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[Preventing Injuries][Prepare for Injuries][Unintentional Injuries][Intentional Injuries]


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.


Note: This information is not intended to take the place of your state's or locality's child care regulations and laws. In every case, the laws and regulations of the city, county, and state in which the child care facility is located must be carefully followed even if they differ from these recommendations.

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