Child Safety and Injury Prevention (Child Care Manual)

Injuries are the leading cause of death and disability among children in Canada. It’s important to know what strategies you can put in place at your centre to prevent injuries.

Child development and injuries

Injuries often happen when a child reaches a developmental milestone and acquires a new skill:

  • Babies can fall from high surfaces, such as change tables and high chairs, when they learn to roll over. At nine months of age, the risk for poisoning and choking increases because their natural tendency is to put objects in their mouth.
  • Toddlers are particularly prone to falls from heights because their climbing ability is not matched by their balancing or reasoning ability. Their mobility and curiosity makes toddlers also susceptible to burn / scald injuries. Toddlers also continue to put objects in their mouth, putting them at risk for poisoning and choking.
  • Preschoolers continue to develop increased coordination and motor skills enabling them to climb and run faster. Falls continue to cause injuries, particularly from climbing on playground structures. Preschoolers are at risk for burn and scald injuries because of their interest in modelling parent behaviour. For example, they see a parent using the stove and want to use it in the same way.

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Common causes of injuries


Falls are the leading cause of injury-related emergency room visits and hospitalizations for children in Niagara. Infants and young children fall for different reasons depending on their age and stage of development. Common causes of falls include:

  • Furniture, such as change tables, high chairs, counters
  • Slips and trips
  • On / down stairs
  • Playground activities / equipment, such as slides and swings
  • Through windows
  • Activities such as running into stationary objects or other children
  • Sports and recreational activities, such as bicycling, skating, contact with an object or person during a sport / recreation activity

Falls causing concussions

Any blow to the head, face or neck, or a blow to the body that transmits a force to the head can cause a concussion. Without identification and proper management, a concussion can result in permanent brain damage, and in rare occasions, even death.

  • Be aware of the signs / symptoms of concussion
  • Know what to do if one is suspected

Prevent falls

  • Provide active supervision
  • Never leave a child unattended on high surfaces, such as a change table. Keep one hand on an infant during diaper changes; this protects the baby from rolling off of a change table.
  • Every time a child is placed in a highchair, fasten the waist belt and any straps between the child’s legs securely. Make sure the tray is locked securely in place. Keep the highchair a safe distance away from walls, doors, windows, and appliances. A child could use their feet to push against the wall / furniture causing the highchair to tip over.
  • Keep floors free of clutter or anything that may cause a child to trip and fall
  • Watch out for slippery floors. Rubber-soled slippers or shoes are safer than socks on smooth floors. Wipe up spills / water on floors quickly.
  • Keep furniture away from windows to keep children from climbing up and out the windows
  • Use approved safety products, such as safety gates to prevent children from falling down stairs and window guards
  • Ensure children are participating in age-appropriate sport / recreational activities

Hazardous substances and poisonings

Children are at greater risk than adults from exposure to hazardous substances because their bodies are not fully developed, they breathe more air relative to body size, and they have more hand-to-mouth contact.

Medication is the leading cause of poisoning in children. Even small amounts of adult medication can be fatal to a child. Examples of hazardous substances / poisons include rubbing alcohol, cleaning products, arts and crafts supplies, and plants.

Prevent poisonings

  • Provide active supervision
  • Keep all hazardous substances / poisons in their original containers and locked away or in a location inaccessible to children. This includes staff purses / backpacks which may contain medications and cosmetics.
  • Keep all products with small magnets and batteries out of reach of young children
  • Read the labels on all products before use and follow the directions carefully. Do not mix cleaning products or chemicals together as some mixtures can produce dangerous fumes.
  • Identify all plants in the child care setting. Plants that are known to be toxic should be removed from the child care setting. Teach children at an early age about the dangers of certain plants and how to recognize these plants.

Burns / scalds

Infants and toddlers are at high risk for burns / scalds because of their natural curiosity and desire to handle objects. Children are particularly at risk of burns because their skin is thinner than adult skin and burns four times more quickly and deeply at the same temperature.

House fires are the main cause of fire and burn-related deaths, but children are more likely to be hospitalized for burns from contact with steam or hot liquids (scalds), including tap water. Hot water or other liquids can burn as badly as burns from a fire.

Prevent burns and scalds

  • Provide active supervision
  • Ensure the hot water heater has been lowered to 49 C. Practice fire drills and emergency procedures at least monthly or appropriate for the building according to the Ontario Fire Code.
  • Keep children away from hot liquids. Spilled tea, coffee, soup and hot tap water are the leading causes of scald injuries in children.
  • Do not drink any hot liquids if you are holding a child
  • Ensure electrical cords and handles to cookware, such as kettles, pots, pans, are out of reach from children so that they cannot pull down hot liquids or foods on top of themselves


Babies under one year old are more likely to drown in the bathtub than in any other place. All children are at risk for drowning, but young children under five years are most at risk because they:

  • Can drown in as little as 2.5 centimetres (one inch) of water
  • Are attracted to water but cannot understand the risks
  • Lack balance and coordination and are at increased risk of falling into bodies of water
  • Have lungs that are smaller than adult lungs and fill quickly

Near-drowning can result in long-term health effects. It can affect the way a child thinks, learns and plays.

Prevent drowning

  • Provide active supervision when children are in or around water, and never leave them alone in a pool or a bathtub, even for a moment
  • Ensure staff supervising water activities know appropriate CPR and First Aid techniques
  • Teach children the following:
    • Walk, don’t run near water play areas
    • Do not push others in or around water play areas
    • Never bring glass near water play areas
    • Never use riding toys near water play areas
  • Ensure that there is a First Aid Kit and a phone within close proximity of any water play area

Suffocation and other breathing-related injuries

Infants and young children are at high risk for suffocation and other breathing-related injuries. Those that survive may suffer brain damage because they have been deprived of oxygen for a period of time.

Common hazards

  • High-risk foods: Foods that have a small round shape, such as hotdogs, peanuts, candies, grapes or popcorn
  • Small objects: Small parts on toys, button batteries, magnets, balloons and plastic bags
  • Sleep environment: Loose blanketing, pillows, stuffed toys, unsafe sleeping positions, ropes, blinds, cribs or beds

Prevent choking and suffocation

  • Provide active supervision
  • Always supervise children when they eat. Make sure they sit down, sit up straight, and eat slowly.
  • Keep these items out of reach: buttons, latex balloons, plastic bags, stuffed animals with buttons or glass eyes / noses, button batteries, magnets, or toys containing small parts
  • Watch for long cords and window coverings. Pull-cords on blinds should be cut short and tied out of reach
  • Remove drawstrings from clothing
  • Clip mittens to coats instead of attaching them with string
  • Make sure cribs and beds meet safety standards

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Car and booster seat safety

Motor vehicle collisions are the number one cause of death by preventable injury for Canadian children between the ages of one and nine.

Children must be properly secured in a child car seat, booster seat or seatbelt, depending on their height, weight and / or age. Research shows that a correctly used child car seat can reduce the likelihood of injury or death by 75 per cent.

The Ontario Highway Traffic Act requires child care providers to use car seats and booster seats when travelling with babies and children.

Installing seats

To be safe and effective, child car seats must:

  • Meet Canadian safety standards. The National Safety Mark indicates that a child car seat is certified to Canadian safety standards, which are different from other standards.
  • Be installed correctly and the child is harnessed in the seat properly according to the manufacturer’s instructions
  • Be appropriate for the height, weight and / or age of the child. Check car seat manufacturer’s instructions for specific weight and height restrictions of the seat. Some child car seats fit more than one stage. It is safest to keep children in each stage for as long as possible.

There are four stages of child car seat and seat belt use for children:

  1. Rear Facing Seats
  2. Forward Facing Seats
  3. Booster Seats
  4. Seat Belts

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Cycling and helmet safety

Children are most likely to get injured while cycling because they are just learning to ride, going too fast, riding near cars / traffic or are not using safety gear.

For child cyclists, the most severe injuries involve the head and brain. Other serious injuries include broken bones, facial injuries and serious skin abrasions that require grafts.

Prevent cycling injuries

  • Provide active supervision
  • Make sure the bike is age-appropriate and fits. A bike that is too big or two small is unsafe. How to check? When a child sits on their bike, their toes should touch the ground on both sides.
  • Ensure the riding environment is safe and appropriate for the child’s developmental stage. For example, residential sidewalks can pose a danger if a child is cycling and a car backs out of a driveway.


Helmets are an important piece of equipment that can protect children from catastrophic brain injuries such as brain bleeds and skull fractures. Helmets do not, however, protect the brain from concussions because they do not eliminate rotational acceleration (or jiggling) of the brain inside the skull.

Ensure the child wears a properly fitted helmet to reduce the risk of serious head and brain injuries. Apply the 2V1 rule to make sure it fits right:

  • 2 – the helmet should sit two finger widths above their eyebrows
  • V – the side straps should fit snugly in a V shape under their ears
  • 1 – only one finger should fit between strap and their chin

Have parents bring their child’s helmet with them as part of their needs for the day at the child care centre.

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Playground safety

Although playgrounds offer a setting for children to be active, they can be a source of injury. The result of falls can be serious, ranging from broken bones to head injuries.

Playground deaths are rare and almost always caused by strangulation. Strangulation can happen when clothing, such as drawstrings, scarf, or a skipping rope gets caught on play equipment, usually at the top of a slide.

Helmets should not be worn when playing on playground equipment as they can get caught on equipment and become a strangulation risk.

Prevent playground injuries

  • Provide active supervision
  • Ensure playground equipment meets current safety standards and that it's clean and in good condition
  • Ensure that safety surfacing is maintained beneath the equipment, especially under high use areas such as swings and slides
  • Make sure the structures on the playground are appropriate for a child’s age and stage of development
  • Teach and model playground safety rules, and remind children how to use equipment safely. For example, never cross in front or behind a moving swing.
  • Check children’s clothing to ensure there are no drawstrings or other cords that can get trapped in equipment. During the winter months, ensure children use a neck warmer (instead of a scarf ) and mitten clips (instead of a cord).
  • Put away skipping ropes while using the playground equipment
  • Ensure children wear proper footwear

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Pedestrian safety

Young children are at risk of pedestrian injuries because they have not yet developed the cognitive and physical skills to cope with the many challenges of traffic.

Prevent pedestrian injuries

  • Provide active supervision
  • Teach pedestrian safety:
    • Integrate pedestrian safety messages into crafts, games and songs
    • Use teachable moments during outdoor walks to emphasize pedestrian safety messages to children based on the child’s development. For example, a two year old riding in a stroller can understand that cars belong on the road and people belong on the sidewalk.

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Product safety

Children are vulnerable to product-related injuries because of their size and developmental abilities, and because they often use a product in ways outside of its intended use, such as sucking or chewing on toy parts.

Prevent injuries

  • Provide active supervision
  • Ensure the product has not been recalled. Check with the manufacturer and / or Health Canada for recalls and safety alerts on consumer products:
  • Follow the manufacturer’s instructions for safe assembly and use of the product
  • Ensure the product is age-appropriate for the child and is being used for its intended purpose

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Tobacco and second-hand smoke

According to the Smoke-Free Ontario Act:

  • You can not smoke or vape on the entire premise of any child care centre or place that provinces an early years program or service
  • Home child care locations must be smoke-free and vape-free at all times (including outdoor spaces that children use), even if children are not present

Responsibilities of operators

  • Ensure that everyone is aware that smoking and vaping is prohibited
  • Remove ashtrays and any objects that serve as one
  • Ensure that no one smokes or vapes on the premises
  • Ensure a person who does not comply does not remain on the premises
  • Post No Smoking or Vaping signs at all entrances, exits, washrooms and other appropriate locations (order signs online)

Dangers of second-hand smoke and vapour

  • Second-hand smoke, also known as environmental tobacco smoke, is made up of both exhaled smoke and the smoke that comes from the burning end of a cigarette
  • There are over 4,000 chemicals in second-hand smoke, including lead, carbon monoxide, arsenic and ammonia
  • Second-hand smoke is more harmful to children because of their developing lungs and immune systems
  • Second-hand smoke can inhibit the growth and development of an unborn baby, resulting in low birth weight and a greater likelihood of problems during pregnancy and delivery
  • In infants and children, second-hand smoke is known to increase the occurrence of ear infections, pneumonia, bronchitis, tonsillitis, asthma, allergies, and sudden infant death syndrome (SIDS)
  • Vaping can increase exposure to chemicals that could harm your health including possible lung damage
  • Second-hand vapour is not harmless and long-term health effects are still unknown

To further protect children from second-hand smoke, suggest to parents / caregivers to:

  • Make their home smoke and vape-free
  • Ensure their vehicle is smoke and vape-free. Ontarians cannot smoke or vape in motor vehicles with passengers under 16 years of age.
  • Insist that other caregivers provide a smoke and vape-free environment

More information:

Call the Niagara Region Public Health Tobacco Hotline 905-688-8248 ext. 7393 or 1-888-505-6074 ext. 7393.

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Parachute Canada
1-647-776-5100 or 1-888-537-7777

Niagara Region Public Health
Parent Talk Line
905-688-8248 ext. 7555

Health Canada
Consumer Product Safety Bureau

Canadian Red Cross

Family and Children’s Services Niagara
905-937-7731 or 1-888-937-7731

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Contact Information

Emergency Numbers

  • Emergency Fire, Police, Ambulance 911
  • Poison Information 1-800-268-9017

Non-Emergency Numbers

  • Ontario Provincial Police 1-888-310-1122
  • Niagara Emergency Medical Services (Ambulance) 905-984-5050
City Niagara Regional Police Services Municipal Fire Departments
Fort Erie 905-871-2300 905-871-1600
Grimsby 905-945-2211 905-945-2113
Lincoln 905-945-2211 905-563-2799
Niagara Falls 905-688-4111 905-356-1321
Niagara-on-the-Lake 905-688-4111 905-468-3266
Pelham 905-735-7811 905-892-3943
Port Colborne 905-735-7811 905-834-4512
St. Catharines 905-688-4111 905-684-4311
Thorold 905-688-4111 905-227-6412
Welland 905-735-7811 905-735-9922
West Lincoln 905-945-2211 905-957-3346

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Last updated: Sept. 30, 2019

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