Caregiver Vigilance

When considering the safety of your infant, toddler or young child under 5 years of age, you must consider caregiver vigilance.  Whether the caregiver is a parent, nanny or grandparent, one thing is true:  your child will not be observed or in plain sight 24 hours a day. 

In fact, results from an excellent 2004-2005 study conducted by Dr. Barbara Morrongiello,  Michael Corbett , MM, Megan McCourt, MM and Natalie Johnston, BA indicated that mother and child are awake and home together (supervised) only about 6.50 hours per day.  That leaves 17.5 hours per day that a child is not directly in sight. The child may be sleeping in a crib, or playing in the activity center, or simply playing with toys around the other side of the kitchen counter.  But let’s face it, there are plenty of moments we take our eyes off our kids.  It may be only a few seconds, a few minutes, or more. The gurgling and babbling can still be heard, so they’re safe, right?  This is reality. It’s impractical to think otherwise.

Naturally characteristics of both child and caregiver factor into the risk of injuries at home. Is the child a natural risk-taker, seeks attention, or not able to control their impulses particularly well.  Age of the child and natural temperament have a lot to do with the risk of in-home injury.

For the most part, as a mother goes through the day with her young child, she is not thinking about the potential for injuries all the time.  This would lead to a rather neurotic approach to parenting, which in itself has some risks for the child.  For example, it could be theorized that a child who is prevented from ever experiencing a fall, a bonk on the head, or the taste of fresh escargot from the garden, may have the potential to struggle later in life with poor problem solving skills, fear of decision-making, or a weak immune system.  That is a topic for a future study.

It is the attitudes about supervision that you may find fascinating. Sherrilyn Coffman, RN, Vicci Martin, RN, Noreen Prill, RN and LCSW, and Beveryly Langley, RV conducted a study of common perceptions held by parents as it relates to how they watch their kids during the day. Results from this study showed that less than 50% of the parents in the study felt that in-home injuries could be prevented.  In other words, things happen whether you are watching or not and you can’t prevent them. 

The same study found that parents tended to be more concerned with kidnapping or abuse of their child, than drowning or car-related injuries. This underlying fear may reduce a caregiver’s diligence at home. 

And here’s the kicker - Dr. Morrongiello’s 2004 study also revealed that even when a child was involved in a serious injury that required medical attention, caregivers are not likely to change their approach to how closely they  supervise that child! Amazing, eh?

In 1993, Anita & Tommy Gärling researched Mothers' Supervision and Perception of Young Children's Risk of Unintentional Injury in the Home.  Mothers of children aged from 1 to 3 years old were asked to rate  the safety risk when children were in different rooms of the house under minimal supervision. These included bedroom, bathroom, family room and kitchen. Which room would you consider the safest?  In Gärling’s study, the response showed that the bedroom and family room were considered safe for 90% of children (any age).  Now back to reality – A 1993 study of this very topic showed that two-thirds of all home injuries happened in the bedroom or family room.  Once again a caregivers perception of safety doesn’t mesh with reality.

Gärling’s study also showed that 76% of two to six year olds get out of bed in the morning before their parents do. When the parents in the study were asked to rate the risk of a child getting injured on something in the house while the child is up and parent is still sleeping, an overwhelming 95% of the parents responded that there was little to no risk of injury!!  Now that is astonishing.  Why would we feel that they need to be closely supervised during the day, but if they are up alone in the morning all is well?  Baffling, eh?  What products do you have in your home that are bright, shiny, enticing, and quite dangerous for a young child to discover when they are up alone unsupervised?

These studies are not cited to scare you straight, but they are shared here to simply make you aware that your perceptions about your child’s safety at home are influenced daily by a lot of different factors.  Nearly 40% of all child injuries (sixty-six percent of injured kids two-year-olds and under) happen in the home. Study after study shows that parents consistently overestimate the skills and cognitive development of their child.  This can lead to less direct child supervision on the part of the parents, and consequently an increase in risk of at-home injury for the child.

Here are a few tips to help guide you as you determine your supervisory limits:

1.    Know your child – If your child is an explorer, very physical and impulsive, you should design your supervision to keep more frequent direct visual contact with the child.  This may decrease with age, but again – you must be confident that your child has developed a strong understanding of cause and effect before you decrease supervision too much. Though your child may be  a true genius, he/she is still a child, and they need your help to stay safe.

2.  Wake Up! – Life with a youngster can be exhausting for sure.  But always wake up with your toddler in the morning and begin your supervision when they open their eyes.  Even if you simply turn on the TV and rest in the same room with your toddler, this is safer than lying behind closed doors in a deep sleep.  Your child deserves your full attention during those 6.5 hours you will spend with him or her that day. 

3.   Child-proof your house – You have likely already done this, but make frequent checks in each room to be sure that the safety plugs and locks you put in place are still there and properly installed.

4.   Clean up – Each night before you turn in, put away toys and/or products that could entice your child, but would be unsafe for them without direct supervision.  Anything with small parts would be a good start.  This way, if they do sneak out of their room without you hearing them, you have reduced the risk of injury. Be sure all sharp knives or utensils are not close to the edges of the kitchen counters.  Close the bathroom doors, and make sure all doors to the outside are securely locked.

5.   Make your expectations known - You may hire a babysitter for a few hours, or ask Grandma to watch your child.  Always write down and discuss your supervision expectations with the sitter.  If you want the child in direct sight at all times, be sure to tell the sitter that. The sitter likely does not know the personality or skills of your child.  They are more likely to overestimate the child's abilities.

6.   Check, Check, Check – Check on your child often during the day.  The younger the child, the more often you should have your eyes directly on them.  While a newborn won't have much risk of injury, a toddler is off and exploring their world with a vengeance!  Keep close tabs on these newly mobile exploration machines! Okay, so there is no way you’re going to have your eyes on your child every second of those 6.5 hours.  Although only you know the amount of supervision your child requires, a rough gauge might be:

a.   Birth up to 3 years – Keep child in direct sight at all times

b.   3-4 year olds – Check every 5 -10 minutes

c.    4-5 year olds – Check every 10-15 minutes

d.   Over 5 year olds – Check every 15-30 minutes

NOTE:  Always err on the side of checking more often. If you have a pool or spa or other accessory that would be immediately life-threatening to a young child, you may need to have much more direct eye contact with them.  Remember it only takes 60 seconds for a child to drown, suffocate or choke to death.  Be vigilant.