Health Manager Orientation Guide

Safety and Unintentional Injury Prevention

Boy wearing a helmet while riding his bicycle.Young children develop rapidly, exploring and experimenting as they build new skills. To do so, they need to have safe environments with adults who are actively supervising them. Most injuries are not accidents. They are predictable and preventable, and staff who are intentionally committed to safety can help keep children from getting injured.

This chapter addresses unintentional injuries, which occur when someone did not mean to cause harm. It does not cover injuries that occur when someone causes harm on purpose, such as child abuse, gun violence, and abusive head trauma.

Children are safer when everyone works together to improve injury prevention strategies in homes, centers, and the community. No matter where your program provides services, health managers work with their management team and partners to make sure that children are protected from hazards and are well supervised. To create safe environments, programs need policies and procedures that support injury-free spaces.

Licensing and other regulatory systems also establish health and safety requirements to ensure the well-being of children in all program settings. Knowing your applicable state, territory, tribal, and local licensing requirements will help to ensure your program is as safe as possible and follows safety regulations. Search the National Database of Child Care Licensing Regulations to find regulations for your jurisdiction. When state, territory, tribal, or local requirements differ from Head Start requirements, programs must apply the stricter requirement. Caring for Our Children Online Standards Database includes best practices related to safety and injury prevention.

Head Start Health Services Competencies

CFH-1 Believe that children and families have the right to be healthy and safe.

CFH-25 Plan and oversee ongoing training to meet programmatic health and safety requirements.

HSPPS Related to Safety and Unintentional Injury Prevention

Social Determinants of Health and Equity Considerations

Children of color, children who live in poverty, or children who live in rural or frontier communities are more likely to experience injuries. These children also have less access to treatment and may have worse outcomes because of racial, economic, and structural inequities. For example, rates of drowning deaths are higher for Black and American Indian and Alaska Native children than children of other races and ethnicities. Drowning deaths are also more common in the South than in other regions of the U.S. Black children are also at an increased risk for fire and burn injuries, pedestrian injuries, falls, and unintentional suffocation in infants.

Sources of Injury Data

See the Centers for Disease Control and Prevention (CDC) WISQARS™ Injury Data for more information about trends in childhood injuries. Review Moving Towards Health Equity: Understanding and Addressing Child and Adolescent Injury Disparities to learn more.

Some of the social determinants of health that influence injury rates and outcomes for young children include access to safe housing and community spaces, health care, nutrition, living conditions, family economic status, and vehicle safety. Addressing these underlying causes of health disparities is an important step in preventing injuries. To address disparities in drowning rates, for example, Head Start programs could provide family education about drowning risks, promote swimming lessons, ensure that all nearby pools and other bodies of water have fences and self-latching gates, and promote constant active supervision whenever children are near water.

Injuries can be very stressful to children and may even result in traumatic stress reactions causing disruptions in a child’s development and behavior. When children are repeatedly or chronically in environments that do not keep them safe, this can create toxic stress. Toxic stress is stress that is “prolonged, severe, or chronic, and can cause significant problems with health and development.” Children who experience toxic stress can face behavioral and learning challenges that lead to adverse impacts on physical and emotional health even into adulthood. For children who are exposed to frequent injuries or who live in environments that may not be safe, Head Start programs can support the children and their families by helping to build resiliency.

Common Causes of Unintentional Injury for Young Children

Unintentional injuries, including drowning and suffocation, are a leading cause of death for children from birth to age 5.

Leading causes of nonfatal emergency department visits for children ages 0–6 are:

  • Falls, such as from playground equipment or while running. Among this age group, falls account for almost half of all emergency department visits.
  • Being unintentionally struck by or against another person, animal, or inanimate object, such as a collision with another child or a table or other piece of furniture.
  • Bites and stings.
  • Injury resulting from entrance of a foreign body into or through the eye or other natural body opening, such as dirt in the eye, pebble in the ear, or small toys in the throat.
  • Injury resulting from a cut, scrape, or puncture by a pointed or sharp instrument or object.

Children ages 0–6 are also more likely to experience unintentional poisoning and choke on objects. Rates of traumatic brain injury are higher for children ages 0–4 than for any other age group.

Building familiarity with common causes of injuries for young children will help everyone prevent these injuries. The health manager is not alone in developing and implementing safety strategies. Everyone — managers, home visitors, family service workers, teachers, and family child care providers ― has an important role in preventing injuries.