| INJURIES
IN THE CHILD CARE SETTING
The risk
of an injury happening is directly related to the physical environment
and children’s behaviors, and how these are managed. Injuries can
be divided into two categories--unintentional and intentional. Unintentional
injuries may result from choking, falls, burns, drowning, swallowing toxic
or other materials (poisoning), cuts from sharp objects, exposure to environmental
hazards such as chemicals, radon, or lead, or animal bites, or other “accidents.”
(Some of the common environmental hazards are addressed in the "Maintaining
a Safe and Healthy Child Care Facility" section of this booklet.)
Intentional injuries are usually due to bites, fights, or abuse.
Preventing
Injuries
You can prevent
most injuries that occur in the child care setting by:
- Supervising
children carefully.
- Checking
the child care and play areas for, and getting rid of, hazards.
- Using
safety equipment for children, such as car seats and seat belts, bicycle
helmets, and padding, such as for the knees and elbows.
- Understanding
what children can do at different stages of development. Children learn
by testing their abilities. They should be allowed to participate in
activities appropriate for their development even though these activities
may result in some minor injuries, such as scrapes and bruises. However,
children should be prevented from taking part in activities or using
equipment that is beyond their abilities and that may result in major
injuries such as broken bones.
- Teaching
children how to use playground equipment safely (e.g., going down the
slide feet first).
Preparing
for Injuries
Injuries
require immediate action. You will need to assess the injury to determine
what type of medical attention, if any, is required. Everyone working
with children should have up-to-date training in first aid and cardiopulmonary
resuscitation (CPR). At a minimum, one person with this training must
be present at the child care site at all times. The next chapter on "Establishing
Policies to Promote Health and Safety" includes a section on policies
you should use to handle injuries and other emergencies.
Unintentional
Injuries
Children
are often injured unintentionally during the normal course of a day. Many
of these injuries, such as scrapes and bruises, are minor and only need
simple first aid. Other injuries can be serious and require medical attention
beyond first aid. Call 911 or your local emergency number if an injured
child has any of the following conditions:
- severe
neck or head injury,
- choking,
- severe
bleeding,
- shock,
- chemicals
in eyes, on skin, or ingested in the mouth, or
- near-drowning.
See the first
aid chart in the next chapter for what actions to take for some common
injuries.
Hazards
in the Facility
Children
in child care have many opportunities for coming in contact with substances
that can hurt them. Child care providers can help reduce children's exposure
to these hazards by taking preventive measures. Chapter III, on "Maintaining
a Safe and Healthy Facility," gives information on preventing children’s
exposure to such harmful substances as chemicals, lead, air pollution,
and radon in the child care setting.
Intentional
Injuries
Aggressive
Behavior and Bites
Children
show aggression (hostile, injurious, or destructive behavior) either verbally
(what they say) or physically (how they act). Verbal aggression by other
children or adults, such as belittling, ridiculing, or taunting a child,
can injure a child's self-esteem. Physical aggression, such as biting,
hitting, scratching, and kicking, may result in physical injuries. Parents
have become greatly concerned about physical injuries that cause bleeding
to their child, especially being bitten by another child, because they
fear this may expose their child to a risk of infection from HIV, which
causes AIDS, or hepatitis B virus, which can cause liver damage.
To deter
aggressive behavior you should:
- Set clear
limits for children's behavior. Explain those limits to both children
and their parents.
- Explain
to a child who is showing aggressive behavior how the aggressive actions
affect the victim.
- Redirect
a child's aggressive behavior by, for example, engaging the child in
a sport or activity that interests the child.
- Teach
and reinforce coping skills.
- Encourage
children to express feelings verbally, in a healthy way.
- Provide
acceptable opportunities for children to release anger. Running outside,
kicking balls, punching bags, and other physical play allows children
to let off steam.
If a child
is bitten by another child:
- Administer
first aid.
- Ask the
parents of the injured child to seek medical care if the bite causes
bleeding.
- Notify
the parents of both children if the bite causes bleeding. Testing the
children for HIV or hepatitis B may be considered and should be discussed
with the health care providers of both children involved.
A child
who is known to be positive for HIV or hepatitis B AND who bites, even
after efforts to change the behavior, should be taken out of the child
care setting until the biting ceases.
Child Abuse
Child abuse
is harm to, or neglect of, a child by another person, whether adult or
child. Child abuse happens in all cultural, ethnic, and income groups.
Child abuse can be physical, emotional/verbal, sexual or through neglect.
Abuse may cause serious injury to the child and may even result in death.
Signs of possible abuse include:
- Physical
Abuse
- Unexplained
or repeated injuries such as welts, bruises, or burns.
- Injuries
that are in the shape of an object (belt buckle, electric cord, etc.)
- Injuries
not likely to happen given the age or ability of the child. For example,
broken bones in a child too young to walk or climb.
- Disagreement
between the child's and the parent's explanation of the injury.
- Unreasonable
explanation of the injury.
- Obvious
neglect of the child (dirty, undernourished, inappropriate clothes for
the weather, lack of medical or dental care).
- Fearful
behavior.
- Emotional/Verbal
Abuse
- Aggressive
or withdrawn behavior.
- Shying
away from physical contact with parents or adults.
- Afraid
to go home.
- Sexual
Abuse
- Child
tells you he/she was sexually mistreated.
- Child
has physical signs such as:
- difficulty
in walking or sitting.
- stained
or bloody underwear.
- genital
or rectal pain, itching, swelling, redness, or discharge
- bruises
or other injuries in the genital or rectal area.
- Child
has behavioral and emotional signs such as:
- difficulty
eating or sleeping.
- soiling
or wetting pants or bed after being potty trained.
- acting
like a much younger child.
- excessive
crying or sadness.
- withdrawing
from activities and others.
- talking
about or acting out sexual acts beyond normal sex play for age.
Abuse can
happen in any family, regardless of any special characteristics. However,
in dealing with parents, be aware of characteristics of families in which
abuse may be more likely:
- Families
who are isolated and have no friends, relatives, church or other support
systems.
- Parents
who tell you they were abused as children.
- Families
who are often in crisis (have money problems, move often).
- Parents
who abuse drugs or alcohol.
- Parents
who are very critical of their child.
- Parents
who are very rigid in disciplining their child.
- Parents
who show too much or too little concern for their child.
- Parents
who feel they have a difficult child.
- Parents
who are under a lot of stress.
If you suspect
child abuse of any kind, you should:
- Take the
child to a quiet, private area.
- Gently
encourage the child to give you enough information to evaluate whether
abuse may have occurred.
- Remain
calm so as not to upset the child.
- If the
child reveals the abuse, reassure him/her that you believe him/her,
that he/she is right to tell you, and that he/she is not bad.
- Tell the
child you are going to talk to persons who can help him/her.
- Return
the child to the group (if appropriate).
- Record
all information.
- Immediately
report the suspected abuse to the proper local authorities. In most
states, reporting suspected abuse is required by law.
If you employ
other providers or accept volunteers to help you care for the children
in your facility, you should check their background for a past history
of child abuse or other criminal activity. Contact your local police department.
Many states require that child care providers have background and criminal
history checks.
Dealing with
child abuse is emotionally difficult for a provider. As a child care provider,
you should get training in recognizing and reporting child abuse before
you are confronted with a suspected case. If you suspect a case of child
abuse, you may need to seek support from your local health department,
child support services department, or other sources within your area.
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