Pediatrics · Safety
Pediatric Safety, Poisoning & SIDS Prevention
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Prepared for Pass the Shift (owner: Kristina, RN). Always follow your facility’s protocols, provider orders, and current references.
1. Overview
Unintentional injury is a leading cause of death in U.S. children over age 1. Most injuries are predictable and preventable. Match teaching to development: infants roll and put everything in their mouths; toddlers climb, explore, and have no sense of danger; school-age kids take risks with peers; teens drive, experiment, and are vulnerable to suicide and violence.
2. Safe Sleep and SIDS Risk Reduction
is the sudden, unexplained death of an infant < 1 year during sleep after a full investigation. It falls under the broader term sudden unexpected infant death (SUID), which also includes accidental suffocation and strangulation in bed. Peak risk is 1–4 months; most occur before 6 months.
AAP safe sleep recommendations (2022), key points — “ABCs: Alone, on the Back, in a Crib”:
- Back to sleep for every sleep (naps and night) until age 1. Once the baby rolls both ways on their own, they can stay in the position they roll to
- Firm, flat, non-inclined surface (crib, bassinet, portable play yard meeting safety standards) with a fitted sheet — no inclined sleepers, car seats, swings, or couches for routine sleep
- Nothing in the sleep space: no pillows, bumper pads, blankets, stuffed toys, or positioners. Use a wearable blanket/sleep sack
- Room-share without bed-sharing, ideally for at least the first 6 months
- Offer a pacifier at sleep times (after breastfeeding is established); don’t force or reinsert once asleep
- Breastfeeding and routine immunizations lower risk
- Avoid smoke, alcohol, and drug exposure during pregnancy and after birth
- Avoid overheating and head covering
- Supervised, awake tummy time daily to build strength and prevent positional plagiocephaly
- Don’t rely on home cardiorespiratory monitors or “smart” baby monitors to reduce SIDS risk
- Swaddling: stop once the baby shows signs of trying to roll (often by ~2 months); never swaddle tummy-down
Nurses model safe sleep in the hospital — parents copy what they see.
3. Injury Prevention by Age
| Age | Major risks | Key teaching |
|---|---|---|
| Infant | Suffocation, falls, car crashes, burns, choking, drowning | Safe sleep; never leave on a changing table or bed; rear-facing car seat in the back seat; water heater ≤ 120 °F (49 °C); test bath water; no hot liquids while holding baby; small objects out of reach |
| Toddler / preschool | Drowning, poisoning, choking, falls (windows, stairs), burns, car crashes, firearms | Gates, window guards, cabinet locks, medicines and cleaners locked up high, arm’s length supervision near any water (bathtubs, buckets, pools — fence pools on 4 sides), turn pot handles in, cover outlets, keep cords away, store firearms unloaded and locked with ammunition separate |
| School-age | Car crashes (pedestrian, bike), sports injuries, drowning, firearms | Booster seat until the adult seat belt fits (often ~4 ft 9 in, ages 8–12); back seat until age 13; helmets; swimming lessons; street safety |
| Adolescent | Motor vehicle crashes (leading cause of death), suicide, homicide, substance use, sports injuries | Seat belts, no texting/impaired driving, graduated licensing, mental health screening, firearm safe storage, safe sports equipment, concussion awareness |
Car seats (AAP): keep children rear-facing as long as possible, until they reach the seat’s maximum height or weight limit (most convertible seats allow this to age 2 or beyond). Then forward-facing with a harness, then booster, then seat belt. Never place a rear-facing seat in front of an active airbag. Harness snug (pinch test) and chest clip at armpit level; no bulky coats under straps.
4. Poisoning
Toddlers are at highest risk for accidental ingestion. Teens may have intentional ingestions — always assess for self-harm.
General steps:
- Assess ABCs and level of consciousness first; call 911 if unresponsive, seizing, or not breathing
- Identify the substance, amount, time, and route; bring the container
- Call Poison Help: 1-800-222-1222 (U.S.) for guidance
- Do NOT induce vomiting (ipecac is no longer recommended)
- Treatments per provider/poison center: activated charcoal (for some ingestions, within ~1 h, only if the airway is protected; not for caustics, hydrocarbons, alcohols, iron, lithium), antidotes, decontamination, supportive care
| Substance | Key facts | Antidote / treatment |
|---|---|---|
| Stage 1 (first 24 h): nausea, vomiting, sweating — or no symptoms; liver injury peaks ~3–4 days. Draw a 4-hour level and plot on the nomogram | N-acetylcysteine (NAC) — most effective within 8 h | |
| Iron (adult vitamins) | GI vomiting/bloody diarrhea, then a “quiet” phase, then shock, metabolic acidosis, liver failure | Deferoxamine (urine may turn “vin rosé”/reddish); charcoal doesn’t bind iron |
| Salicylates (aspirin, oil of wintergreen) | Tinnitus, hyperventilation, vomiting, mixed respiratory alkalosis + metabolic acidosis, hyperthermia | Supportive, sodium bicarbonate (urine alkalinization), dialysis |
| Lead | Old paint (pre-1978 homes), soil, some imported products/spices/cosmetics. Pica, irritability, learning problems, anemia, abdominal pain; high levels → encephalopathy. No safe blood lead level; CDC uses a reference value (currently 3.5 mcg/dL) | Remove the source; nutrition (iron, calcium); chelation (e.g., succimer PO; CaNa₂EDTA IV) for high levels |
| Caustics (drain cleaner, dishwasher pods) | Burns to mouth/esophagus; drooling, dysphagia, stridor | Don’t induce vomiting or neutralize; airway; endoscopy |
| Hydrocarbons (gasoline, lamp oil) | Aspiration pneumonitis — coughing, gagging | No vomiting; supportive; respiratory monitoring |
| / magnets | Battery can burn through the esophagus in ~2 hours | Emergency removal; honey (or sucralfate in hospital) may be advised by poison center/ED for children > 1 yr in some cases if ingestion within 12 h — only on expert advice |
| Opioids (including fentanyl, caregiver meds) | Pinpoint pupils, respiratory depression, sedation | Naloxone; supportive care |
| Cannabis edibles | Sedation, ataxia, tachycardia; young children can become very ill | Supportive |
5. Foreign Body Aspiration and Choking
- Peak age 1–3 years; common items: nuts, popcorn, hot dogs, grapes, hard candy, small toy parts, coins, balloons
- Signs: sudden coughing/choking, wheezing, stridor, decreased breath sounds on one side (often the right main bronchus in older children)
- Conscious choking infant (< 1 yr): 5 back blows + 5 chest thrusts (no abdominal thrusts). Child ≥ 1 yr: abdominal thrusts (Heimlich). If unresponsive → start CPR, look in the mouth before breaths; no blind finger sweeps
- If the child can cough forcefully or speak, let them cough and stay with them
6. Burns and Drowning (key points)
- Scald burns are most common in young children; stocking-glove pattern or symmetric immersion burns with clear lines suggest abuse
- Drowning is silent and fast — often happens in minutes with a supervisor nearby but distracted. Use a “water watcher,” lifejackets, pool fencing, empty buckets/tubs, swim lessons, CPR training for caregivers
7. Memory Aids
- Safe sleep “ABC”: Alone, Back, Crib — “Nothing but baby”
- Car seats: “Rear as long as the seat allows; boost until the belt fits; back seat until 13”
- Poison: “ABCs, call 1-800-222-1222, never make them vomit”
- Antidotes: Acetaminophen → NAC (“Acetaminophen = Acetylcysteine”); Iron → Deferoxamine (“Ferrous → De-fer-oxamine”); Opioid → Naloxone; Lead → chelation
- Button battery = “2 hours to burn”
- Choking: Infant “5 and 5” (back blows/chest thrusts); child = abdominal thrusts
8. NCLEX-Style Practice Questions
1. A parent of a 2-month-old asks how to reduce the risk of SIDS. Which statements by the parent indicate correct understanding? Select all that apply.
A. “I’ll place my baby on her back for naps and at night.”
B. “I’ll use soft bumper pads so she doesn’t hit her head.”
C. “Her crib will be in our room, but she’ll sleep in her own crib.”
D. “I can let her sleep in her car seat in the house every night.”
E. “I’ll use a sleep sack instead of a loose blanket.”
Answer: A, C, E. Back sleeping, room-sharing without bed-sharing, and wearable blankets reduce risk. Bumper pads (B) and routine sleep in sitting devices like car seats (D) increase suffocation risk.
2. A mother calls saying her 3-year-old swallowed several of her iron tablets 30 minutes ago. The child is vomiting. What should the nurse advise first?
A. “Give syrup of ipecac to make him vomit more.”
B. “Bring him to the emergency department now; call 911 if he becomes drowsy or has trouble breathing.”
C. “Give him milk and watch at home.”
D. “Give activated charcoal from your medicine cabinet.”
Answer: B. Iron ingestion can be fatal in young children and needs emergency evaluation (deferoxamine may be needed). Ipecac is no longer recommended, milk doesn’t help, and charcoal doesn’t bind iron.
3. A 15-year-old is brought in 2 hours after taking a large number of acetaminophen tablets. She has mild nausea and otherwise feels fine. What is the priority understanding for the nurse?
A. She feels fine, so the ingestion was not toxic
B. Early symptoms may be mild; obtain a 4-hour acetaminophen level and anticipate N-acetylcysteine
C. Induce vomiting immediately
D. Treat only if jaundice develops
Answer: B. Acetaminophen overdose is often nearly symptom-free early, while liver damage develops over days. NAC works best within 8 hours. Also assess suicide risk and maintain safety.
4. A 10-month-old is choking on a piece of food, is unable to cry, and is still conscious. What should the nurse do?
A. Perform abdominal thrusts
B. Give 5 back blows followed by 5 chest thrusts
C. Do a blind finger sweep
D. Give rescue breaths
Answer: B. For conscious infants, alternate 5 back blows and 5 chest thrusts until the object comes out or the infant becomes unresponsive. Abdominal thrusts are for children ≥ 1 year.
5. Which instruction is most appropriate for the parent of a 4-year-old who weighs 40 lb, according to AAP car seat guidance?
A. “Move him to a seat belt in the front seat.”
B. “Keep him in a car seat with a harness until he reaches the seat’s height or weight limit, in the back seat.”
C. “He can use a lap belt only.”
D. “Turn his seat rear-facing in the front seat.”
Answer: B. Children stay in a harnessed car seat as long as the seat allows, then move to a booster until the seat belt fits properly, and ride in the back seat until age 13.
References
American Academy of Pediatrics. (n.d.). A parent’s guide to safe sleep. HealthyChildren.org. Retrieved October 15, 2026, from https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/a-parents-guide-to-safe-sleep.aspx
Daley, S. F., & Lovik, K. (2026). Sudden infant death syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560807/
Moon, R. Y., Carlin, R. F., Hand, I., & the Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. (2022). Sleep-related infant deaths: Updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics, 150(1), e2022057990. https://doi.org/10.1542/peds.2022-057990
National Council of State Boards of Nursing. (2026). 2026 NCLEX-RN test plan. https://www.nclex.com/test-plans.page
Schaffer, D. H., Murray, B. P., & Khazaeni, B. (2026). Acetaminophen toxicity. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441917/