Health Manager Orientation Guide

Safety and Unintentional Injury Prevention Considerations for Infants and Toddlers

Two adults supervising several small children playing on the floor with toys.By exploring and experimenting, infants and toddlers are gaining new skills to engage in the world around them. This constant exploration also puts them at a higher risk for injuries. The types of injuries often correspond to a child’s developmental stage. When program staff understand a child’s abilities, are aware of possible risks, and learn how to provide safe environments, infants and toddlers can learn and thrive.

Safe Sleep Environments

Infants are at risk for suffocation and Sudden Unexpected Infant Death (SUID). Young infants are unable to control their muscles or regulate their breathing and body temperature. Staff and families can reduce this risk by placing infants on their backs in cribs without any loose bedding or soft objects and dressing them lightly to avoid getting overheated.

  • Only use cribs and mattresses that meet the CPSC and ASTM safety standards and properly inspect them for safety hazards.
  • Do not place cribs within reach of window blinds, draperies, and cords.
  • When an infant becomes large enough or mobile enough to reach crib latches or potentially climb out of a crib, transition them to a different sleeping environment (such as a cot or sleeping mat).

Infant carriers, slings, car seats, swings, and bouncers are not safe sleep environments. If an infant falls asleep in this equipment, move them to a safe sleep environment.

Swaddling and sleep sacks can calm very young infants. Infant sleep clothing, such as a wearable blanket or sleep sack, keeps babies warm and is also safe for young infants until they can roll over. It is not safe for babies to be swaddled once they are able to roll over. A loose blanket, including a swaddling blanket that comes unwrapped, could cover the infant’s face and increase the risk of suffocation.

Feeding and Eating

Serve food to infants and toddlers that is developmentally appropriate. A baby’s throat is small and easily obstructed. Young infants are learning how to control their tongue, chew, and swallow, but they are still not efficient chewers. As they grow, they gain more control over their ability to move food around in their mouths and to eat strained and puréed food without choking.

Tips for Feeding Infants and Toddlers

  • Securely hold an infant who is bottle feeding to supports a baby’s breathing and prevents falls.
  • Never put a bottle-fed infant down with a bottle.
  • Review this resource, Reducing the Risk of Choking in Young Children at Mealtimes by the U.S. Department of Agriculture’s (USDA’s) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This handout includes a list of foods to avoid because they could cause a child to choke.
  • Position adults close to young children when they are eating and actively supervise them to act quickly if an infant or toddler starts to choke on their food.
  • Use safety straps in a highchair to reduce the likelihood of an injury from a fall.
  • Do not hold infants and toddlers when handling hot food or beverages or place hot liquids and foods at a child’s level.
  • Heat bottles under warm, running tap water or in a container of water that is no warmer than 120 degrees for five minutes or use bottle warmers.
  • Test the temperature of the liquid in a bottle by shaking a few drops on the inside of your wrist. The American Academy of Pediatrics (AAP) suggests that this is the easiest way to test the temperature of the liquid.
  • Serve food at room temperature. Heating food in a microwave poses the risk of burns from hot spots in the food.
  • Stir foods while they are being heated to distribute heat evenly.

USDA has more safety guidance in Feeding Infants in the Child and Adult Care Food Program.


While diapering it is important to always have one hand on the child. Children may move their arms or legs, thrust them onto the changing pad, attempt to roll over, or scoot forward or backward. It is important to never leave them alone because their movements can be unpredictable. Staying hands-on can prevent a baby from falling off a changing table or other high surface.

  • Keep diaper-changing materials, including wipes and ointments, where you can reach them easily, but away from an infant or toddler’s grasp.
  • Engage babies during diapering. This creates positive learning opportunities and helps prevent injuries by focusing a baby’s attention during diapering.
  • Talk to children about what you are doing during a diapering routine. This helps them gain a sense of safety and predictability.

Safe Indoor Play

Choosing safe toys for infants and toddlers is important for their learning and development. Infants explore their toys with their mouths. Therefore, toys should be made of material that is sturdy, easy to clean, and free from loose or small parts.

  • Use a small-parts cylinder (2.25 inches long by 1.25 inches wide) to identify toys that may be a choking hazard.
  • Never use toys made from small magnets. They are unsafe for infants and toddlers because, if swallowed, the magnets can damage the child’s digestive system.

When choosing classroom equipment, select equipment that will not trap a young infant’s head or limbs.

  • Always use the provided safety straps, and place equipment on the floor so infants cannot fall.
  • Regularly inspect toys and equipment to identify, remove, or repair any objects that may cause injury.
  • Do not use baby walkers, because they are unsafe.

Safe Outdoor Play

Playgrounds should have a designated area with developmentally appropriate equipment for very young children. Toddlers are just learning to walk and explore, and they excel at getting out from the watchful eye of the provider. Infants and toddlers are top-heavy and tend to fall forward and headfirst when they lose their balance. Because of the range of developmental stages in infants and toddlers, it is important to practice active supervision while children are using playground equipment.

  • Use bucket-style swings for infants who can hold their heads up and sit up on their own. Use buckles or seat belts to secure infants and toddlers in bucket-style swings.
  • Do not sit on slides with an infant in your lap.
  • Use active supervision to guide toddlers on climbing structures to prevent fall injuries.
  • Help toddlers down the slide by holding their waist. 
  • Put properly fitted helmets on all children 1 year of age and over when they are riding toys with wheels (children should be 1 year of age or older). Remove helmets as soon as children stop riding the equipment.

An infant or small child can drown within 30 seconds in as little as one or two inches of liquid. Children between 1 and 4 years of age are at greatest risk of drowning. Young children do not have enough muscle development in their upper body to pull up out of a bucket, toilet, or bathtub or any body of water.

  • Actively supervise whenever a child is in or near water.
  • Turn buckets and wading pools upside down when not in use.
  • Use walls or fences and gates with child-proof locks to prevent unsupervised access to swimming pools and other bodies of water.

Sun safety is an important element of safe outdoor play.

  • Limit sun exposure between 10 a.m. and 4 p.m., when UV rays are strongest.
  • Do not place infants younger than 6 months in direct sunlight. Use hats, long sleeves, long pants, and shade structures to minimize exposure.
  • Have children wear child-safe, shatter-resistant sunglasses with at least 99% UV protection.
  • Obtain written permission from a parent or guardian to apply sunscreen to an infant or child in a program and follow all label instructions. The AAP recommends sunscreen with a sun protection factor (SPF) of 15-30.
  • Apply sunscreen on small areas of the body that may get exposed to sun on infants younger than 6 months of age.
  • Apply sunscreen on toddlers and infants older than 6 months of age to all areas of their bodies.

Tips and Strategies Related to Safety and Unintentional Injury Prevention for Infants and Toddlers

  • Provide training and technical assistance to staff and families to address the following:
    • Sudden infant death syndrome and safe sleep practices
    • Infant and toddler feeding
    • Safe environments for infants and toddlers
    • Active supervision
  • Use equipment that contributes to a safe environment, including electrical socket covers, bumpers for furniture, gates for stairs and doorways, locks for cabinets and drawers, and smoke and carbon monoxide detectors.
  • Collaborate with families to understand each child’s developmental stage to be aware of individual safety risks.