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6 Ways to Save Your Child's Life

It's a natural instinct: You see a TV report about a violent prowler a hundred miles away, and that night you double-bolt your front door and wonder if your 4-year-old's bedroom window is unlocked.

The next morning, running late, you let your son  -- just this once  -- get strapped into the backseat without climbing into his booster seat because he's already had one tantrum this morning (over the new cereal that turned his milk a funny color), because he insists that the seat is "for babies," and because...did we mention you're running late? Yes, car accidents are a lot more common than prowlers, but you'll drive slowly. Let's face it: We're not always smart about which safety precautions make a difference. "Everyone's bombarded with information about different risks, and it can be tricky to sort out what's truly big," says Kim Thompson, an associate professor of risk analysis at the Harvard School of Public Health, where she directs the Kids Risk Project. "Scary, sensational news can lead us to believe that less common risks are bigger than what really matters."

Yet for every danger we blow out of proportion, there's a crucial one we let slip. It's easy to be derailed -- by our moms ("We didn't do that with you, and you're still here"), other moms ("Aren't you being a little neurotic?"), even doctors who downplay concerns ("That's okay, if you want to").

For a simple plan to protect kids, read on.

No smoking allowed!

Make your home a no-smoking section
Benefit: Reduces risks of respiratory illness and fire

Your new baby's health -- not to mention your own -- depends on it. "In homes in which parents smoke, we see much more SIDS, asthma, pneumonia, and ear infections among children," says John Sattenspiel, M.D., a spokesperson for the American Academy of Family Physicians. Parental smoking is the cause of at least 150,000 annual new cases of lower respiratory tract infections (such as bronchitis and pneumonia) in babies under 18 months, and at least 200,000 new cases of childhood asthma. As schoolchildren, kids raised around smoke may perform worse on math and reading tests; as adults, they're more likely to get lung cancer.

Yet 40 percent of kids under age 5 live in a household with a smoker. If your home still has one, at least make this firm commitment: No smoking in the house or car. Studies show that limiting smoking to one room still means high nicotine levels throughout the house. Smokeless ashtrays don't do much, either. If someone smokes, it needs to be outside.

Remember, too, that where there's a smoker, there's fire  -- and the tiny flame of a lighter or match can quickly prove fatal in the hands of a child. More than 300 children ages 5 and younger die in fires every year, most often from playing with lighters or matches.

Fire prevention:

* Keep matches and lighters far above children's reach.

* Remind visiting smokers to keep supplies with them (no matches on the kitchen table) and away from kids.

* Every home, even one with no smokers, needs a working smoke alarm on each floor, near the bedrooms.

Caution in the water

Keep your eyes on a bathing baby
Benefit: Reduces risk of drowning

Each year, more than 50 babies under age 1 drown, usually at home in a bathtub. "That number could drop almost to zero if babies in tubs were watched at every moment -- no leaving for 'just a minute' to answer the phone," says Kim Thompson of Harvard's Kids Risk Project. Bathing babies need "touch supervision," meaning an adult caregiver -- not just an older sibling -- is within arm's reach at all times.

Water precautions:

* Gather everything you need before your baby gets into the tub: towels, shampoo, cell, or cordless phone.

* If you can't ignore a doorbell (or the ringing phone, if you forgot to bring it with you), scoop up your baby in a towel and bring him along with you. Yes, your bathroom floor will get wet, and you might need another dry towel later for the baby (and you), but safety first.

* A bath seat is not meant to be a safety device. "It frees up your hands, but you still have to keep your eyes on your baby at all times," says Thompson.

* Empty any buckets of water you've used while cleaning as soon as the job is done. "A container with as little as two inches of water is a hazard, especially with top-heavy toddlers, who can't get out if they fall in headfirst," says Thompson.

* Put a safety lock on your toilet seats until your child's ready for potty training, usually between ages 2 and 3.

* Extend touch supervision to the pool and beach up to age 5, even if your child's had swimming lessons and can stay afloat. "Don't be overconfident, thinking he won't get in trouble," says Thompson. "There's no substitute for supervision."

Sleep safety

Make a secure sleeping zone
Benefit: Reduces risks of SIDS and suffocation

Each year, about 2,000 seemingly healthy babies go to sleep and never wake up. Sudden infant death syndrome (SIDS) is the leading cause of death among babies between 1 month and 1 year. The key to prevention remains putting infants to sleep on their backs, not their sides or stomachs (before the "Back to Sleep" campaign began in 1994, three times as many babies died each year). "Be sure all other caregivers do the same," says James Kemp, M.D., associate professor of pediatrics at Saint Louis University School of Medicine. Some grandparents still favor tummy sleeping for babies, mistakenly thinking that back sleeping causes choking. In truth, a baby who's used to back sleeping is at particularly high risk of SIDS if she's then put to sleep on her tummy. (Back-sleeping babies need plenty of tummy time  -- but only when they're awake.)

But back sleeping isn't protective if it's on your big bed, says Dr. Kemp. Yes, it's easier to nurse if you're co-sleeping, and there's evidence breastfeeding helps prevent SIDS. That's one reason the American Academy of Pediatrics's new breastfeeding guidelines (for the first time) suggest that moms and babies sleep "in proximity to each other." But that doesn't mean in your bed. When your baby's had her fill, put her to bed in a roll-away crib in your bedroom if you want to keep her close, or in a bassinet that attaches to your bed.

Nor should you let down your guard once your baby's past the peak risk of SIDS, which drops off after 6 months and disappears by age 1. Kids' rooms are also a common site of suffocation. In 2002, the most recent year for which statistics are available, 710 babies under age 1 died from suffocation, as did 75 children ages 1 to 5.

Safeguard the nursery:

* Be sure the mattress fits tightly against the frame.

* Tuck sheets and blankets beneath the mattress so they go no higher than your baby's chest; better yet, zip her into a blanket sleeper.

* Select simple furnishings and bedding: no corner posts and knobs that can catch clothing around the neck; no decorative cutouts that could entrap a child's head; no pillows, fluffy comforters, or puffy bumper pads that could cover the face.

* Decline any borrowed, hand-me-down, or hotel/motel crib that fails the soda-can test: If a soda can is able to pass through the slats, your baby's head could get stuck.

* Watch out for window-covering cords that a child can grab and wrap around the neck. Since the mid '90s, blinds have been redesigned without looped cords to eliminate the hazard, but if your home still has an older, dangerous style, cut the loop in half or call 800-311-7996 to request a free repair kit provided by the Home Safety Council.

Vaccine safety

Stay on top of vaccines  -- even ones that aren't required
Benefit: Reduces risk of potentially fatal illness

"Vaccines are one of the top two lifesavers for kids, right up there with clean water," says Paul Offit, M.D., chief of infectious diseases at the Children's Hospital of Philadelphia. Today more kids than ever get their routine immunizations by the recommended ages. Work with your pediatrician to make sure your child does, too, and also consider whether she may benefit from certain nonroutine ones.

Vaccines: Beyond the mandatory

* Influenza: It's now recommended for all children ages 6 to 24 months  -- the most likely group to be hospitalized -- but kids older than 2 also benefit from flu protection.

* Hepatitis A: This liver disease sickens thousands and kills 100 people in the United States each year. Your child should be vaccinated if you live in Alaska, Arizona, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah, or Washington, and it may be a good idea for certain children in Arkansas, Colorado, Missouri, Montana, Texas, and Wyoming.

* Planning international travel? Check to see whether any vaccines are recommended for you and your child where you're going. Don't rely on what's mandatory-that's just to protect the country you're visiting, not your family. The best site is the one run by the Centers for Disease Control and Prevention.

Choking concerns

Watch out for small foods
Benefit: Reduces risk of choking

Some of a kid's favorite foods -- hot dogs, grapes, carrots, raisins, cheese cubes, peanut butter, hard or chewy candies -- can prove deadly if they get stuck in her small airways.

The risk extends well beyond toddlerhood. Joan Adler of Warren, New Jersey, learned this in the hardest way possible when her 4-year-old son, Eric, choked to death on a cut-up hot dog. Even though her pediatrician stopped giving food warnings after age 2, she continued to slice hot dogs for her son. But she was unaware that the coin-size pieces she understood to be safe could still plug a child's airway.

Several large food firms include choking-hazard labels on potentially dangerous foods, and consumer advocates want the federal government to require that all do.

Watch out for non-food choking hazards, too: coins, small balls, balloons, rings, pen caps, pop-tops, or gum.

To make food safe for a child 4 or under:

* Slice hot dogs lengthwise in half, and then in half again; then cut them into pieces no bigger than a quarter-inch wide.

* Cut grapes into quarter-inch pieces

* Chop meat or cheese into very small pieces -- remember that your child's gullet is not much wider than one of his fingers.

* Spread peanut butter thinly, and never serve from a spoon.

* Don't serve raw vegetables (such as carrots), nuts, seeds, raisins, dried fruit, popcorn, hard candies, jelly beans, caramels and chewy candies, gum, or marshmallows.

Safety on the road

Protect your child on the road
Benefit: Reduces risk of serious motor-vehicle injuries

"The last decision my husband made was to buckle our six-year-old daughter into a booster seat  -- and that saved Stephanie's life," says Laurie Tonegato of Atascadero, California. Stephanie not only survived the rollover accident that took her father's life, but she escaped with only a broken collarbone. "The seat belt fit just as it was supposed to," says Tonegato. "The police who responded to the scene said if she hadn't been in the booster, the belt would have been over her throat, and the impact would have killed her."

Motor-vehicle crashes are the leading killers of kids ages 1 to 7 -- about 900 a year. Most parents are diligent about putting babies and young children in car seats, but booster-seat use is low. More than half of all states now mandate not just car seats but boosters, which position children ages 4 to 8 or older so the seat belt fits snugly across the chest (not the neck). A child in a booster has only one-quarter the risk of a serious head injury in a crash compared to one in a lap-and-shoulder belt. He's also protected from "seat-belt syndrome" -- abdominal or spinal injuries caused when the lap belt rides over the stomach in a car crash.

Even if your state doesn't require a booster, insist that your child ride in one. If he protests that they're "for babies," point out that he'll be able to see out the window better. Be firm.

To keep a child safe, from his first car trip on:

* Use a rear-facing seat until your baby is at least 1 year old, no matter what he weighs; then you may switch to a forward-facing, five-point harness model.

* Move to a booster when your child outgrows the harness. A booster can be used until a child weighs 80 to 100 pounds, depending on the model; check the manufacturer's instructions. (Do not use a shield booster  -- the type with a padded arm across the front, originally designed for lap-only belts and children weighing 20 to 40 pounds. They're not safe.)

* Since 2002 cars and safety seats have a LATCH system for easy installation. But some seats are safer if attached with the car's seat belts (the old way). Check with your seat's manufacturer (the number's in the instruction booklet). Also use seat belts to attach car seats if your child is 48 pounds or more.

* Your child can graduate from the booster to an adult seat belt when he can sit for the whole trip with his back against the seat, knees bent comfortably over the edge. The belt should cross the shoulder between the neck and arms, and the lap belt should ride low, touching the thighs.

* Until your child turns 13, he needs to ride in the backseat. A study in the March issue of Pediatrics found that even kids who are properly restrained in the front seat are nearly twice as likely to be seriously injured in a crash compared to those properly restrained in the backseat.

* Not sure your child seat or booster seat is positioned correctly? Find out where to get it checked for free in your area. If you'd rather learn how to do it yourself, check out www.carseat.org or call 800-745-SAFE.

* Drive the safest car you can buy. If you have an SUV, which is more prone to rollovers than other vehicles, check your tire pressure monthly and don't overload it; if you're buying a new one, make sure it has an electronic stability control system.

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