HOME AND FIRE SAFETY By Mark B. Levin, M.D. The Pediatric Group, P.A., Princeton

This is the 44th article written in a series for Princeton Online Click here for an archive of other articles.

"Accidents happen." While this phrase, like much folk wisdom, contains an element of truth, accidents can be prevented. Childproofing a home, that is, removing dangerous items from a child's reach and vision, greatly reduces the risk of accidents and their adverse consequences. Children are both curious and imitative. No matter how many parental admonitions, children often explore what is not familiar and imitate what they see others do. A parent's first task is to remove, or make inaccessible, objects that are either dangerous or forbidden. While we applaud efforts to teach a child to shun dangerous objects and obey their parents, knowledge of child development makes us skeptical that children will uniformly heed parental advice. Some children may be naturally cautious, quick learners or commendably compliant. Others, however, remind us that children's behavior can be unpredictable. Given that children may not be totally trustworthy, assuring home and fire safety is critical to the prevention of domestic disasters and loss of life. Adequate childproofing includes physical preparation, planning and mastering correct procedures.

Discerning right from wrong occurs naturally between five and six years old in most children. Prior to the age of five, children are in their reality-fantasy confusion stage, wherein they believe truth is what they want it to be. A parent can certainly condition a child, much as a pet can be trained, to avoid certain objects out of fear. This kind of training requires compulsive consistency, as inconsistent re-enforcement extinguishes the conditioned response and engenders oppositional behavior by the child. The disciplinary methods used to re-enforce such behavior teach a child to follow rules for fear of violence or physical pain, rather than to make an appropriate decision based on reasoning right from wrong. The former may tempt a child to try an ill advised behavior if s/he feels the chances are of not getting caught are favorable, or worse, if s/he believes the only way to get attention is to commit indiscretions. One can easily conjure a similarity between this thought process and that of criminals. The re-enforcing consequences in this scenario are after the fact, as the crime has already been enacted when the discipline is administered. At that point, the parent-child relationship is negative and the damage the parent wanted to prevent has already been done.

The more developmentally appropriate way to assure safety is making forbidden objects inaccessible to the child's prying hands. This protects the child, protects the object and allows the parent to interact with the child in a positive, rather than in an adversarial, manner. Objects that can not be placed out of reach can be either protected or blockaded. Some specifics on preparing your home inside and out are listed at the end of this article. Remember that childproofing a home is but the first step. Things get moved around and left open. Ongoing surveillance is crucial to the successful prevention of accidental injuries and poisonings.

Despite our best efforts, accidents will inevitably occur and we must be prepared to deal with this eventuality. Planning includes having important information at our fingertips and knowing what procedures to follow under adverse circumstances. Post the National Poison Center toll-free telephone number (1-800-222-1222) in a prominent location near the telephone in the kitchen (the room in which most poisonings occur). If you call, have the following information available:

• Your name and telephone number
• Your child's name, age and weight
• Any medical conditions your child has
• Any medicines your child takes
• The name of the item your child swallowed (and spell it)
• The amount and the time it was swallowed

Poison in the eye or on the skin should be flushed immediately with large amounts of room temperature water for at least 15 minutes.

The If possible, program your phone's speed dialing system with important emergency numbers, such as 9-1-1, that of your child's doctor and dentist. Establish a fire safety plan, which includes:

• identifying two modes of egress from every room in the house
• never returning to a burning building once having escaped
• identifying a meeting place outside the home
• assuring that fire ladders are non-flammable and can support the weight of every family member
• install type C fire extinguishers (can be used on any type of fire)
• checking fire extinguishers and smoke alarm batteries monthly and being familiar with their operation (remember the helpful mnemonic P.A.S.S., which means pull the Pin, Aim, Squeeze the handle, and Sweep the spray across the fire)
• being familiar with the stop-drop-and roll technique
• assuring easy and clear visibility of your house number from the street
• HAVING FIRE DRILLS

Homes that have playground equipment or swimming pools require special accommodations. No part of swing sets or slides should be more than six feet off the ground. The ground under this equipment should be covered by shock-absorbing material, such as wood chips or rubber mats. Pools must be fenced with a locking gate (check your local ordinances for specifications) and be supplied with life preservers (swimming tubes and "floaties" are not adequate) or life jackets. Use of any of these facilities must be continuously supervised by an adult. For pools, this adult must be CPR-competent. Small pools should be emptied after use, since small children can drown in as little as an inch or two of water.

More information and guides can be found on numerous Poison Control, Fire Safety and medical web sites, such as www.njpies.org, www.ama-assn.org, www.usfa.fema.gov, and www.fireplans.com.

Childproofing tips

Kitchen:
Never put toxic items on the kitchen table where children are trained to eat
Install child locks on cabinet doors and drawers, especially on cabinet doors under the sink where you store dangerous products
Put knives in drawers with the blades toward the rear
Keep sharp or pointed object away from the edges of counter tops
Cook on rear burners only
Remain in the kitchen while cooking
Turn pot handles away from counter edges
Latch ovens and dishwashers to prevent toddlers from climbing in
If front facing, remove oven knobs until your are ready to use them
Keep doilies and toaster and coffee pot wires from the edge of counter tops
Install a fire extinguisher and smoke alarm
Keep plastic shopping bags out of reach
Keep medicines in their childproof containers and locked up
Keep the floor clean

Bedroom:
Install a smoke alarm in each bedroom or in the hall between adjacent bedrooms
Install a carbon monoxide monitor in bedrooms near a garage, kitchen or furnace
Install "tot-finders" on children's bedroom windows (this is a sticker that alerts the firefighter that a child is in that room; tot-finders can usually be obtained from the local fire station)
Close bedroom doors at night to prevent venting a fire
Dress children only in flame-retardant sleepwear
NEVER smoke in bed

Living room:
Leave low shelves empty, especially of electronic equipment
Stabilize television stands
Install fireplace doors and have fireplace chimney cleaned yearly
Burn only wood in the fireplace (burning pieces of paper can escape)
Extinguish the fire completely before leaving the house or going to bed
Tie up drapery cords out of reach
Check the underside of furniture for protruding staple, nails and screws
Check the floor under furniture for paper clips, coins, tacks and hardened pieces of food

Bathroom:
Medicines must be in childproof containers and be kept in a high cabinet or locked up
Store toothpaste, shampoo and soap in a different cabinet from medicines
Call medicines by their correct name; do not refer to them as "candy"
Empty outdated medicines into the toilet
Keep toilet lids down
Obtain a fire ladder for window egress
Take your own medicines out of sight of children (they may try to copy you)

General:
Put small or fragile objects out of reach
NO SMOKING
Do not keep balloons in the house
Run electrical wires behind furniture, but never under rugs
Install safety electrical sockets or socket covers
Do not overload sockets
Assure that night-lights do not touch bedspreads, drapery or other fabrics
Install smoke alarms and fire extinguishers on each floor and near a hobby area
Install gates on stairs if your child is under two years old (see www.ama-assn.org/insight/h_focus/nemours/safety/product.htm for specifications)
Keep water temperature at or below 120 degrees Fahrenheit
Keep plastic garbage bags and plastic bags from dry-cleaners our of reach
Distribute flashlights in each room (either leave a re-chargeable flashlight plugged in or assure fresh batteries are available)
Install a house alarm with a panic button
Keep lit candles out of reach
Keep matches and lighters out of reach
Keep alcoholic beverages in a locked cabinet
Do not keep firearms in the house, or at least keep them locked in a separate cabinet from the Ammunition
Be sure coal, wood or kerosene burning stoves are in good working order. If you smell gas, turn off the appliance, leave the house and call the gas company
Be particularly careful at holiday times. Often adults are reveling and the children are exploring unsupervised. Ornaments, popcorn, fireplaces, toxic plants and electrical wires are frequent sources of injury and choking.

Basement or Laundry Area:
Install a fire extinguisher and smoke alarm
Keep laundry chemicals out of reach
Install hook-and-eyelet locks on basement doors and use them religiously

Attic:
Keep attic door locked
Garage:
Store tools securely and out of reach of small children
Never store non-food items (such as pesticides, kerosene, gasoline, paint thinner, fertilizer, etc.) in food containers
Install a fire extinguisher
Keep garbage pails clean and spray with insect repellent to keep bees away
Open the garage door before starting your car

Yard:
Keep barbecues inaccessible to children
Vehicles:
Always use seat belts and suitable child restraints
Keep the doors locked
Never leave the cigarette lighter socket exposed
Never leave a child in the vehicle unattended
Never leave the keys in the vehicle
Beware of seat belt buckles that can heat up in the sun
Keep the exhaust system, brakes and tires in good repair

Dr. Mark B. Levin 

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.

ŠAll rights reserved, The Pediatric Group, P.A. 2004