Health and Safety, Ages 2 to 5 Years

This topic advises parents and caregivers on ways to help prevent illness and accidental injuries in young children. It is not able to or meant to cover every risk that faces a child. However, the topic addresses many of the most common hazards, so you can help minimize the risk of infections and injuries and identify areas and situations that can be dangerous to a child between ages 2 and 5 years.

Why are accidents a concern for 2- to 5-year-olds?

Accidental injuries are a leading cause of death in children older than 1 year. The ages 2 through 5 are a time when children gain many new skills and feel increasingly independent. Despite their developing confidence, young children still need close supervision and careful guidance from parents and other caregivers. Keeping your child physically safe is an ongoing responsibility.

What are the most common hazards?

Car accidents are the leading cause of death and injury in young children.¹ Many other injuries result from everyday activities. Drowning, falling, choking, burns, and poisoning are all common household accidents that harm children. Outdoor play, such as riding tricycles and bikes, exploring playgrounds, or being near streets, can also lead to injuries.

How can I teach my child to be aware of potential accidents?

Establishing and consistently enforcing rules and limits are the best ways to help your child learn about dangers. Children between ages 2 and 5 need close supervision. Most young children need many reminders before they understand that an action or behavior is unsafe.

Children also go through active and curious phases. Recognize these periods and anticipate hazards. For example, your child may learn to ride a tricycle and enjoy the thrill of pedaling furiously around the driveway and occasionally venture into the street. Make sure you supervise your child and are firm with your rules, such as keeping the street off limits.

How can stress affect the safety of my child?

Having and protecting a child is an immense responsibility that can overwhelm some parents. It's important to keep your stress level in check, to help prevent accidents. Most injuries to children occur when caregivers are tired, hungry, emotionally drained, or having difficulty in their relationships. Heightened stress can result from changes in the daily routine, moving to a new house, or expecting another child.

Frequently Asked Questions

Handling food safely, practicing basic hygiene to prevent communicable diseases, and getting regular physical exams and immunizations are all healthy habits that help protect your child against illness and infection.

Safe food preparation and precautions

Thorough cleaning and food preparation helps keep you and your child from getting food-borne illnesses. Do your best to ensure that the restaurants where you eat also handle food safely.

The U.S. Department of Agriculture recommends the following steps to prevent food poisoning:

• Prepare foods safely. Because germs spread easily on surfaces that many people use or touch, it is important to wash your hands frequently and keep surfaces clean.
• Shop safely. Raw meats, seafood, and eggs can contaminate other foods they touch. Keep these items wrapped in plastic and away from fresh foods in your shopping cart.
• Cook foods safely. Meats and foods that have been in contact with raw meat need to be cooked thoroughly to prevent the growth of bacteria. The specific temperature varies by type of food.
• Store foods safely. Keep food temperatures at safe levels to prevent bacterial growth that can cause illness. For example, perishable foods should be refrigerated promptly, not left out on the counter.
• Follow labels on food packaging. Look for expiration dates on perishable foods before you buy or eat them. Also, follow cooking guidelines that are provided, such as temperature and cooking time.
• Serve foods safely. Keep hot foods hot—140°F (60°C) or above—and cold foods cold—40°F (4.44°C) or below. If you are not sure if a food is safe to eat, throw it out.

For more information, see the topic Food Poisoning and Safe Food Handling.

Protect against the spread of illness

Although colds and flu are more common in the colder months, they can occur any time of year. Take extra precautions to help protect your child against these and other viral and bacterial infections.

• Be aware of higher risk of germs in public areas. Avoid exposing your child to a large crowd if he or she has been ill recently or has an otherwise weakened immune system, especially when a contagious illness is going around. Also, it may be helpful to have a hand sanitizer and disposable wipes on hand to clean hands and to wipe off shopping carts or other shared items in public places.
• Avoid close contact with others who are sick. Keep your child away from others who are obviously ill. Also, if your child is ill, avoid contact with other children until the contagious period is over. Talk to your doctor if you are unsure about how long your child is likely to be contagious.
• Wash your hands frequently. Keeping your hands clean is an obvious but often overlooked means of preventing the spread of germs.
• Wash and disinfect surfaces and toys. Areas where germs collect, such as the kitchen and bathroom, should be kept clean and frequently disinfected.
• Teach children to cover their mouths when they cough or sneeze, preferably using a tissue so that germs do not get on their hands. Also show them how to use tissues to wipe their noses.
• Consider flu shots for your child. The inactivated flu vaccine (flu shot) is recommended for:
  • All healthy children between 6 months and 59 months (4 years 11 months) of age.
  • All children who are at least 6 months of age and have certain medical conditions (such as asthma, chronic heart or lung disorders, or an impaired immune system) that put them at high risk for complications of the flu.
  • Siblings and close contacts of children 59 months of age and younger who could spread the flu to those at high risk. Healthy people ages 2 through 49 years can usually get the nasal spray form of the vaccine, called FluMist. Pregnant women can get the flu shot but not FluMist. For the latest flu vaccine recommendations from the U.S. Centers for Disease Control and Prevention (CDC), see the Vaccine Information Statement Web site at http://www.cdc.gov/vaccines/pubs/vis/default.htm. Also, for more information, see the topics Immunizations or Influenza.

Visit the doctor regularly

Make sure you regularly schedule well child appointments. During these visits, a health professional:

• Gives your child a general physical examination.
• Gives or schedules vaccinations, also called immunizations. These provide important protection for your child against harmful disease. The standard immunization schedule outlines the recommended vaccinations and the ages at which they should be given. For more information, see the topic Immunizations.
• Asks you questions about your child's health and development and whether you have any concerns.

Preventing your child from having accidents and injuries is a huge task. Children between the ages of 2 and 5 reason with self-centered (egocentric) perceptions and magical thinking. These thought patterns lead children to overestimate what is in their control, which contributes to their vulnerability. They are often unaware of the consequences of their actions.

You can help protect your child from accidents and injuries by taking general safety measures around your home. Also, think ahead about what potentially dangerous situations will attract your child.

Some parents think that strict safety measures are not needed because their child is closely supervised or has not yet shown an interest in dangerous areas or items. Although responsible supervision is important, it is not realistic to think that you can watch your child's every move or that he or she will never become curious about something off-limits. Also, constant hovering over children can limit their experiences and confidence. Balancing supervision with safety precautions will help prevent accidents and injuries, as well as allow children to explore.

The following are common accidents and injuries that can occur around the house, and some suggestions on how to prevent them.

Falls

Preventing falls is not always easy. Toddlers and young children often move quickly. Their excitement about their mobility and their lack of experience can make them unaware of dangers, such as stairs or hills. Children between 4 and 5 years of age anticipate many dangers but may not have the physical skills to successfully avoid accidents. You can help prevent young children from falling by putting up stairway barriers, monitoring their play area, and providing stable play equipment. Also, keep walkways, decks, porches, and stairways free of objects.

Choking

Children between the ages of 2 and 5 years can easily choke on everyday objects and food. Your child still needs your supervision, even though he or she may be able to eat independently.

You can help prevent choking by taking basic precautions in how you prepare foods and by teaching your child safe eating habits.

• Establish certain areas for eating, such as the kitchen table or dining room. Help your child learn to sit down while eating and to chew carefully. Do not force a child to eat when he or she is not hungry. These practices also help your child to develop healthy eating habits.
• Learn to recognize signs of choking so you can react quickly. For example, a child who is choking can't talk, cry, breathe, or cough.
• Know how to select and prepare foods. For example, choose soft foods that can be cut up into small pieces, such as cooked carrots. Avoid round, firm foods such as hot dogs, grapes, nuts, and raisins.
• Be aware that young children may choke on small objects. Generally, objects smaller than 1.3 in. (3.3 cm) in diameter and 2.3 in. (5.8 cm) long are choking hazards. Examples include coins, buttons, and bottle caps. Keep these items out of reach.
• Do not allow your child to eat while he or she is walking, running, playing, or riding in a car.
• Do not allow your child to chew gum or eat hard candy.
• Do not leave rubber bands or deflated balloons around the house where children can reach them.

Strangulation and suffocation

A variety of household items can strangle a young child. Make sure loose cords, objects, and furniture do not pose strangling risks. The following suggestions can help you reduce potential hazards.^{2, 3}

• Keep cords for blinds and drapes out of reach. Attach cords to mounts that hold them taut and wrap them around wall brackets.
• Cords with loops should be cut and equipped with safety tassels.
• Do not use accordion-style gates. Babies or young children can get their heads trapped in the gate and may strangle.
• Make sure furniture does not have cutout portions or other areas that can trap your child's head.

Suffocation is another danger for young children. Teach your child about suffocation and the importance of a safe play area. Pay attention to possible suffocation dangers, such as:

• Trunks of cars. Keep rear fold-down seats closed so children are not able to climb into the trunk from inside the car. Also, always lock car doors and keep the keys out of sight and out of reach of your child.
• Refrigerators and freezers, even those that are not in use. If you are storing an old refrigerator or freezer, be sure to take the door off.
• Plastic sacks. Do not let your child play with plastic sacks, and keep them out of reach. Many children like to put sacks over their head during play, which can lead to suffocation.

Poisoning

To prevent poisoning, identify household cleaners and other chemicals, plants, medicines, makeup, perfumes, and any other products that, when eaten or inhaled, can harm a child. It is critical to properly store these items out of reach of young children. If you have a possible poisoning emergency, call 1-800-222-1222 and you will be automatically transferred to the closest poison control center. For more information on poisoning, see the topic Poisoning.

Lead poisoning is another cause for concern in young children who may chew on contaminated paint flakes, painted objects, or toys. House paint is no longer made with lead, but older homes (those built before 1978) may still have lead-containing paint on walls and other surfaces. Have your home tested if you are unsure whether it contains any lead-based paint. In 2007, the U.S. Consumer Product Safety Commission (CPSC) found high lead content in many children’s toys and jewelry made in other countries. For a complete list of recalled products, see the CPSC Web site at www.cpsc.gov. Also see the topic Lead Poisoning for more information.

Prevent carbon monoxide poisoning by frequently monitoring levels and taking precautionary measures, such as having your furnace checked each year. Carbon monoxide (CO) is a colorless, odorless, and tasteless gas. It is produced from burning fuels such as natural gas, gasoline, fuel oil, or wood (for example, in indoor heating systems, car engines, cooking appliances, or fires). High carbon monoxide levels quickly affect young children because of their small size. See the topic Carbon Monoxide Poisoning for more information.

Fire hazards

Prevent household fires by having and maintaining smoke detectors, planning and practicing escape routes, and teaching your child basic fire safety skills. Children between the ages of 2 and 5 are often curious about fire. Warn your child about the dangers of fire, and explain why only grown-ups are allowed to use it.

Burns

Serious burns are most often caused by heat, electricity, or chemicals. Other types of burns include radiation burns (usually from sun exposure) and friction burns. Prevent burn injuries to your child by identifying dangers in your home and removing them or blocking your child's access to them.

• Most heat burns can be prevented by keeping your child away from fire, steam, hot water and other hot liquids, and hot objects. Consider buying pajamas made of flame-resistant fabric for your child.
• To avoid electrical burns, keep electrical cords out of reach of your child and use safety covers on all outlets. Keep your child indoors and away from windows during electrical storms.
• Prevent chemical burns by keeping all caustic or corrosive products out of reach of children. Acid, such as from batteries, and alkaline products, such as drain cleaners, are especially dangerous.
• Sunburns (radiation burns) can permanently damage a child's skin. Radiation burns are caused by the sun, tanning booths, sunlamps, X-rays, or radiation therapy for cancer treatment. Radiation burns in children usually are caused by sun exposure. Keep children out of the sun or use sun-protection measures when your child is outdoors.
• Friction burns are usually minor injuries, many of which can be prevented by providing proper play equipment and helping children to avoid scrapes.
• Enjoy fireworks from a distance. Almost half of persons injured from fireworks are children 14 years of age and younger.⁴ Children can also get burns from using and being around firecrackers and sparklers. Sparklers have been shown to be most dangerous for children under 5 years of age.⁴

Guns and other weapons

Gun and firearm safety measures should be established for all households and especially those where children live or visit. All guns and firearms should be kept in a locked area, unloaded, and out of reach of children. Also, store knives (even kitchen knives), swords, and other weapons safely out of reach.

Pets

Pets are in many households. Children who live in homes without pets likely will encounter animals in other environments. Many injuries can be avoided by teaching children how to properly interact with pets. Also, pet owners who train and keep their animals healthy are less likely to have problems when children are around.

• Teach your child how to interact with pets. Explain that animals can hurt you when they are scared, hurt, eating, or protecting their babies. Teach your child to speak quietly and move slowly around animals and to watch for body language that can alert your child to stay away.
• Train and prepare your pet to behave around children. A well-trained and obedient pet is less likely to harm a young child.

Drowning

Children younger than 5 years of age die from drowning more than any other age group.⁵ Help prevent a drowning tragedy by following the recommendations from the U.S. Consumer Product Safety Commission, the National Safety Council, and the American Academy of Pediatrics.

• Supervise all baths at all times. Always stay within arm's reach of your child. Never leave your child alone in the tub—even with an older sibling.
• Control access to water in your home. Keep large bodies of water fenced, such as a pond or pool, and empty all buckets and coolers when not in use. Keep toilet lids down and consider securing them with safety latches.
• Keep pool areas safe. When visiting public or private pools, make sure your children are supervised closely and that they are familiar with pool safety rules. If you have your own pool, make sure to follow all your local regulatory safety codes. These usually are available through your city planning department.
• Teach swimming safety. Make sure your child knows basic rules, such as to always swim with a buddy and to never push another child into the water. Always have your child wear a life jacket when swimming or boating.
• Recognize the dangers of hot tubs and spas. Teach your child that hot tubs and spas are not places to play, and consider making them off limits.
• Keep children away from irrigation canals. Do not let your child play in or near irrigation canals.

In addition to these precautions, learn first aid and CPR (cardiopulmonary resuscitation). Knowing these skills can make the difference between life and death in an emergency situation.

It is a constant challenge to keep your child safe. Children between the ages of 2 and 5 years often do not recognize dangers without constant reminders because they reason with self-centered (egocentric) perceptions and magical thinking. These thought patterns lead children to overestimate what is in their control, which contributes to their vulnerability. They are often unaware of the consequences of their actions.

You cannot protect your child from every danger he or she can possibly encounter outside the home. However, you can equip your child with some basic safety rules and precautions. Let your child's natural surroundings give you ideas for general training to help prepare your child for a variety of situations he or she may face.

To help avoid accidents, injuries, and unsafe situations outside the home, establish and review basic rules before outings and frequently reinforce them.

Basic safety precautions

• Always use a car seat. Car accidents are the leading cause of death and injury in young children.¹ Many injuries and deaths can be avoided by using proper child restraints. Because state regulations vary and may not include important points to keep your child as safe as possible, follow basic guidelines established by the American Academy of Pediatrics (AAP). Basic recommendations for 2- to 5-year-olds include using a forward-facing, safety-approved, and properly installed seat until a child weighs 40 lb (18.1 kg) The back seat is the safest place for a child to ride. Never allow a child weighing less than 80 lb (36.3 kg) or younger than 12 years of age to ride in the front seat of a vehicle equipped with airbags. Your child should be in a car seat every time he or she rides in a vehicle, without exception. Do not make it negotiable—rather, be firm that riding in a car seat is required for every car trip.
• Never leave your child alone in a car. Heat inside the car and other factors could cause long-lasting injury—or death—in a matter of minutes. A young child's body temperature can raise 3 to 5 times faster than that of an adult. Keeping the car windows down will not protect your child in hot or warm weather. Other injuries could also occur from a child getting stuck in the trunk or setting the car in motion.
• Help your child become "street smart." Teach your child basic rules about the dangers of cars and streets.
• Help your child understand "stranger danger." Many parents fear child abduction. Most children who are abducted are not taken by strangers, but rather by a parent, relative, family friend, or acquaintance. However, it is still important to teach your child to be cautious of strangers and how to react when they feel they are threatened.
• Teach proper behavior around animals. Your child should learn how to respond to unfamiliar animals. Teach your child how to interact with family pets and other animals that he or she is likely to come across.
• Wear sunscreen to prevent sunburns (radiation burns). Radiation burns are caused by the sun, tanning booths, sunlamps, X-rays, or radiation therapy for cancer treatment. Radiation burns in children usually are caused by sun exposure and can cause permanent skin damage. Keep children out of the sun or use sun-protection measures when your child is outdoors.
• Use insect repellents to prevent bites and stings. Also, take action to prevent exposure to stinging insects, such as having your child wear closed shoes, socks, and clothes that fully cover his or her body when outdoors.
• Teach your child swimming safety. You can help prevent a drowning accident by making sure your child knows how to behave while in and around water. If you have a swimming pool at home, make sure to take safety measures. If you live near irrigation canals, teach your child not to play in or near them.
• Keep your child safe on the playground. Make sure all play equipment is safe, in good repair, and appropriate for your child's age. Closely supervise all young children while they are playing on any equipment.

Before your child visits an unfamiliar home, ask whether you need to be aware of any dangerous areas, weapons in the home, pets, or other safety issues. In addition, it is always a good idea to see the household for yourself. Don't be afraid to voice any concerns you have about safety. You are ultimately responsible for protecting your child.

Choosing child care

Before enrolling your child in day care, evaluate the environment and talk with the care providers. Ask questions about their safety guidelines. Identify any hazards and ask how they are handled. Inspect the food preparation area and ask how often it is cleaned and with what kinds of products. For more information, see the topic Choosing Child Care.

Going along for the ride: Exercising caution

Many parents and caregivers want to share their favorite activities with their young children. This can help build common interests and appreciation for exercise and other pursuits. Be sure, however, to recognize the safety issues related to these activities. Remember that your child's comfort and safety are most important.

• Keep your child safe in strollers and carts. Use the safety straps and follow the printed instructions. For example, signs on shopping carts usually advise against putting a child in the area reserved for shopping items.
• Use extra caution when riding bikes and tricycles. Make sure you and your child always wear helmets and practice safe riding habits, such as avoiding busy streets. Bike ride only during daylight hours.
• Prevent sunburns by taking extra precautions, such as applying sunscreen and putting on a hat before going outdoors. In addition, be careful your child does not develop heat exhaustion from being out in warm temperatures. Small bodies can develop these problems much more quickly than adults. Do not keep your child out in warm weather for long periods, keep water or other drinks on hand, and never leave your child alone in a car, even with the windows down. For more information, see the topics Sunburn and Heat-Related Illnesses.
• Monitor air pollution when planning to take your child with you for outdoor activities. Children's lungs are especially sensitive to pollution. You can check your newspaper or local weather station for details about air pollution levels.

Connection between parental well-being and child safety

Taking care of yourself is a vital part of keeping your child safe. Although accidents can occur at any time, most happen during times of excess stress, such as when:²

• Parents and children are hungry and tired, especially right after work and before dinner.
• Another baby is expected.
• There is an illness or death in the family.
• Marital problems develop.
• Major changes in the routine or environment occur, such as when a child's caregiver changes, or when moving to a new house, or even going on vacation.

Recognize the signs of stress and what situations cause it. Be extra vigilant during these times and take care of yourself and your personal relationships.

For more information, see the topic Stress Management.

Seeking help

All parents have times when they feel exhausted, frustrated, angry, sad, or overwhelmed. Recognize that this is a normal part of being human and a parent. However, if these feelings become too much for you to handle alone, keep your child safe by getting help. For example, when your emotions are too much for you to handle alone, you may not have the energy or desire to watch your child as closely as you should. Some parents injure their children when their emotions cause them to shake, hit, or push them. This can result in such problems as shaken baby syndrome, which can cause permanent brain damage or even death.

Call 911 immediately if you feel you are about to injure yourself or your child.

Places to go for help include:

• Your family health professional (such as a family medicine doctor).
• A pediatrician.
• A licensed mental health counselor.
• Your local hospital.
• Parenting organizations (see the Other Places to Get Help section of this topic).

For more information on physical harm to children, see the topics Shaken Baby Syndrome and Child Abuse and Neglect. For more information on handling difficult emotions, see the topics Depression, Anger and Hostility, and Anxiety.

Online Resources

Organizations

• Animal and Human Bites
• Burns
• Carbon Monoxide Poisoning
• Child Abuse and Neglect
• Child Car Seats
• Choking Rescue Procedure (Heimlich Maneuver)
• Choosing Child Care
• Coughs
• Cuts
• Dehydration
• Environmental Illness
• Food Poisoning and Safe Food Handling
• Growth and Development, Ages 2 to 5 Years
• Immunizations
• Insect Bites and Stings and Spider Bites
• Lead Poisoning
• Poisoning
• Preventing Poisoning in Young Children
• Stress Management

Citations

1. Centers for Disease Control and Prevention (2005). CDC's Unintentional Injury Activities—2004. Available online: http://www.cdc.gov/ncipc/pub-res/unintentional_activity/2004/DUIP_Activity_Rpt2004.pdf.

2. American Academy of Pediatrics (2004). Keeping your child safe. In SP Shevlov, RE Hannemann, eds., Caring for Your Baby and Young Child: Birth to Age 5, 4th ed., pp. 423–470. New York: Bantam.

3. Window Covering Safety Council (2003). Kids...cords...caution: Learn how to keep your children safe. Basic Cord Safety. Available online: http://www.windowcoverings.org/basiccordsafety.html.

4. Centers for Disease Control and Prevention (2006). Fireworks-Related Injuries. Available online: http://www.cdc.gov/ncipc/factsheets/fworks.htm.

5. National Safety Council (2006). Water safety. National Safety Council Fact Sheet. Available online: http://nsc.org/library/facts/drown.htm.

Other Works Consulted

• American Academy of Pediatrics (2002). Pool safety for children. The Injury Prevention Program (TIPP). Available online: http://www.aap.org/family/tipppool.htm.

• American Academy of Pediatrics (2002). Water safety for your school-age child. The Injury Prevention Program (TIPP). Available online: http://www.aap.org/family/tipwater.htm.

• Humane Society of the United States (2006). Teaching your child to avoid dog bites. Available online: http://www.hsus.org/pets/pet_care/dog_care/stay_dog_bite_free/teaching_your_child_to_avoid_dog_bites.html.