The great outdoors, from parks and beaches, to your own garden, seems fraught with danger in the form of physical injuries or bites ranging from insects to large animals like dogs. Knowing what to do if it occurs will not only give you a peace of mind but also allow your child to continue exploring the world beyond his front porch.

Stings and bites are common in a tropical country like ours. Often, these are harmless, from ants, mosquitoes or sand flies. Some may cause more pain and discomfort, such as bee stings. However, some harmless bee sting may be fatal, as a result of an allergic reaction. Some bites from wasps, some spiders and snakes may be fatal or cause serious illness.

Has Your Child Been Stung?

The most common sign is crying from pain and discomfort. Other telltale signs include:

• Swelling over the affected area.
• Presence of stinger at the site.
• Allergic reaction to the sting, which in some cases, may progress to anaphylaxis.

Early signs of allergy include generalised itchiness, hives that may appear anywhere on the body, runny nose, sneezing and watery eyes. Anaphylaxis (allergic reactions) if left untreated may be fatal. Symptoms include difficulty in breathing, swelling of lips and eyes, feeling faint and loss of consciousness.

Treating Bee Stings

Some simple steps in which you could take to reduce your child’s discomfort if stung or bitten by an insect:

• Remove the stinger as fast as possible, and clean the area with soap and water.
• Apply ice over the affected site to numb the pain and reduce swelling. Oral paracetamol or ibuprofen will help reduce the pain while antihistamines will reduce the itch.
• Do see a doctor should there be any adverse reactions from the sting/bite.

Flea Bites

Fleabites are generally harmless. However, they do itch and may sometimes cause allergic reactions. Fleabites are not confined to families with pets. House dust mites belong to the flea family too, and are often found in beddings. The bites are noticed as red dots on body or limbs that may be extremely itchy and the affected area may be swollen. In most cases, applying antiitch or mild steroid cream will suffice. Taking oral antihistamines may help alleviate itchiness.

The best way to prevent fleabites is to get rid of the fleas. For house dust mites, bedding should be aired and exposed to sunlight. Children soft toys should be washed regularly with very hot water to kill the mites. Household pets such as cats and dogs should be bathed regularly to prevent flea infestations.

Bitten by a Dog?

Although Malaysia is free from rabies, dog bites can still result in severe injuries and infections, which may be fatal. Apart from blood loss, dog bites may result in local bacterial infections and tetanus (lockjaw).

Treatment of Dog Bites

• Clean the wound with water and antiseptic.
• Stop the bleeding by pressing over the wound.
• Seek immediate medical attention.
• Your child may require a tetanus shot if the last shot was more than 10 years ago.
• Most cases will require a course of antibiotics to treat secondary infection.

If your child encounters a stray dog, he should remain motionless instead of running and screaming as this would lead the dog to chase him. Children should also be more cautious – not disturbing or playing with dogs that are sleeping, eating, or caring for pups.

Sometimes, despite all the preventive measures, your child may still be a victim of insect or dog bites. If bitten, teach your child to report to you immediately. It is important that you stay calm, try to administer first aid and seek further medical attention.

Toys not only make up a very important part of good childhood memories, they also play a role in aiding a child's development. However, toy-related injuries can occur.

While older children generally know how to use their toys, babies and kids younger than 3 years old may not know how to play with theirs safely. Toys may pose different potential safety hazards, such as choking and cut injuries, in the young and vulnerable group.

Therefore, be a 'fussy' parent when it comes to selecting toys for your child. Take every step to ensure your child's toys are safe and appropriate for his age and developmental stage.

Toy Dangers to Watch Out

Here are some toys that you would want to keep away from your young child.

How to Choose Safe Toys

The first step in choosing safe toys is to read the toy labels carefully, making sure that the toys:

• Are appropriate for your child's age; toys made for older children may be dangerous in the hands of little ones.
• Are large enough so they won't pose choking hazards.
• Don't have cords or long strings that may pose strangulation hazards; the length should not exceed 30cm.
• If made from fabric, should be flame-resistant.
• If stuffed toys, should be washable, have no staples inside and sewn small parts are not easily removed.
• If painted, should be painted with lead-free paint and not flaking.
• Are not assembled with easily exposed pins, staples or nails.
• Are made from non-toxic materials.

Selecting Age-appropriate Toys

Toys not only should be safe, they should also be suitable for their age. When playing with safe and age-appropriate toys, your child is less exposed to toy dangers, and is able to enjoy playing and gain benefit from it.
0-6 months - Babies learn to reach and grasp what they see (eye-hand coordination). Suitable toys include light-weight rattles, squeaky rubber toys, busy boxes, and floating tub toys.
6-8 months - Babies can now hold small toys; they love to transfer toys from hand to hand. Toys they enjoy are such as light-weight fabric balls, pictures blocks, and mobile toys. (where baby can push around).
8-18 months - Babies begin to experiment with size, shape and space. Suitable toys are push/pull toys (eg wagon), blocks, rings on poles, shape sorters, simple take-apart toys, and picture books.
18-24 months - Toddlers enjoy pretend play. Parents may get dolls, kitchen/tea sets, play house, and toy cars (eg train sets, trucks) for their children.
2-4 years - Toddlers are developing skills in various areas. Parents can provide a variety of toys to aid children's development, eg art supplies to help develop creativity, simple puzzles and construction sets to aid develop fine and gross motor skills, miniature basketballs and hoops and other outdoor equipments to train physical skills.

Soft Landing

Condition: Choose playgrounds where the ground is covered with rubber mats or grass surfaces. These surfaces should extend at least 6 feet beyond the play equipment.

At Play:

• Ensure that the ground is free from broken glass, debris, standing water or objects that could cause kids to trip and fall, such as rocks or tree branches.
• Watch out for muddy patches on the grass that could be slippery and cause a child to fall.

Swings

Condition: Swings with soft seats are preferable.

At Play:

• Your child should sit on the seat, and should not be allowed to stand or kneel.
• Make sure that no one is standing in front of the swing.
• There should not be more than one child on a swing.

Slides

Condition: The slide should be a sturdy structure with guardrails.

At Play:

• The child should slide down feet first, in a sitting position.
• Do not let allow children to slide down in a group.
• Always check that the bottom of the slide is clear.

Seesaw

Condition: There should be no loose or broken parts. If the height of the seesaw centre is higher than a child’s waist or shoulder, it should be at least 9 feet away from other equipment.

At Play:

• Your child should hold on tightly using both hands.
• Children should be seated facing one another.
• Ensure that other adults and children always keep a safe distance from a seesaw when it is in motion.

Climbing Equipment

Condition: Check all equipment for sharp points and protrusions that may cause injury.

At Play:

• Ensure that children do not race across the bars.
• This equipment is not suitable for younger children aged 5 years and below.
• Teach children to use both hands while climbing and beware of swinging feet.

Firstly, never allow children aged 12 years and below, including infants, to ride in the front seat! Front passenger airbags inflate at speed of up to 100km/h in a crash. This can injure or kill a child even in a slow-speed crash.

Secondly, child-safety seats at the back are a must. They are an important lifesaver. If a crash occurs, child safety seats help:

• Restrain your child.
• Prevent him from being thrown about inside or flung out of the car in an accident.
• Absorb the impact of a crash.

1. Keep young children out of the kitchen.
   
   
2. Keep sharp utensils and appliances out of your child’s reach.
   
   
3. Install locks or guards on drawers, cabinets and doors.
   
   
4. Install a stove guard to prevent your child from touching flames or hot burners. Use stove knob covers to prevent children from playing with them.
   
   
5. Hanging cords from electrical appliances such as blender and rice cooker is dangerous. Unplug appliance cords when not in use and keep them tied up and out of children’s reach. Hide them with cord cover or tape.
   
   
6. Make a habit of turning pot handles inward and away from the edge of the stove. Never eat, drink, carry or prepare foods or beverages while holding a baby.
   
   
7. Keep hot drinks and foods away from the edges of tables and counter tops.
   
   
8. Remove plastic bags immediately. Punch holes and tie them into knots before throwing them away. Alternatively, keep them out of reach of children. In addition to the potential for suffocation, children can choke on small pieces of plastic bag.
   
   
9. Tablecloths that hang over table edges can easily be pulled down and anything on top can fall on the child. Make sure it is fasten with pegs or clips.
   
   
10. Store automatic dishwasher detergent and other toxic cleaning supplies in their original containers, out of a child’s reach.
    

At Home

• Install topple-proof furniture and use corner protectors over sharp edges of your furniture. Lock your windows and prevent access to balconies especially in high-rise buildings.
• Label all chemicals and medicines and keep them locked in a child-resistant cupboard. Do not reuse soft drink containers to store hazardous liquids.
• Keep your children away from all hot appliances.
• Children should not run and play in the kitchen or any area where there is outdoor cooking.
• Keep knives and sharp utensils out of reach.
• To prevent choking, make sure your children sit down when eating and never give nuts or small sweets to children below 5 years of age.

Outdoors

• Do not let your child play by the roadside or in carparks with moving vehicles.
• Look for playgrounds with equipment less than 1.5 meters high to prevent falls and those with soft flooring or soft rubber which are safer for children.
• Always watch your child, especially when he is trying something new at the playground
• Children should never be left alone by the poolside or beach, or allowed to swim in a pool or in the sea without adult supervision.

Preschool

• Send your child to a preschool with a sufficient number of staff to supervise the children.
• Preschool furniture should have rounded corners and not be too light (eg plastic chairs) as these are unsafe.
• Sinks and toilets must be child-sized.
• Grounds should be properly fenced and locked to keep intruders out. Toilet facilities and play areas should be within these boundaries.

In The Car, On The Road

• Strap your child into a safety seat or booster seat each time you travel, no matter how short the trip.
• Activate child-proof locks to prevent your child from opening the door while you are driving.
• Never leave your child unattended in the car.
• Teach your children road basic safety rules and always hold their hand when walking on the sidewalk, crossing the road or even in a car parking lot. Walk with the child away from traffic.

In the event of a fall, look out for the following indications of a possible serious injury. Get medical help immediately if your child has any of the following:

• Pain, swelling, deformity or inability to move any limb
• Limping or inability to stand up and walk
• Loss of consciousness, drowsiness, headache or vomiting
• Irritability, slurred speech
• Deep cuts that do not stop bleeding
• Open wounds that are heavily contaminated with soil or other fragments

and sizes so make sure you buy the right seat for your child. Infant seats are for infants up to 12 months old (or who weigh 10 kg) and are fitted facing the rear of the car. Convertible car seats are for children aged between 1 and 4 years and can be installed either forward- or rear-facing, depending on the child’s weight. Booster seats are for children aged 4-10 years old or who weigh between 18 kg and 22 kg. These seats raise children to a height at which it’s safe for them to use the adult seat belts. If you are not sure what seat to buy, ask your paediatrician.

2. Buckle up.
Do it for yourself; do it for the children, too. As stated in the previous point, young children must be placed in car seats. If your child has outgrown the booster seat, he is now tall enough to use the adult seat belt in the back seat. No child under 12 should sit in the front passenger seat. At all times, ensure that driver and all passengers are safely buckled up.

3. Keep to the speed limit.
Don’t succumb to the temptation of speeding. If it is raining, visibility will be low and you may need to drive a little slower to give you more time to recover in case you come across obstacles on the road such as fallen tree branches and stalled cars.

4. Stay alert.
Take a break at least once an hour by pulling into a highway rest stop. If you feel sleepy, take a 15- to 30-minute nap. Stopping frequently will also give children the chance to stretch their legs, which will prevent restlessness and consequent grumpiness. If possible, take turns at the wheel with your spouse or other travelling companions who have valid driving licences.

5. Watch out.
If others on the road are driving dangerously or recklessly, keep your distance from them. If you turn into a rest stop to get away and they follow you, do not get out of your vehicle! Choose bigger rest stops that have more motorists around, and don’t unlock or open the doors if anyone suspicious is loitering near where you’re parked.

6. Lock the doors.
This isn’t only necessary when your car is stationary. If one of you fails to close a door tight, the lock will be able to prevent it from swinging open while you move (to some extent). To be extra sure, walk round the car making sure all doors are closed securely before you get in, yourself. If your car comes with a child lock feature, use it.

So, however difficult, you need to strike the balance between safeguarding your child and giving him the freedom to develop. What you can do is to exercise a little foresight and make the effort to prevent potential accidents. This entails removing, modifying or eliminating the obvious dangers, particularly the deadly seven that are described below.

Also, prepare yourself to handle an emergency. Keep a well-stocked first-aid kit at home and in the car. Read books, browse the internet or attend a course to find out how to deal with choking, bleeding and poisoning. If you wish, learn cardiopulmonary resuscitation (CPR). Should a serious accident occur, act calmly and swiftly.

In most cases, these preventive and emergency measures would be enough to ensure your child’s safety or, if the need arises, to help save his life.

1. FALLS & TUMBLES

The buai, a hammock suspended by a spring, can be hazardous. Babies placed inside to sleep have been known to fall out. Also, a loose spring or vigorous rocking have led to children hitting the floor or
colliding with nearby furniture. Put your child in a cot; it is safer.

Avoid baby walkers. It is debatable whether these devices will actually help him learn to walk but one
thing is for sure – they have been known to cause serious injury. They can tip over and cause your child to suffer bumps, bruises and fractures. Furthermore, there have been painful incidents where the wheels on badly-designed walkers have rolled over children’s toes. Also, some children have rolled to perilous places (like the top of the stairs) only to plunge to an untimely death.

If you live in a high-rise apartment or a multi-storey house, have your windows and balconies barred. Whether your child was just curious about what’s outside or imagining he was Superman, falling can be fatal.

Staircases are equally notorious. Before your child begins to crawl on all fours, put up safety gates at the top of your stairs. As soon as he’s ready, teach him how to climb the stairs correctly – ie by holding onto the hand rails.

Falling can also occur in the playground. So, always check to ensure the safety of the equipment. A rusty handle on the see-saw, for instance, could come off and cause your child to fall to the ground. Never let your child ride the swing, climb the slides or hang on the monkey bars before he is old and strong enough. Even then, be sure to supervise him constantly.

If possible, choose a playground that has a softer surface – like grass turf, sand, wood chips or shredded rubber – to cushion your child should he fall.

When shopping, you might wheel your child about in the trolley. If so, restrain him with a safety belt. Also do not allow him to fidget too much as he could throw the trolley off balance and fall, as a result. Never leave your child in the trolley unattended.

2. MOTOR VEHICLE ACCIDENTS

Deaths resulting from motor accidents are common among children under age 15. Do not allow your child to venture onto the road by himself. You should always walk on the side of the traffic to prevent him from accidentally going to far out ... and into the pathway of a car. When your child grows older, teach him how to cross the road safely.

When in the car, everyone must wear a seat belt. Until your child is big enough, place him in a child car seat. Preferably, place him in the backseat where he’ll be safer. Most important, drive safely. When your child learns to ride a bicycle, make sure he wears a safety helmet.

3. POISONING

Infants and toddlers tend to put things into their mouths as a way of discovering or exploring things. Sometimes, this can result in accidental poisoning.

Prevent such mishaps by locking up all medicines. Keep cleaning solutions and chemicals in their original containers (not in soft drink or juice bottles) and place them far away from actual beverages. Beware especially of moth balls and homecare products with colourful packaging; they can look like tempting sweets or chocolate bars. Some plants (like certain mushrooms, berries and shrubs) can be poisonous. Check with the Poisons Centre before you add a new and unfamiliar plant to your garden.

4. DROWNING

Don’t leave your baby or young toddler alone in the bathtub. Keep toilet lids closed and empty all water buckets.

Your child will probably love playing in water but he can drown, even in a few inches. Never let him out of sight when near water, whether it’s a lake, swimming pool or wading pool. Around your house, keep him away from monsoon drains and make sure sewage tanks are covered.

5. BURNS & SCALDS

Many burns and scalds occur in the kitchen. When cooking, place pots and pans on the back burners, out of your child’s reach. Turn the pot handles away from the front of the stove so that they will not be accidentally dragged or knocked down.

Before bathing your child, test the temperature of the water by moving your hand through it for several seconds. His skin is a lot more sensitive than yours, so a mild temperature will do.

Keep matches and lighters away from your child’s inquisitive fingers. If possible, install smoke detectors in your house to reduce the risk of fire. At least once a year, check to make sure that it works.

6. CHOKING & STRANGULATION

With his small airway, your child can easily choke on small objects like buttons, jewelry, beads and small toys. Even small round foods (like grapes and nuts) pose a risk and have to be given carefully.

Secure the cords to window blind so that your child does not gets tangled up or strangled by them. Properly discard or store away plastic bags to avoid him putting them over his head.

7. CHILD ABUSE

Sometimes, the greatest injury a child can suffer is inflicted by those who were meant to love him – his parents or caretakers. The results could range from severe physical and mental trauma, to death itself. If you can’t help abusing your child, whether verbally or physically, seek professional help.

Physical Abuse

Hitting, burning or causing any bodily harm to a child for no apparent reason is physical abuse. While it’s the parents’ duty to guide their children to have proper behaviour, they should never abuse their authority.

Emotional Abuse

Scolding or picking on a child because he gets poor results and comparing him with others is hurtful, especially when he is trying his best. Instead, find something positive he has done: has he been polite or kept his room neat? If so, praise him for it! Encourage him to find his own special talents and develop them. If you see him having difficulties, help him improve instead of labelling him “useless” or “stupid”.

Sexual Abuse

If your child tells you that someone has touched his private parts, do not ignore him and think that he has imagined it. Young children do not usually make up such stories without some kind of direct experience. Encourage them to talk about it and listen to what they have to say. Many children are afraid to say anything because the abuser has threatened them, told them no one will believe them or that they will be blamed for what had happened. Stand up for your child and assure him that you will protect him from anyone who tries to hurt him. Seek professional help, and never think that your child will be safe with the abuser just because he/she promised to stop or has apologised.

Neglect

Neglect occurs when a child’s family fails to provide for his needs despite being able to do so. Most families realise the need to provide children with necessities such as food, clothing, health care and education. However, they sometimes overlook proper supervision, which may expose a child to danger. For example, children can die of heat exhaustion and suffocation if left locked for hours in parked vehicles. They can drown if left to play by themselves near a pool of water.

Children without the chance to form a close bond with their parents can suffer from emotional neglect. The bond begins when they are babies and develops when parents are directly involved in the care of their children. Building a good relationship with children helps them to be emotionally secure and lays the foundation for good communication as children become older.

Don’t Lose Your Head

While babies and young children are adorable, they can drive you up the wall with their nonstop crying or misbehaviour. The moment you find yourself losing patience with your child, take a few deep breaths and STOP. Hitting or shaking a young child in anger can cause serious injuries to his brain and other internal organs. The key here is to stay calm and in control. Here are some alternatives:

• Take a few deep breathes and count to 20.
• Put your child on a time-out chair.
• Ask yourself why you are angry: is it your child or are you angry about something else?
• Talk to someone – call a family member or friend.
• Ask someone else to watch the child for a little while and take a break.
• Splash cool water on your face.
• Turn on some music or hug a pillow.
• If your baby cries, soothe him by rocking him gently or talking softly. Don’t shake him!

Discipline vs Abuse:

Drawing The Line

Some actions are clearly abusive and cannot be considered “acceptable discipline”:

• Beating that causes injury with bruises and bleeding
• Caning a baby or toddler who is too young to understand what is right and wrong
• Kicking, punching and shoving a child against something hard
• Causing burns or scalds
• Hitting a child during a quarrel with someone else
• Hitting a child out of anger and frustration although it doesn’t concern the child
• Punishing a child due to unreasonable expectations (eg. hitting a two-year-old for wetting his pants)
• Hitting a child while under the influence of alcohol or drugs
• Punishing a child without first explaining that a certain behaviour is unacceptable
• Depriving a child of food and drink or exposing him to harsh elements

If you find it hard to control your child, get professional help immediately.

Warning Signs of Sexual Abuse

Below is a list of signs that indicate the possibility of sexual abuse:

• Pain around the private parts
• Blood or discharge around the private parts or underwear
• Sexual behaviour towards others
• Sudden rebellious or aggressive behaviour
• Smoking, taking drugs or alcohol
• Appearing sad, depressed or suicidal
• Pregnancy
• Playing truant and running away
• Falling grades in school
• Difficulty sleeping, nightmares and poor appetite

Protecting The Innocents

Protecting children from abuse is the responsibility of the whole community. This includes extended family, friends, neighbours and teachers as well as agencies like health care and welfare services. The child protection law currently in force in Malaysia is the Child Act 2001, which provides for children suspected to have been abused to be cared for under the authority of the Department of Social Welfare.

Travel safely

Now that you’re a parent, you have not only your own safety to think of, but that of your children. Some things cannot be avoided, but do what you can to prevent a road accident from harming or killing your child.

1. Safety seats. In case an accident occurs, nothing can keep your children as safe as a properly fitted and installed child safety seat will. These seats may make the difference between life and death. There are different types of seats for children of different ages and sizes so make sure you buy the right seat for your child. Infant seats are for infants up to 12 months old (or who weigh 10 kg) and are fitted facing the rear of the car. Convertible car seats are for children aged between 1 and 4 years and can be installed either forward- or rear-facing, depending on the child’s weight. Booster seats are for children aged 4-10 years old or who weigh between 18 kg and 22 kg. These seats raise children to a height at which it’s safe for them to use the adult seat belts. If you are not sure what seat to buy, ask your paediatrician. Whether you’re taking a 5-minute drive to the convenience stores or visiting your parents in your hometown, child safety seats are a must to keep your little ones safe.
   
   
2. Buckle up. Do it for yourself; do it for the children, too. As stated in the previous point, young children must be placed in car seats. If your child has outgrown the booster seat, he is now tall enough to use the adult seat belt in the back seat. No child under 12 should sit in the front passenger seat. At all times, ensure that driver and all passengers are safely buckled up.
   
   
3. Keep to the speed limit. Even if you left two hours behind schedule, don’t succumb to the temptation of speeding. If it is raining, visibility will be low and you may need to drive a little slower to give you more time to recover in case you come across obstacles on the road such as fallen tree branches and stalled cars.
   
   
4. Stay alert. Take a break at least once an hour by pulling into a highway rest stop. If you feel sleepy, take a 15- to 30-minute nap. Stopping frequently will also give children the chance to stretch their legs, which will prevent restlessness and consequent grumpiness. If possible, take turns at the wheel with your spouse or other travelling companions who have valid driving licences. This may mean you have to take over at entertaining the children, though!
   
   
5. Watch out. If others on the road are driving dangerously or recklessly, keep your distance from them. If you turn into a rest stop to get away and they follow you, do not get out of your vehicle! Choose bigger rest stops that have more motorists around, and don’t unlock or open the doors if anyone suspicious is loitering near where you’re parked.
   
   
6. Lock the doors. This isn’t only necessary when your car is stationary. If one of you fails to close a door tight, the lock will be able to prevent it from swinging open while you move (to some extent). To be extra sure, walk round the car making sure all doors are closed securely before you get in, yourself. If your car comes with a child lock feature, use it.

Eat safely

Celebrations (especially Malaysian ones!) are usually a time for great feasting. You may appreciate this time to catch up with your long-lost cousin over the family reunion dinner, but keep an eye on the children’s eating as well.

• Forbid playing while eating. This includes acting up at the table, participating in food fights, and playing with food. If your child is full, allow him to leave the dining table.
  
  
• Watch what he eats at meals. However adept your child is at eating on his own, he may be unfamiliar with some of the foods served. Look out for tiny bones, seeds or pits in what he’s eating. To be safe, cut all his food into bite-size pieces and be very careful to remove all potentially harmful objects.
  
  
• Watch what he eats between meals. Some popular festive snacks are not appropriate for young children as they carry a risk of injury by choking, or poking or scratching the mouth, gums and throat. These include:
  - Biscuits containing whole or powdered nuts
  - Pickled fruits (most do not have their seeds/pits removed)
  - Sweets and desserts with a sticky or powdery texture (eg dodol, kacang tumbuk, rava ladoo, tong yuen and traditional kueh using glutinous rice as a base)
  - Jelly sweets and jelly, including agar-agar and konnyaku

Play safe, stay safe

Visiting the old family home, or where your parents now live in your hometown, will bring a wash of nostalgia from your own childhood. While you catch up with your now grown siblings and cousins, keep an eye on the younger generation as they play:

• Keep children away from stoves, fires and charcoal pits used for cooking