GROWTH and DEVELOPMENT
Growth and development: Occurs in a cephalocaudal sequence. Motor skills progress in
a proximal distal sequence.
Infancy: Birth to 1 year
The infant moves from reflexive to intentional actions, to visual then physical searching
for an object (looking for a dropped object), to practicing hand-eye coordination (shaking
a rattle). At 6 months when something disappears from his/her vision, it is completely
―gone.‖ By the end of the first year, he/she begins to understand that an object (such as
mother) exists outside of his/her immediate perception (object permanence). The infant
also begins to associate a symbol with an event (mother picking up purse to leave).
Erikson: Trust vs. Mistrust – the infant develops a sense of self from the development
of a trusting relationship with a consistent primary caregiver. Basic needs are for
warmth, food and comfort. Interference in this relationship may result in delays in
growth and development.
Freud: Oral Stage- sucking, swallowing, chewing and biting are not only pleasurable,
but also crucial for survival. Demand for immediate gratification by crying (from being
hungry, wet or uncomfortable) and is gradually modified over the months to finding ways
to achieve fulfillment.
Piaget: Sensorimotor Stage-the infant is learning through all his/her senses and motor
activities. This is the time when all future cognitive functioning is laid down. The infant
is egocentric. Everything is perceived in relation to self.
Kohlberg: Egocentric Orientation Stage of the Preconventional morality level. This is
the stage that which is good is what one likes and wants. Judgments are made on the
basis of liking that which helps and disliking that which hurts.
Developmental Milestones:
Birth weight doubles in 4-6 months
Birth weight triples in 1 year
Posterior fontanel closes by 2-3 months
Height increases by 50% in 1 year
Head circumference chest circumference
Psychosocial
3 Months
Motor
3 Months
Toys
3 Months
Social smile
Responds to stimuli with whole body
Knows primary caregiver
Squeals aloud to show pleasure
Lifts head and chest in prone position
Follows objects with eyes
Moves arms and legs simultaneously
Can hold a rattle
Music box
Mobile
Mirror
6 Months
6 Months
6 Months
Apprehensive of strangers
Babbles and coos
Observes environment
Rolls from side to side well
Sits with assistance
transfers objects from hand to hand
rolls from back to abdomen
holds bottle
sits in high chair
Rattle
Soft toys
Bright colors
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
9 Months
9 Months
9 Months
Waves ―bye-bye‖
Mama, Dada indiscriminately
Stranger anxiety
Exhibits object permanency
Sits well without assistance
Uses pincer grasp
Creeps on hands and knees
Stands with assistance
Rattle
Soft toys
Bright colors
12 Months
12 Months
12 Months
Imitates behaviors
Cooperates with dressing
Mama, Dada has meaning
Shows jealousy
Birth weight tripled
Walks with assistance
Turns pages in a book
Stands without assistance
Attempts to stack blocks
Push and pull
Cloth books
Surprise toys
Ball
Issues Related to Hospitalization:
Nursing Interventions:
Interrupted routine
Lack of stimulation
Parental separation
Delayed response to cry/needs
Encourage caregiver to room in
Primary nursing
Hold for feedings
Promote home routines
Respond promptly to cry and other needs
Nutrition
Food Introduction
Instructions for Feeding
Breast milk/iron fortified formula for 1st year
Grains: 4-6 months
Fruits/vegetables
Meat/eggs
Feed all solids with spoon
Introduce at 3-4 day intervals
Common reaction: eczema
Do not dilute formula
Feeding is one of the major activities for infancy
Play
Infant play is characterized as onlooker and solitary. The infant actively watches others.
When he/she participates in play activities it is usually of the solitary type with minimal
interaction with other persons. The infant uses the hands and mouth as exploring organs.
Play develops gross and fine motor skills and spatial relationships.
Anticipatory Guidance/Health Promotion
Safety in vehicle, crib, bath falls, nutrition and feeding, colic teething, thumb/pacifier
sucking, temperament, immunizations, stimulation
Safety
Infants up to 20 lb (9kg) should be restrained in a rear-facing car seat in the middle of the
back seat of a car.
Crib side rails up.
Never leave infant unattended on bed, changing table or bathtub.
Check temperature of bath water, foods and formula.
Teach injury prevention: aspiration of foreign objects, suffocation, falls, poisonings and
burns.
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
Toddler 1 year to 3 years
Maternal attachment is firmly in place. Ritualistic behavior is exhibited during the
toddler period: ritualism is the toddler’s need to maintain sameness and reliability;
provides a sense of comfort. He/she has a short attention span ( 15 min.) and still takes
naps. The toddler has poorly developed body boundaries, and any intrusion (even a
painless one) produces anxiety.
Erikson: Autonomy vs. Shame and Doubt- the toddler develops a sense of
independence through exploration of the world around him/her and encouragement from
the primary caregiver. The child learns to tolerate frustration through socialization and
toilet training. Failure to achieve autonomy may leave the child feeling doubtful about
his/her abilities.
Freud: Anal-Uretheral phase- it is during toilet training that the delay gratification
becomes required and expected. Activity is centered around the anus and buttocks with
the emphasis on control of the elimination of body waste.
Piaget: Piaget’s final two phases of the Sensorimotor stage occur during the toddler
period, and the beginning of the Preoperational stage occurs. As the Sensorimotor stage
ends, the child now understands object permanence and causality. The child uses trial
and error and repetition learning. During toddler hood, the child begins the
Preconceptual phase of the preoperational stage. There is the beginning ability to use
symbols in language and play and continued egocentrism.
Kohlberg: Preconventional morality level continues with the Egocentricity Orientation
stage.
Physiological:
Birth weight quadruples by 2 years
Anterior fontanel closes by 18 months
Sphincter control begins around age 2 years
Potbelly appearance
Head circumference = chest circumference
Psychosocial
15 Months
Motor
15 Months
Toys
15 Months
Uses 4-6 words
Knows 1 body part
Walks without assistance
Builds tower of 2 blocks
Push and pull
Blocks
24 Months
24 Months
24 Months
Understands possession
Negativistic
Transitional object
Separation anxiety
Parallel play
Temper tantrums
Walks up and down stairs
Climbs
Removes clothes
Build tower of 6 blocks
Turns doorknob
Sphincter control
Walks and runs fairly well
Picks up objects without falling
Push and pull
Riding toys
Jack in box
Blocks
Finger-paints
Water play
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
36 Months
36 Months
36 Months
Agreeable behavior
Shares well
Nightmares
Fear of monsters
Knows first & last name
Knows sex difference
Ritualistic behavior
Runs well
Dresses and undresses
Jumps from a step
Peddles forward & backwards
Holds pencil with tripod grip
Walks on tip toe
Tricycle
Dress up clothes
Crayons
Puzzles
Books
Videos
Issues related to Hospitalization:
Separation from parents
Nursing Interventions:
Caregiver rooming in
Primary nursing
Transitional object
Loss of Control
Offer appropriate choices
Set limits
Regressive Behavior
Reassurance
Personal/Social
Very social beings. Security objects important. Increasing level of comprehension.
Nutrition
Growth slows at age 12-18 months, the appetite and need for food decreases. Toddlers
are ―picky‖ and ritualistic eaters. Avoid large pieces of food such as hot dogs, grapes,
cherries and peanuts. Child is able to feed self by 3 years. Food jags/fads common (eats
one food 3 days, on fourth day refuses it). See ritualism in meals (refuses to eat if
favorite plate, or cup not available)
Play
The toddler continues solitary play, but engages in parallel play. This is play in which
several toddlers will be playing in the same proximity and perhaps with the type of toys,
but not interacting with each other.
Anticipatory Guidance/Health Promotion
Safety, discipline, temper tantrums, toilet training, sibling rivalry, negativism, fears,
separation anxiety.
Safety
Continue to use car seat properly: children greater than 20 lb. (9 kg) should be in a
forward-facing position in the back seat of the car.
Supervise indoor play and outdoor activities-swimming
Teach use of syrup of ipecac for accidental ingestions
Teach injury prevention: childproof home, suffocation (plastic bags, pacifier, toys),
burns (ovens, heaters, stoves, sunburns, check water and food temperature)
Aspiration related to latex balloons
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
Toilet Training
The child’s bladder and bowel muscles and innervations must be physically mature and
the bladder large enough to hold urine for several hours at a time. The child should be
able to remove pants and underwear independently, sit quietly for short periods, imitate
behaviors, and want to please parents. Success should be praised and accidents cleaned
up without comment. If the child is not interested, it is best to stop and wait a month.
Discipline
Suddenly, the compliant infant has now turned into a negative toddler. Discipline
becomes a major issue. Parents should set simple rules and apply them consistently to
acquire socially acceptable behaviors.
Temper Tantrums
Temper tantrums are a normal behavior occurring because of a toddler’s inability to
control his feelings when frustrated. Since they cannot use language to express feelings,
they use their body. Do not give in to their demands; it rewards them to try again.
Sibling Rivalry
The next baby is often born when the first child is in the toddler years. The toddler may
perceive the baby as a rival for the mother’s affections and time and may verbally and
sometimes physically attempt to harm the infant. Allow the toddler to assist in the
preparation for the new infant. Schedule times during the day for just the toddler.
Preschool 3 to 6 years
Erikson: Initiative vs Guilt – the child develops a sense of self-esteem through task
accomplishment. There is less need for direct supervision. The child asks many
questions and begins to take responsibility for his/her own actions. There is beginning
conscience development and regard for others. The preschooler wants to conform to
others. Conflict will arise when the child oversteps the limits of his/her abilities and will
acquire a sense of guilt for not behaving appropriately.
Freud: The Phallic stage which focuses on knowledge of gender differences,
competition for the parent of the opposite sex, conflict and final resolution through the
identification with the parent of the same sex (Oedipal/Electra Complex). There is
exploration of his/her body as well as others. The preschooler fears mutilation, especially
any threat to the genital area.
Piaget: The Preoperational stage continues during the preschool years with the Intuitive
phase. During this phase egocentrism lessens. There is energetic learning. The child
becomes sophisticated in the use of symbols and language. Pre-logical thinking appears.
The preschooler blends fantasy with reality. They exhibit magical thinking.
Preschoolers believe that nothing happens by chance.
Kohlberg: Preschoolers are completing the second and third stages in his
Preconventional morality level. The younger preschooler exhibits the PunishmentModified by Pauline Kerr
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GROWTH and DEVELOPMENT
Obedience orientation stage. He/she is good because a parent say he/she must be.
He/she avoids punishment and obeys without question those who have authority. For the
older preschooler, right behaviors consist of that which satisfies his/her own needs.
Physiological:
Growth is slow and steady; 4-5 lb/year
Height increases 2-3 inches/year
Body systems mature
All deciduous teeth present
Psychosocial
Motor
Toys
Magical Thinking
Imitates adult behavior
Associative play
Speaks in complete sentences
Inquisitive questions
Fear of body mutilation
Masturbation
Identifies with the same sex parent
Vocabulary to 2100 words by 5 yrs.
Uses adjectives and pronouns
Kicks well
Copies a triangle
Threads beads
Uses alternate feet on stairs
Uses scissors
Catches a ball
Draws a person
Balances on alternate feet by 5 yrs.
Skips & hops on one foot by 4 yrs.
Rides a tricycle
Videos
Coloring books
Play house
Story time
Arts & crafts
Ball
Puppets
Clay
Tricycle
Issues Related to Hospitalization:
Separation from parents
Nursing Interventions:
Caregiver rooming in
Pictures of family
Telephone calls
Leave parent’s belongings with child
Body mutilation
Explain procedures in simple terms
Offer Band-Aids
Give examples of sensations
Loss of control
Offer appropriate choices
Set limits
Nutrition
Similar to the toddler’s eating patterns. Demonstrates food preferences: likes and
dislikes. Influenced by others eating habits. Requirement is 90 kcal/kg/day.
Play
The preschooler interacts with others in Associative play. Play is highly imitative,
dramatic, and imaginative and reflects sex role standards. They may also have an
imaginary playmate, evidence of a vivid imagination.
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
Anticipatory Guidance/Health Promotion
Safety
Car seat belt can provide safety when child reaches either 40 lb. or 4 years.
Injury prevention: Traffic safety, strangers, and fire prevention/safety, water safety.
Sex Education
Preschoolers are curious about everything and ask sex related questions along with their
other questions. Always determine why they are asking the question before answering.
Sex education should also include sexual abuse education. The child should understand
who may touch private parts and who needs to be reported to a trusted adult.
Masturbation
Occasional masturbation is normal and an expression of sexual development.
Imaginary Friends
Sometimes used as companions when other playmates are not available. As long as the
child is interacting with the real world, imaginary friends should be tolerated as an
example of the child’s vivid imagination.
Fears
A vivid imagination also brings fears. They may be real or unreal. Fears should not be
dismissed and should be dealt with appropriately.
School Age 6-12 years
Erikson: Industry vs. Inferiority- this is the age of self-concept development. The child
achieves a sense of personal and interpersonal competence by acquisition of technologic
and social skills. They have a variety interests, learn rules and how to win/lose. Peer
group activities encourage cooperation and competitiveness. Inability to acquire a sense
of accomplishment will result in a sense of inferiority.
Freud: Latent stage- there is a resolution of the sexual conflict and investment in other
interest and peers. Sexual feelings are dormant.
Piaget: Concrete Operational- School-age children achieve a beginning logic ability to
order and relate experiences to an organized whole (begin to see the ―whole‖ picture).
They demonstrate conservation (ability to understand that a mass can change in size,
volume or length without losing or adding to the original mass). They understand the
relationship between numbers, letters, words and time, and have the ability to classify
objects. They have beginning problem-solving capabilities.
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
Kohlberg: The child enters the Conventional morality level of which there are two
phases. The first phase exhibited by the younger school age child is the “Good Boy—
Nice Girl Orientation. Behavior that meets with approval is viewed as ―good‖. The
older school age child exhibits the Law and Order Orientation. In this orientation, it is
important to obey the law because it is the law.
Physiological:
Weight: steady, slow growth; gains approximately 5 lb/year
Height: increase 1-2 in/year; boys differ little at first, but by end of this period
girls will gain more weight and height compared to boys
Reaches one half of adult height by age 6 years
Doubles strength and physical capabilities
Deciduous teeth are replaced by permanent teeth
Psychosocial
Motor
Toys
Same sex friends
Loves school
Interactive play
Collects things
Physical skills maximized
Cursive writing
Rides a 2-wheeler
Runs, swims, dances
Board games
Card games
Video games
Team activities
Computer games
Issues Related to Hospitalization:
Separation from family, friends, and school
Nursing Interventions:
Frequent visits by family
Telephone calls
Communication with school
Fear of bodily injury
Explain all procedures
Child to participate in care
Provide for privacy
Reassure illness is not a
punishment
Nutrition
There is a risk of obesity in this age group and a tendency to eat ―junk‖ food.
Secondary sex characteristics begin at 10 years in girls; 12 years in boys.
Requirement is 85 kcal/kg/day.
Irregular family meals
schedule of working parents.
Play
Play is primarily Group oriented, especially with the same sex.
Rules and rituals
Formalized groups/clubs
Becomes sensitive to social norms and pressures of peer groups
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
Anticipatory Guidance/Health Promotion
Safety
The incidence of accidents/injuries is less likely. Proper use of sports equipment should
be stressed. Discourage risk-taking behaviors (smoking, alcohol, drugs, sex). Teach
injury protection concerning bicycle safety, firearms.
Sex Education
Should be introduced.
Television
TV rarely depicts reality. The violence appears to desensitize children. Imitation of TV
role models increases aggressiveness in play and life situations unless an adult points out
inappropriate TV behaviors.
Adolescent 12-18 years
Erikson: Identity vs. Role Confusion-the adolescent focuses on independence from the
family and uses the peer group as a bridge between dependence on the family and
complete independent behavior. Peer group and peer acceptance is extremely important.
It is a time of trying on different roles to see how they fit and making comparisons with
the peer group. He/she has wide mood swings, and fantasizes and daydreams. There may
be conflict with parents over independence and control. He/she feels invulnerable. If the
adolescent is unable to acquire a stable sense of self, direction and place, identity
diffusion may result.
Freud: Genital Stage- during this time the adolescent vacillates between dependence and
independence. Puberty can be frightening or satisfying for the adolescent. The focus is
on the genitals, with emphasis on masturbation, sexual intercourse, and feelings for
others.
Kohlberg: Post Conventional levels consist of the Social Contract Orientation, Higher
Law and Conscience Orientation, and the Universal-Ethical Principle Orientation. The
age of each of these stages varies considerably among individuals, and adolescents may
or may not exhibit these stages, or may exhibit the stages later in life.
In the Social Contract Orientation, judgments are made on the basis of individual rights
and standards that have been agreed upon by the whole society.
In the Higher Law and Conscience Orientation, judgments are made on the basis of
benefiting society and leading to cooperation and the good of all.
In the Universal Ethical Principle Orientation, judgments are made on the basis of
consequence in accord with ethical principles such as justice, integrity, equality,
reciprocity of human rights, and respect for the dignity of human beings. Kohlberg
believes that few individuals reach this stage of moral reasoning.
Physiological:
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
Weight: rapid period of growth causes anxiety; girls gain 15-55 lb. (7-25 kg)
boys gain 15-65 lb. (7-29 kg.)
Height: attain final 20% of mature height; girl’s height increases approximately
3 in/year, slows at menarche, stops at 16 years; boys: increases
4 in/year, growth spurt approximately at 13 years, slows in late teens
Primary and secondary sex characteristics develop
Puberty occurs 2 years earlier in girls than boys
Adult body type
Psychosocial
Motor
Toys
Peer pressure
Rebellious behavior
Risk taking behavior
Body image
Maximized strength
Maximized fine motor
Team activities
Video games
Issues Related to Hospitalization:
Separation from friends
Nursing Interventions:
Encourage friends to visit
Telephone privileges
Body image disturbance
Provide privacy
Assist with ADLs
Allow to wear own clothes
Non-compliance
Provide with support group
Encourage compliance
Nutrition
―Hollow leg stage‖: appetite increases. Requirements; 60 to 80 kcal/kg/day—1,500 to
3,000 kcal/day (11-14 years); 2,100 to 3,900 kcal/day (15-18 years). Peers influence food
choices. Adolescents are at risk for fad diets.
Play
The adolescent identifies with a peer group. Girls enjoy shopping, talking to friends, and
experimenting with clothes, make-up and hairstyles. Boys enjoy outdoor sports and
electronic games. Both sexes enjoy movies, popular music and access to vehicles.
Interests are subject to rapid change.
Anticipatory Guidance/Health Promotion
Safety
Accidents are the chief cause of death: motor vehicle accidents (MVA), sports, and
firearms. Adolescents may display lack of impulse control, reckless behaviors, sense of
invulnerability.
Puberty
Related to hormonal changes. Apocrine glands become active and may develop body
odor.
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
Development of secondary sex characteristics: girls experience breast development,
menarche (average age 121/2 yrs.), pubic hair; boys experience enlargement of the testes
(13 yrs.), increase in scrotum and penis size, nocturnal emission, pubic hair, vocal
changes, possibly gynecomastia.
Sexuality
Adolescence is a time of experimenting, including sexual experimentation. Adolescents
are at risk for sexually transmitted diseases and pregnancies. They need education on
STD prevention, HIV/AIDS, contraception and how to say ―NO‖. Education related to
sexuality is best accepted if it is truthful, realistic and relevant to their world and peer
experience. Pelvic exams/pap smears begin when teen becomes sexually active.
Substance Abuse
Adolescents experiment with legal (tobacco, alcohol, OTCs, prescribed) and illegal
(street drugs) substances. Education is needed.
Communicating with Adolescents
Allow the adolescent an opportunity to express their feelings.
Encourage exploration of their fears.
If hospitalized, provide honest intimation, involve in decision making.
Egocentric and vacillate between independence and dependence.
Areas of stress:
Body image
Sexuality conflicts
School pressures
Finances
Competitive pressures
Decisions about future rules
Limit setting and discipline:
Teens need firm but reasonable limitation to protect them
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
PROVIDING NURSING CARE TO CHILDREN
Medications and Intravenous Therapy
General Considerations:
All pediatric doses are calculated according to the child’s weight or body surface.
Allow the child to make appropriate choices to gain cooperation.
Never force a child to take medication.
Never tell a child a medicine is ―candy‖.
PO
IV
IM (22-25 gauge)
Use dropper, syringe or small cup
Do not mix with formula or milk
If child vomits consider toxicity
Ask parents about successful methods
Assess site Q 1h.
Use only a microdrip
Use a pump
Pacifier for infants
1 in. needle for young child
1-1 1/2in. older child
No more than 2 cc @ each site
Restrain child properly
Safety Considerations
All children under 3 years old must be in a crib with a covered top.
Side rails must be all the way up when the child is in the crib.
Children under 6 years may not be left unattended unless they are in their cribs.
Do not prop bottles.
Place infants in side-lying or supine position after feeding.
Special Considerations
Behavior is the most significant indicator of well being in children.
Approach the child according to the developmental abilities, not chronological age.
Encourage cooperation.
Give appropriate choices.
Give positive statements.
Restraints
Use the least amount of restraint to achieve safety.
Obtain practitioner order.
Remove Q 2 hours while child is awake.
Assess for circulatory impairment Q 1 hour.
Types:
Mitten – prevents use of hands
Elbow – prevents child from reaching the face
Wrist – prevents child from using arms
Clove hitch – limits motion of extremities
Mummy – prevents movement of trunk and extremities
Modified by Pauline Kerr
Page 12
GROWTH and DEVELOPMENT
CHILDREN’S UNDERSTANDING OF DEATH
Infant
Death has no meaning
Reacts to pain, parental separation
Toddler
Cannot comprehend finality
Death is seen as temporary
Reacts more to pain, parental separation
Disturbed by parents’ and others’ behavior
Pre-school
Death is final, but perceived as sleep or a departure
Attaches literal explanations (―with God in heaven‖)
May perceive death as a punishment
Greatest fear is parental separation
School Age
Death is final, inevitable
Fear is of the unknown
May ask questions to assimilate the concept of death
May work out fears by having services for a dead pet
Adolescent
Mature understanding of death
Illness (and death) is perceived as being different and not being
Fears isolation from peer group and parents
Feel invulnerable, so death is perceived as a tremendous threat
Reactions may straddle child and adult understanding
Modified by Pauline Kerr
Page 13
GROWTH and DEVELOPMENT
APPROACHING THE CHILD
Infant
Position in parent’s lap or on a table
Warm hands
Quiet infant with pacifier/bottle
Count respiratory rate before touching child, then apical rate
Do heart and lungs when quiet
Distract with a toy/talking
Elicit reflexes during examination
Lay a diaper on the male
Restrain with parent assist
Do mouth and ears last
Toddler
Position sitting or lying on parent’s lap
Ignore/avoid eye contact initially
Introduce equipment slowly, allow to inspect, play with it
Remove clothing as examined
Do mouth/ears last
Heart: listen to knee, hand, doll first
Shine ‖light‖ on hand or arm before mouth and ear
Use restraint as necessary
Pre-school
Position on table
Allow to inspect equipment
Demonstrate equipment
Compliment on appearance
Reassure if ―no shots‖
Use positive statements for instructions
Use games – draw face on glove
School-age
Position on table
Give simple explanations and teaching
Talk to distract and relax
Respect privacy – examine genitalia last and quickly
Adolescent
Needs privacy – use gown and sheet
Emphasize normals
Be business-like and professional – do not act like them
Examine genitalia matter of fact
Modified by Pauline Kerr
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GROWTH and DEVELOPMENT
SAFETY
Infant
Use a car safety seat at all times until your child weighs at least 40 pounds
Car seats must be properly secured in the back seat, preferably in the middle
Keep medication, cleaning solutions, and other dangerous substances in childproof
containers, locked up and out of the reach of children
Use safety gates across stairways (top and bottom) and guards on windows above the first
floor
Keep hot water heater temperature below 120 F
Keep unused electrical outlets covered with plastic guards
Provide constant supervision for babies using a baby walker. Block the access to
stairways and to objects that can fall or cause burns
Keep objects and foods that cause choking away from the child (balloons, small toy parts,
coins, hot dogs, peanuts, and hard candies)
Use fences that go all the way around pools and keep gates to pools locked
Children of All Ages
Use smoke detectors in each home. Change the batteries every year and check once a
month that they work
If there is a gun in the home, make sure the gun and ammunition are locked up separately
and kept out of reach of children
Never drive after drinking alcohol
Use car safety seat belts at all times
Teach children traffic safety. Children under nine years need supervision when crossing
streets
Teach children when and how to call 911
Learn basic life-saving skills (CPR)
Keep a bottle of ipecac at home to treat poisoning. Call a primary care provider or local
poison control before using it. Post the phone number of poison control near the phone.
Check the expiration date of the ipecac regularly
Modified by Pauline Kerr
Page 15