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824 UNIT 5 The Nursing Role in Health Promotion for a Childrearing Family

BOX 29.4 ✽ Focus on Family Teaching

Accident Prevention Measures for Infants

Q. Bryan’s mother is worried about keeping him safe. She asks, “How can I prevent accidents at this age?”
A. Here are some tips to help prevent specific types of accidents:
Potential Accident Prevention Measures
General Know the whereabouts of infants at all times.
Be aware that the frequency of accidents is increased when parents are under stress. Take
special precautions at these times.
Choose babysitters carefully and explain and enforce all precautions when sitters are in charge.
Aspiration Be certain any object that an infant can grasp and bring to the mouth is either safe to eat or too
big to fit in the mouth. Do not feed an infant foods such as popcorn or peanuts, because these
are easily aspirated. Store baby products such as powder out of infant’s reach; powder is high
risk for aspiration.
Inspect toys and pacifiers for small parts that could be aspirated if broken off; do not make home-
made pacifiers.
Falls Never leave an infant on an unprotected surface, such as a bed or couch, even if the child is in
an infant seat.
Place a gate at the top and bottom of stairways; do not allow an infant to walk with a sharp
object in the hands or mouth (it could pierce the throat in a fall).
Raise crib rails and make sure they are locked before walking away from crib.
Do not leave a child unattended in a highchair; avoid using an infant walker.
Motor vehicle Never transport unless an infant is buckled into an infant car seat in the back seat of the car. Be
aware of the proper technique for placing an infant in a car seat.
Do not be distracted by an infant while driving.
Do not leave an infant unattended in a parked car (can become dehydrated from excess heat,
move gear shift, or be abducted).
Suffocation Allow no plastic bags within infant’s reach.
Do not use pillows in a crib.
Store unused appliances such as refrigerators or stoves with the doors removed.
Buy a crib that is approved for safety (spacing of rails is not over 23⁄8 in [6 cm] apart).
Remove constricting clothing such as a bib from neck at bedtime.
Drowning Do not leave infants alone in a bathtub or unsupervised near water (even buckets of cleaning
water).
Animal bites Do not allow an infant to approach a strange dog; supervise play with family pets.
Poisoning Never present medication as a candy.
Buy medications in containers with safety caps; put away immediately after use.
Never take medication in front of infants. Place all medication and poisons in locked cabinets or
overhead shelves.
Never leave medication in a pocket or handbag.
Use no lead-based paint in any area of the home.
Hang plants or set on high surfaces.
Post telephone number of the poison control center by the telephone.
Burns Test warmth of formula and food before feeding (use extra precaution with microwave warming).
Do not smoke or drink hot liquids while holding or caring for infant.
Buy flame-retardant clothing for infants.
Use a sunscreen on a child over 6 months when out in direct or indirect sunlight; limit the child’s
sun exposure to less than 30 min at a time.
Turn handles of pans toward back of stove.
Use a cool-mist, not a hot-mist, vaporizer; remain in room to monitor so child cannot reach
vaporizer. Keep a screen in front of a fireplace or heater.
Monitor infants carefully near candles. Do not leave infants unsupervised near hot-water faucets.
Do not allow infants to blow out matches (don’t teach children that fire is fun).
Keep electric wires and cords out of reach; cover electrical outlets with safety plugs.
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850 UNIT 5 The Nursing Role in Health Promotion for a Childrearing Family

BOX 30.4 ✽ Focus on Family Teaching

Common Safety Measures to Prevent Accidents During the Toddler Years

Q. Ms. Matthis tells you, “My toddler is constantly on the go. How can I keep him safe?”
A. Accident prevention must be ongoing while your child is a toddler. Try the following precautions:
Potential Accident Prevention Measure
Motor vehicles Maintain child in car seat; do not be distracted from safe driving by a child in a car.
Do not allow child to play outside unsupervised. Do not allow child to operate electronic garage doors.
Supervise toddler who is too young to be left alone on a tricycle.
Teach safety with pedaling toys (look before crossing driveways; do not cross streets) but do not
expect that toddler will obey these rules at all times (in other words, stay close by).
Falls Keep house windows closed or keep secure screens in place.
Place gates at top and bottom of stairs. Supervise at playgrounds.
Do not allow child to walk with sharp object in hand or mouth.
Raise crib rails and check to make sure they are locked before walking away from crib.
Aspiration Examine toys for small parts that could be aspirated; remove toys that appear dangerous.
Do not feed toddler popcorn, peanuts, etc.; urge children not to eat while running. Do not leave
toddler alone with a balloon.
Drowning Do not leave toddler alone in a bathtub or near water (including buckets of cleaning water and
washing machines).
Animal bites Do not allow toddler to approach strange dogs.
Supervise child’s play with family pets.
Poisoning Never present medication as candy. Buy medications with childproof caps; put away immediately
after use.
Never take medication in front of child.
Place all medication and poisons in locked cabinets or overhead shelves where child cannot
reach them.
Never leave medication in parents’ purse or pocket, where child can reach it.
Always store food or substances in their original containers.
Know the names of house plants and find out if they are poisonous. (Call regional poison control
center for information.)
Hang plants or set them on high surfaces beyond toddler’s grasp.
Be certain that small batteries or magnets are out of reach.
Post telephone number of nearest poison control center by the telephone.
Inspect toys to be certain they are free of lead-based paint.
Burns Buy flame-retardant clothing.
Cook on the back burners of stove if possible and turn handles of pots toward back of stove to
prevent toddler from reaching up and pulling them down.
Use cool-mist vaporizer rather than steam vaporizer or remain in room when vaporizer is operating
so child is not tempted to play with it.
Keep screen in front of fireplace or heater.
Monitor toddlers carefully when they are near lit candles.
Do not leave toddlers unsupervised near hot-water faucets.
Check temperature setting for hot-water heater and turn down thermostat if it is over 125° F.
Do not leave coffee/tea pots on a table where child can reach them.
Never drink hot beverages when a child is sitting on your lap or playing within reach.
Do not allow toddlers to blow out matches (teach that fire is not fun); store matches out of reach.
Keep electric wires and cords out of toddler’s reach; cover electrical outlets with safety plugs.
General Know whereabouts of toddlers at all times. Toddlers can climb onto chairs, stools, etc., they could
not manage before; can turn door knobs and go places they could not go before.
Be aware that the frequency of accidents increases when the family is under stress and therefore
less attentive to children. Special precautions must be taken at these times.
Be aware some children are more active, curious, and impulsive and therefore more vulnerable to
accidents than others.

over 2 years old should have a total fat intake between 30% after which 2% milk can be introduced (Rolfes, Pinna, &
and 35% of calories, with most fat coming from sources of Whitney, 2009).
polyunsaturated and monounsaturated fatty acids, such as
fish, nuts, and vegetable oils—the same as for adults. Promoting Adequate Intake With a Vegetarian Diet
Trans–fatty acids should be kept to a minimum. Adequate
calcium and phosphorus intake is important for bone mi- Vegetarian diets are adequate for toddlers if parents are well
neralization. Milk should be whole milk until age 2 years, informed about needed vitamins and minerals (Theobald,
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CHAPTER 31 Nursing Care of a Family With a Preschool Child 869

BOX 31.4 ✽ Focus on Family Teaching

Common Safety Measures to Prevent Accidents During the Preschool Years

Q. Cathy’s father says to you, “My preschooler is so active! How can I keep her safe?”
A. All of the safety measures that apply to toddlers also apply to preschoolers. In addition, try these tips:
Possible Accident Prevention Measure
Motor vehicles Teach safety with tricycle (look before crossing driveways; do not cross streets).
Teach child to always hold hands with a grownup before crossing a street.
Teach parking lot safety (hold hands with grownup; do not run behind cars that are backing up).
Children should wear helmets when riding bicycles.
Falls Supervise preschooler at playgrounds.
Remove drawstrings from hooded clothing.
Help child to judge safe distances for jumping or safe heights for climbing.
Drowning Teach beginning swimming.
Animal bites Do not allow child to approach strange dogs.
Supervise child’s play with family pets.
Poisoning Never present medication as a candy.
Never take medication in front of a child.
Never store food or substances in containers other than their own.
Post telephone number of local poison control center by the telephone.
Teach child that medication is a serious substance and not for play.
Burns Store matches in closed containers.
Do not allow preschooler to help light birthday candles, fireplaces, etc. (fire is not fun or a “treat”).
Community safety Teach preschooler that not all people are friends (“Do not talk to strangers or take candy from
strangers”).
Define a stranger as someone a child does not know, not someone odd-looking.
Teach child to say “no” to people whose touching the child does not enjoy, including family members.
(When a child is sexually abused, the offender is usually a family member or close family
friend.)
General Know whereabouts of preschooler at all times.
Be aware that frequency of accidents is increased when parents are under stress. Special
precautions must be taken at these times.
Some children are more active, curious, and impulsive and therefore more vulnerable to
accidents than others.

in front of children. Additional safety points for the child will ever be in situations in which the information will
preschool period are summarized in Box 31.4. be needed, nor do they want to terrify their child about the
world. However, if the information is presented in a calm yet
Keeping Children Safe, Strong, and Free serious manner, children can begin to use it to build safe
habits that will help them later when they are old enough to
The preschool years are not too early a time to educate chil- walk home from school alone or play with their friends, un-
dren about the potential threat of harm from strangers or supervised, at a public playground.
even how to address bullying behavior from people (children
or adults) they meet at preschool or at play. This includes: Motor Vehicle and Bicycle Safety
• Warning a child never to talk with or accept a ride from a With more and more cars being equipped with front-seat air
stranger bags, make certain parents safely buckle preschoolers into car
• Teaching a child how to call for help in an emergency seats in the back seat (American Academy of Pediatrics
(yelling or running to a designated neighbor’s house if [AAP], 2009). Parents should stress the important role of seat
outside, or dialing 911 if near a telephone) belts in preventing injury in accidents and should make it a
• Describing what police officers look like and explaining rule that the car does not move until seatbelts are fastened.
that police officers can help in an emergency situation Many preschoolers outgrow their first car seats during this
• Explaining that if children or adults ask them to keep se- period (when they reach 40 lb) and need to graduate to a
crets about anything that has made them uncomfortable, booster-type seat. Remind parents to check the position of
they should tell their parents or another trusted adult, the shoulder harness so it does not go across a child’s face or
even if they have promised to keep the secret throat.
• Explaining that bullying behavior from other children is Preschool is also the right age to promote bicycle safety
not to be tolerated and should be reported so they can re- (Pardi, 2007). Head injuries are a major cause of death and
ceive help managing it injury to preschoolers, and bicycle accidents are among the
It is often difficult for parents to impart this type of in- major causes of such injuries. Some parents may have al-
formation to preschoolers because they cannot imagine their ready purchased a helmet for their child when the child was
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896 UNIT 5 The Nursing Role in Health Promotion for a Childrearing Family

BOX 32.4 ✽ Focus on Family Teaching

Common Safety Measures to Prevent Accidents During the School Years
Q. Shelly’s mother tells you, “My school-ager is constantly on the go. How can I keep her free from accidents when I’m
not always with her?”
A. Putting preventive steps in place is the key.
Accident Preventive Measure
Motor vehicle Insist children use seat belts in a car; role model their use.
accidents Teach street-crossing safety; stress that streets are no place for rough-housing, pushing,
or shoving.
Teach bicycle safety, including advice not to take “passengers” on a bicycle and to use
a helmet.
Teach parking lot and school bus safety (do not walk in back of parked cars, wait for
crossing guard, etc.).
Community Avoid unsafe areas, such as train yards, grain silos, back alleys.
Do not go with strangers (parents can establish a code word with child; child does not
leave school with anyone who does not know the word).
Children should say “no” to anyone who touches them if they do not wish it, including
family members (most sexual abuse is by a family member, not a stranger).
For late school-age, teach rules of safer sex (use of condoms; inspecting partner, etc.).
Burns Teach safety with candles, matches, campfires—fire is not fun.
Teach safety with beginning cooking skills (remember to include microwave oven safety,
such as closing firmly before turning on oven; not using metal containers).
Teach safety with sun exposure—use sun block.
Do not climb electric poles.
Falls Teach that rough-housing on fences, climbing on roofs, etc., is hazardous.
Teach skateboard, scooter, and skating safety.
Sports injuries Teach that wearing appropriate equipment for sports (face masks for hockey; mouthpiece
and cup for football; helmet for bicycle riding, skateboarding, or in-line skating; batting
helmets for baseball) is not babyish but smart.
Stress not to play to a point of exhaustion or in a sport beyond physical capability
(no pitching baseball or toe ballet for an early grade-school child).
Use trampolines only with adult supervision to avoid serious neck injury.
Drowning Teach how to swim; dares and rough-housing when diving or swimming are not
appropriate. Do not swim beyond limits of capabilities.
Drugs Help your child avoid all recreational drugs and take prescription medicine only as
directed. Avoid tobacco and alcohol.
Firearms Teach safe firearm use. Keep firearms in locked cabinets with bullets separate from gun.
General School-age children should keep adults informed regarding where they are and what they
are doing.
Be aware that the frequency of accidents increases when parents are under stress and
therefore less attentive. Special precautions must be taken at these times.
Some children are more active, curious, and impulsive and therefore more vulnerable to
accidents than others.

Early school age is not too young to put in place pre- may eat meals they have planned or prepared more willingly
ventive measures against cardiovascular changes later in life. than ones that are just set in front of them.
Limiting salty foods, for example, can help prevent hyper- Most parents would like children to develop better table
tension (He, Marrero, & Macgregor, 2008). Excessive sat- manners. Because they are in a hurry to finish eating, school-
urated fat can lead to the formation of artery plaques and age children tend to gulp their food. Many meals are inter-
cardiovascular disease. rupted by spilled milk. As children become teenagers and are
Teach parents to make every attempt to make mealtime a more aware of the impression they make on others, manners
happy and enjoyable part of the day for everyone. Some school- often improve dramatically. It is often comforting for parents
age children learn to eat as quickly as possible (and so incom- to know that children typically display better table manners
pletely) to escape from the table before something unpleasant in other people’s homes than in their own.
happens, such as an argument they can sense is brewing.
Recommended Dietary Reference Intakes
Fostering Industry
Although parents may have less to say about what a school-
As a part of fostering industry, school-age children usually enjoy age child eats, it is important that the increasing energy re-
helping to plan meals. They can prepare foods such as instant quirements that come with this age (often in spurts) are met
pudding, Jell-O, salads, scrambled eggs, and sandwiches. They daily with foods of high nutritional value.