Safety and Prevention

2006 American Heart Association

Scene Assessment for Out-of-Hospital Providers

Conduct a
Scene
Assessment

For out-of-hospital providers a scene assessment is always the first

step before patient assessment. It is natural to want to rush to a
seriously ill or injured child and immediately begin providing care. A
brief survey of the environment, however, will identify safety concerns
and risks to emergency personnel, to caregivers, and to the child.
Once you identify risks, you can implement proper safety precautions
and improve the chances of successful rescue or resuscitation.
In assessing the scene be alert for the following:
Contaminants or communicable diseases
Environmental safety hazards
Warning signs of crime scenes or other violence
Hazardous material

Contaminants
or Communicable
Diseases

Survey the scene for risks of

contamination by blood or body fluids
communicable diseases (eg, evidence of chicken pox or
meningococcemia)
airborne contaminants
other potentially infectious material
Consistent with standard precautions, treat all human blood and body
fluids (eg, saliva) as infectious. Take other precautions based on
identified risks present at the scene. For example, in one situation
disposable gloves might be the only precaution necessary. In another
situation emergency personnel might need to protect themselves with
not only disposable gloves but also protective eyewear, masks, and in
some cases an N95 or HEPA respirator.

Environmental Safety
Hazards

Survey the scene for possible environmental safety hazards. Take

appropriate measures to ensure the safety of all emergency
personnel, caregivers, and the child before performing a patient
assessment. Examples of possible safety hazards are
downed power lines
unstable buildings due to fire or earthquakes
unstable vehicles at crash sites
oncoming traffic

2006 American Heart Association

Warning
Signs of
Crime Scenes
or Other
Violence

If dispatched to a possible crime scene or a scene where violence or

abuse has occurred, proceed cautiously. Be alert for the following
warning signs:
Loud voices or arguing
Evidence of forced entry
Weaponseither used or visible
Evidence of alcohol or drug use
Unusual silence
Evaluate the scene carefully and take appropriate actions. Remember
that your safety and the safety of your coworkers is a top priority. If the
telecommunications center did not identify the site as a crime scene
and you suspect that a crime has taken place, summon proper
authorities immediately. Never enter the scene if your safety is not
ensured.
Once at the scene note the childs environment. Look for evidence of
child abuse or possible maltreatment by the caregiver. Include any
relevant observations of the scene in the information you provide to
the receiving facility or attending physician.

Hazardous
Material

Be alert to incidents that may involve hazardous materials. Examples

of hazardous materials that you might encounter in the home or
workplace include
fuel spills or leaking gasoline
paint spills
pesticides and fertilizers
carbon monoxide (eg, detector is alarming)
unusual odors that might indicate drug manufacturing
chemicals
unidentified powders
possible explosives
Labels, shipping papers, or other materials can provide important
clues to the identification of a substance as hazardous. Special
personnel may need to be called to the scene to properly identify the
involved substances. Many cities have trained personnel that respond
to hazardous materials (hazmat) incidents as part of their duties. Local
fire departments have contact information for agencies that provide
guidance in toxicology, biologic and disease hazards, and hazardous
chemicals. The local poison control center is another resource if there
is a concern about an ill or injured child.

2006 American Heart Association

Reducing the Risk of SIDS

Introduction

Sudden infant death syndrome (SIDS) is a major cause of death

in infants under 1 year of age, with the most deaths occurring in
infants from 2 to 4 months of age.1 SIDS is sometimes called
crib death. This type of death occurs suddenly and cannot be
explained, even after a thorough case investigation, a complete
autopsy, examination of the death scene, and review of the
clinical history.2

Risk Factors
for SIDS

The cause of SIDS is unknown. Probably a variety of conditions

caused by several mechanisms are involved, including
rebreathing asphyxia with decreased arousal and possibly
blunted response to hypoxemia or hypercarbia.3
SIDS occurs much more frequently in infants who sleep prone
(on their abdomen) than in infants who sleep supine (on their
back) or on their side.4-6 The prone position, particularly on a
soft surface, is thought to contribute to rebreathing asphyxia.3
This type of asphyxia occurs when air is trapped close to the
infants mouth and nose, resulting in rebreathing (breathing of
expired air). Rebreathing reduces inspired oxygen and
increases carbon dioxide.
Primary risk factors of SIDS include

prone sleeping position

sleeping on a soft surface5,6
second-hand smoke7,8

Other factors that have been associated with an increased risk

of SIDS include winter months, lower family income, male
gender, a mother who smokes cigarettes or is addicted to
drugs, a history of apparent life-threatening events, and low
birth weight. Parent-infant bed sharing may also increase the
risk of SIDS.9

Risk
Reduction of
SIDS

The incidence of SIDS declined 40%10 after the Back to Sleep

public education campaign was introduced in the United States
in 1992. This campaign educates caregivers to place infants on
their backs to sleep as opposed to placing them on their
abdomens.

2006 American Heart Association

The American Academy of Pediatrics Task Force on SIDS

issued a policy statement in 2005.11 Recommendations to
reduce the risk of SIDS are outlined in this statement and are
summarized below.

2
3
4
5

6
7

Recommendation
Place the infant on the back (ie, in a supine position)
for sleeping. Note: Side sleeping is not as safe and is
not advised.
Place the infant on a firm sleep surface. A firm
mattress with appropriate covering is recommended.
Do not place soft objects or loose bedding around
the infant during sleep.
Avoid smoking during pregnancy.
Place the infant in a separate but proximate sleeping
environment. Bed sharing for infant sleeping, as
practiced in the United States and other Western
countries, is associated with an increased risk of SIDS
compared with the alternative of a separate sleep
surface. The risk of SIDS has been shown to be reduced
when the infant sleeps in a crib, bassinet, or alternative
in the same room as the mother. The American Academy
of Pediatrics recommends that the infant may be brought
into the parents bed for nursing or comforting but should
be returned to the infants own crib or bassinet when the
parent is ready to return to sleep.
Consider offering a pacifier. The reduced risk of SIDS
associated with pacifier use is compelling.
Avoid overheating. Clothe the infant lightly for sleeping.
Bedroom temperature should be kept comfortable for a
lightly clothed adult. Avoid overbundling.
Avoid commercial devices that are marketed to
reduce the risk of SIDS. There is no evidence that use
of various commercial devices decreases the incidence
of SIDS.
There is no evidence that the use of home monitors
decreases the incidence of SIDS.

More information on the AAP policy statement is available on

the world wide web at:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/5/1245.
Accessed August 31, 2006.

2006 American Heart Association

References

1.

2.

3.
4.

5.
6.

7.

8.

9.
10.
11.

Changing concepts of sudden infant death syndrome: implications for infant

sleeping environment and sleep position. American Academy of Pediatrics. Task
Force on Infant Sleep Position and Sudden Infant Death Syndrome. Pediatrics.
2000;105:650-656.
Willinger M, James LS, Catz C. Defining the sudden infant death syndrome
(SIDS): deliberations of an expert panel convened by the National Institute of
Child Health and Human Development. Pediatr Pathol. 1991;11:677-684.
Brooks J. Sudden infant death syndrome. Pediatr Ann. 1995;24:345-383.
Positioning and sudden infant death syndrome (SIDS): update. American
Academy of Pediatrics Task Force on Infant Positioning and SIDS. Pediatrics.
1996;98:1216-1218.
American Academy of Pediatrics AAP Task Force on Infant Positioning and
SIDS: Positioning and SIDS. Pediatrics. 1992;89:1120-1126.
Willinger M, Hoffman HJ, Hartford RB. Infant sleep position and risk for sudden
infant death syndrome: report of meeting held January 13 and 14, 1994, National
Institutes of Health, Bethesda, MD. Pediatrics. 1994;93:814-819.
Tong EK, England L, Glantz SA. Changing conclusions on secondhand smoke in
a sudden infant death syndrome review funded by the tobacco industry.
Pediatrics. 2005;115:e356-e366.
Anderson ME, Johnson DC, Batal HA. Sudden Infant Death Syndrome and
prenatal maternal smoking: rising attributed risk in the Back to Sleep era. BMC
Med. 2005;3:4.
Carroll-Pankhurst C, Mortimer EA, Jr. Sudden infant death syndrome,
bedsharing, parental weight, and age at death. Pediatrics. 2001;107:530-536.
Hoyert DL, Kochanek KD, Murphy SL. Deaths: final data for 1997. Natl Vital Stat
Rep. 1999;47:1-104.
Filiano JJ, Kinney HC. Sudden infant death syndrome and brainstem research.
Pediatr Ann. 1995;24:379-383.

2006 American Heart Association

Sudden Cardiac Arrest

Introduction

Sudden cardiac arrest (SCA) due to ventricular fibrillation (VF)

or ventricular tachycardia (VT) is uncommon in infants and
children. SCA becomes more common in adolescents. An
estimate of cases in the United States is approximately 500
episodes per year1 Warning prodromal symptoms such as
syncope, near-syncope, or chest pain are experienced in only
half of patients.3

Causes of
SCA

Causes of pediatric SCA are largely cardiac (see the Table and
the Figure).2,4 Hypertrophic cardiomyopathy was present in
approximately 36% of patients with SCA in one study.5
Anomalous origin of the left coronary artery from the right
coronary cusp (with the coronary vessel coursing between the
aorta and pulmonary artery) was present in another 19% of
patients in the same study.5 Long QT syndrome, another cause
of pediatric SCA, is being diagnosed with increased frequency
in children and adolescents.6 Commotio cordis, caused by a
sudden blow to the chest during the repolarization of the
myocardium, is also a rare cause of SCA in children and
adolescents. Among drugs of abuse and stimulants causing
pediatric SCA are ephedra and cocaine. All of the conditions
listed in the Table can lead to VF or VT.

Figure. Causes of SCA in Young Athletes. Based on percentages from

Maron BJ. Sudden death in young athletes. N Engl J Med. 2003;349:10641075.

2006 American Heart Association

Prevention

Prevention of SCA involves both primary and secondary

prevention measures. Primary prevention involves

screening for risk factors

identifying the patient at risk and referring for treatment
increasing public awareness

Secondary prevention involves

Screening for
SCA Risk
Factors

prompt recognition, high-quality resuscitation, and AED

use in the out-of-hospital setting (CPR training and lay
rescuer AED)
school emergency medical response plan

Healthcare providers should screen for SCA risk factors.

Because many of the causes of SCA are genetic, once a first
affected family member is identified, comprehensive
investigation of further familial involvement is critical. Routine
screening with a preparticipation athletic evaluation form listing
questions about the patient and family history that may reveal a
risk of SCA is appropriate. Such a form endorsed by the
American Academy of Pediatrics (AAP), American Academy of
Family Physicians, American College of Sports Medicine,
American Medical Society for Sports Medicine, American
Orthopaedic Society for Sports Medicine, and American
Osteopathic Academy of Sports Medicine can be found at
www.aap.org/sections/sportsmedicine/spmedeval.pdf.
Routine electrocardiogram and echocardiogram screening is
not cost-effective and can lead to misdiagnosis.7 Such tests
should be used at the discretion of the healthcare provider
based on findings of the history and physical examination.

Identifying the
Patient at
Risk and
Referring for
Treatment

Questions that may reveal patient risk or family history of SCA

should be asked of any active child or adolescent in the office
setting or emergency department. This is particularly true if the
patient is being evaluated for seizure, syncope, complex
ventricular arrhythmia, or palpitations. The physical examination
may reveal specific findings, such as abnormal blood pressure
or pulses, heart murmur, arrhythmia, or syndromic features.8
Attention, however, should be focused primarily on patient and
family history because many children and adolescents at risk for
SCA do not have significant physical examination findings.

2006 American Heart Association

If the history or physical examination leads to a suspicion of risk

for SCA, refer the patient to a pediatric cardiologist with
expertise in diagnosing and managing the uncommon cardiac
disorders causing SCA. Appropriate treatment including medical
therapy, activity restriction, and other modalities may be
implemented once a diagnosis of risk factors for SCA is
confirmed.

Increasing
Public
Awareness

Make the effort to educate families and your local community

about warning signs of SCA.

Resuscitation
in the Field

When SCA is suspected (a sudden collapse in an otherwise

healthy person), the lone healthcare provider should activate
the EMS system and get an AED (if available) and then return
to the victim to start CPR, because rapid defibrillation and CPR
are the keys to survival. When several bystanders are present,
one rescuer can remain with the victim to begin CPR while
another activates the EMS system and gets the AED.
CPR training and lay rescuer AED programs offering
comprehensive training in the use of an AED are proliferating in
public sites and schools around the United States. When an
AED is not immediately available, high-quality CPR can prolong
the duration of VF (thus prolonging the duration of time
defibrillation may be attempted) and may double or triple
survival at any interval to defibrillation.

School
Emergency
Response
Plans

The Medical Emergency Response Plan for Schools was

introduced by the AHA in January 2004 and endorsed by the
American Academy of Pediatrics, the American College of
Emergency Physicians, the National Association of School
Nurses, and the American Red Cross.9 This public health
initiative encourages schools to implement a plan to respond to
life-threatening medical emergencies. It consists of 5 core
elements:

Effective and efficient campus communication (links all

parts of the campus, including field houses, modular
classrooms, and practice and playing fields; enables
school personnel or students to activate the EMS system
immediately when an emergency occurs)
Coordinated and practiced response plan (should be

2006 American Heart Association

Criteria for
Lay Rescuer
AED
Programs

developed in concert with the school nurse, school or

athletic team physicians, athletic trainers, and local EMS
providers)
Risk reduction (includes safety precautions to prevent
injuries and identification of students and staff with
medical conditions that may result in SCA)
Training and equipment for first aid and CPR (several
teachers should be trained as CPR and first aid
instructors, and all high school students should receive
training in CPR)
Implementation of lay rescuer AED program in schools
with an established need (see Criteria for Lay Rescuer
AED Programs)

Criteria for established need of a lay rescuer AED program are

reasonable probability of AED use within 5 years or an

incident necessitating such use within the past 5 years
child or adult in the school believed to be at risk for SCA
EMS call-toshock time (interval from EMS notification to
defibrillator placement) <5 minutes cannot be achieved
reliably with conventional EMS services, and collapsetoshock time (interval from victim collapse to defibrillator
placement) <5 minutes can be achieved reliably by
training and equipping lay first responders

Criteria used in the North American Public Access Defibrillation

study to predict sites of likely adult SCA were sites having >250
adults over 50 years of age present for >16 hours per day.10

Four
Elements for
Success of
Lay Rescuer
AED
Programs

Four elements are critical to the success of a lay rescuer AED

program:

Planned and practiced response (typically this requires

oversight by a healthcare provider)
Training of anticipated rescuers in CPR and use of an
AED (including updates as needed)
Coordination with the local EMS system
Process of ongoing quality improvement (with practice
drills and incident assessment)

Article adapted from Ellison A, Riehle TJ, Berger S, Campbell RM.

Preventingwith the goal of eradicatingsudden cardiac death in
children.
Contemporary Pediatrics. Oct 1, 2005

2006 American Heart Association

10

References

1.

2.
3.
4.
5.

6.

7.
8.
9.

10.

Berger S, Kugler JD, Thomas JA, et al. Sudden cardiac death in children and
adolescents: introduction and overview. Pediatr Clin North Am. 2004;51:12011209.
Maron BJ. Sudden death in young athletes. N Engl J Med. 2003;349:1064-1075.
Liberthson RR. Sudden death from cardiac causes in children and young adults.
N Engl J Med. 1996;334:1039-1044.
Riehle TJ, Campbell RC. Screening for sudden cardiac death using the
preparticipation physical exam. Congenital Cardiol Today. 2005;3:12.
Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive
athletes. Clinical, demographic, and pathological profiles. Jama. 1996;276:199204.
Vincent GM. The Long QT and Brugada syndromes: causes of unexpected
syncope and sudden cardiac death in children and young adults. Semin Pediatr
Neurol. 2005;12:15-24.
Seto CK. Preparticipation cardiovascular screening. Clin Sports Med.
2003;22:23-35.
Facial features clue to new syndrome. http://www.hopkinschildrens.org/
pages/news/CCNSpring05/patient.html. Accessed September 9, 2005.
Hazinski MF, Markenson D, Neish S, et al. Response to cardiac arrest and
selected life-threatening medical emergencies: the medical emergency response
plan for schools: A statement for healthcare providers, policymakers, school
administrators, and community leaders. Circulation. 2004;109:278-291.
The Public Access Defibrillation Trial Investigators. Public-access defibrillation
and survival after out-of-hospital cardiac arrest. N Engl J Med. 2004;351:637646.

2006 American Heart Association

11

Child and Infant

Safety Checklist
The Safety Checklist can help you learn risks for injury at home, in the car, at childcare centers, at schools,
and on playgrounds. The Safety Checklist also tells you what to do to reduce risk. It is impossible to eliminate every risk for every child. For this reason, you must know how to respond to an emergency.

Action

I follow this
safety
precaution
( = yes)

Purchase of safety
item is required for
all shaded boxes
( = item purchased)

Car Safety
1. Make sure that every person in the car buckles up correctly.
2.Have children who are less than 12 years old ride in the
BACK seat and use correct child restraints or lap-shoulder
restraints for age.
3.Use a rear-facing infant safety seat for infants until they
weigh at least 20 lb (9 kg) and are 1 year old.
Secure all car seats in the BACK seat of the car.
Secure the seat according to the manufacturers instructions.
To see if the seat is secure, try to push the seat forward,
backward, and side-to-side. Tighten the belt to be sure
that the seat does not move more than inch (1 cm).
For proper adjustment, the seat belt buckle and latch
plate (if needed) must be located well below the frame or
toward the center of the seat.

S
 afety item
Infant safety seat

4.Wait until a child weighs 20 lb (9 kg) and is at least 1 year old

and can sit with good head control before using a convertible
seat or toddler seat in the forward-facing position. Secure
these seats in the BACK seat of the car.

S
 afety item
Child safety seat

5.Use a belt-positioning booster seat for children who weigh

40 to 80 lb (18 to 36 kg). Secure the seat with a 3-point seat
belt (lap and shoulder belt) in the BACK seat of the car.
If a shield is provided, fasten it close to the childs body.
Properly install the tether harness if required.

S
 afety item
Belt-positioning
booster seat

6.Children cannot be properly restrained with a lap-shoulder

belt until they are at least 4 feet 9 inches (58 inches or 148
cm) tall, weigh 80 lb (36 kg), and can sit in the automobile
seat with their knees bent over the edge. Always use a combination lap-shoulder belt to restrain children sitting in an
automobile seat.
The shoulder belt should fit across the shoulder and
breastbone. If it crosses the childs face and neck, use
a belt-positioning booster seat to be sure that the belt is
properly placed. Do not hook the shoulder belt under the
childs arm.
All children 12 years old or younger should ride in the
BACK seat.
2006 American Heart Association

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Action

I follow this
safety
precaution
( = yes)

Purchase of safety
item is required for
all shaded boxes
( = item purchased)

General Indoor Safety

7.Place a sticker with emergency phone numbers near or on
the phone. Include numbers for the EMS system, police, fire
department, local hospital or physician, the poison control
center in your area, and your telephone number.

S
 afety item
Phone sticker
with emergency
response numbers

8.Install smoke detectors on the ceiling in the hallway outside

areas where children sleep or nap and on each floor at the
head of stairs. Test the alarm monthly and replace batteries
twice a year (for example, in the fall and spring when the
time changes to and from daylight saving time).

S
 afety item
Smoke detector

9.Make sure that there are two unobstructed emergency exits

from the home, childcare center, classroom, or other area
where children are likely to be present.
10. Develop and practice a fire escape plan.
11. Make sure that a working fire extinguisher is available.

S
 afety item
Fire extinguisher

12.Make sure that all space heaters are safety approved. They
should be in safe operating condition. They should be
placed out of a childs reach and at least 3 feet from curtains, papers, and furniture. The heaters should have protective covers.
13.Make sure all wood-burning stoves are inspected yearly
and vented properly. Place stoves out of a childs reach.
14.Make sure that electrical cords are not frayed or overloaded. Place out of a childs reach.
15.Install shock stops (plastic outlet plugs) or outlet covers
on all electrical outlets.

S
 afety item
Plastic outlet
plugs

16.To prevent falls, always keep one hand on an infant sitting

or lying on a high surface such as a changing table.
17.Place healthy full-term infants on their back or side to sleep.
Do not place infants on their stomach to sleep.
18.Make sure the crib is safe:

The crib mattress fits snugly with no more than two

fingers width between the mattress and crib railing.

The distance between crib slats should be less than

2 /8 inches (so the infants head wont be caught).
Do not put any fluffy material, stuffed animals, or fluffy
blankets or comforters in the crib with the infant
19.Be sure that stairs, railings, porches, and balconies are
strong and in good repair.
2006 American Heart Association

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Action

I follow this
safety
precaution
( = yes)

Purchase of safety
item is required for
all shaded boxes
( = item purchased)

20. Keep halls and stairs lighted to prevent falls.

21.Put toddler gates at the top and bottom of stairs. (Do not
use accordion-type gates with wide spaces at the top. The
childs head could become trapped in such a gate, and the
child could strangle.)

S
 afety item
Toddler gates
(NOT accordiontype)

22. Do not let your child use an infant walker.

23.To prevent falls, put locks (available at hardware stores) on
all windows. Put gates on the lower part of open windows.

Safety

item
Window locks,
gates

24.Store medicines and vitamins in child-resistant containers

out of a childs reach.

Safety

item
Child-resistant
containers

25. Store cleaning products out of a childs sight and reach.

Store and label all household poisons in their original

containers in high locked cabinets (not under sinks).

Do not store chemicals or poisons in soda bottles.

Store cleaning products away from food.

26. Install safety latches or locks on cabinets that contain

potentially dangerous items and are within a childs reach.

Safety

item
Safety latches or
locks on cabinets

27.Keep purses that contain vitamins, medicines, cigarettes,

matches, jewelry, and calculators (which have easy-to-swallow button batteries) out of a childs reach.
28.Install a lock or hook-and-eye latch on the door to the
basement or garage to keep children from entering those
areas. Put a lock at the top of the doorframe.

S
 afety item
Latch on basement, garage
doors

29.Keep plants that may be harmful out of a childs reach.

(Many plants are poisonous. Check with your poison control
center.)
30.Make sure that toy chests have lightweight lids, no lids, or
safe-closing hinges.

2006 American Heart Association

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Action

I follow this
safety
precaution
( = yes)

Purchase of safety
item is required for
all shaded boxes
( = item purchased)

Kitchen Safety
31. To reduce the risk of burns:

Keep hot liquids, foods, and cooking utensils out of a

childs reach.

Put hot liquids and food away from the edge of the table.

Cook on back burners when possible and turn pot handles toward the center of the stove.

Avoid using tablecloths and placemats that can be

pulled, spilling hot liquids or food.

Keep high chairs and stools away from the stove.

Do not keep snacks near the stove.

Teach young children the meaning of the word hot.

32.Keep all foods and small items (including balloons) that can
choke a child out of reach. Test toys for size with a toiletpaper roll. If a toy can fit inside the roll, it can choke a small
child.
33. Keep knives and other sharp objects out of a childs reach.
Bathroom Safety
34.Bathe children in no more than 1 or 2 inches of water. Stay
with infants and young children throughout bath time. Do
not leave small infants or toddlers in the bathtub in the care
of young siblings.
35.Use skid-proof mats or stickers in the bathtub.

S
 afety itembath
mats or stickers

36.Adjust the maximum temperature of the water heater to

120 to 130F (48.9 to 54.4C) or medium heat. Test temperature with a thermometer.
37.Keep electrical appliances (radios, hairdryers, space heaters, etc) out of the bathroom or unplugged, away from
water, and out of a childs reach.
Firearms
38.If firearms are stored in the home, keep them locked and
out of a childs sight and reach. Lock and unload guns individually before storing them. Store ammunition separate
from the firearms.

S
 afety item
trigger lock,
lockboxes for
firearms

Outdoor Safety
39.Make sure playground equipment is assembled and
anchored correctly according to the manufacturers instructions. The playground should have a level, cushioned surface such as sand or wood chips.
2006 American Heart Association

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Action
40. Make sure your child knows the rules of safe bicycling:
Wear a protective helmet.
Use the correct-size bicycle.
Ride on the right side of the road (with traffic).
Use hand signals and wear bright or reflective clothing.

I follow this
safety
precaution
( = yes)

Purchase of safety
item is required for
all shaded boxes
( = item purchased)
S
 afety item
Bicycle helmet

41. Do not allow children to play with fireworks.

42.Make sure your child is properly protected while roller skating or skateboarding:
Wear a helmet and protective pads on the knees and
elbows.
Skate only in rinks or parks that are free of traffic.

S
 afety item
Helmet and
protective
padding

43.Make sure your child is properly protected while riding on

sleds or snow disks.
Sled only during daylight hours and only in a safe, supervised area away from motor vehicles.
44.Make sure your child is properly protected while participating in contact sports:
Proper adult instruction and supervision are provided.
Teammates are about the same weight and size.
Appropriate safety equipment is used.

Safety item
Safety equipment
for contact sports

45. To reduce the risk of animal bites, teach your child

How to handle and care for a pet.
Never to try to separate fighting animals, even when a
familiar pet is involved.
To avoid unfamiliar animals.
46.If you have a home swimming pool, make sure the pool is
totally enclosed with fencing that is at least 5 feet high and
that all gates are self-closing and self-latching. There should
be no direct access (without a locked gate) from the home
into the pool area. In addition:
An adult must always supervise children while they swim.
Never allow a child to swim alone.
Change young children from swimsuits into street
clothes, and remove all toys from the pool area at the
end of swim time.
All adults and older children should learn CPR.
Pools on nearby properties should be protected from use
by unsupervised children.

2006 American Heart Association

Safety item
5-foot fence
around swimming
pool with
self-closing,
self-latching gate

16

Note: Much of the safety information presented in this table is based on the SAFEHOME program and
the Childrens Traffic Safety Program at Vanderbilt University in Nashville, Tenn. The Massachusetts
Department of Public Health developed the SAFEHOME program as part of its Statewide Comprehensive
Injury Prevention Program. The Federal Division of Maternal and Child Health funded the SAFEHOME program. The Department of Transportation and the Tennessee Governors Highway Safety Program funded
the Childrens Traffic Safety Program.

2006 American Heart Association

17