pick up items that are dropped
2. May need to change carseat if child is over 20 pounds
3. Avoid hot surfaces - ovens and irons.
4. Don't leave buckets around filled with water. Make sure toilet seat is down or has a lock
5. Bicycle helmet should be worn if parents ride child on back of bike in a safe seat

1. Pedestrian issues need to be discussed. Street awareness.
2. Swimming pool and lake safety
3. Lock firearms and ammunition separately
4. Yards or play areas should be fenced in. Child can not be left outside unsupervised.

1. Playground equipment and ground that it is on should be inspected for safety
2. Discussion of "stranger danger" and "touching" should be initiated

References

1. Cohen LR, Runyan CW, Downs SM and Bowling JM. Pediatric Injury Prevention Counseling Priorities. Pediatrics. 1997; 99(5):704-710.
2. Rivara FP. Pediatrics Injury Control in 1999: Where do we go from here? Pediatrics. 1999; 103(4):S883-888.
3. Shafi S and Gilbert JC. Minor Pediatric Injuries. Pediatric Clinics of North America. 1998; 45(4):831-851.
4. American Academy of Pediatrics.  Office-based Counseling for Unintenttional Injury Prevention.  Pediatrics Jan 2007