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Protecting your child


your child
Immunisations                                99
Commonchildhoodillnesses                  105
Reducingtheriskofaccidents             107
Safetyinthesun                           113


• All children are offered            immunisations
  a programme of routine
  immunisations designed to           By the age of about 13 months,
  protect them from potentially       it is recommended that your
  dangerous diseases.                 child has the following vaccines:
• Non-routine immunisations           • DTaP/IPV/Hib
  are available for children with
                                      • PCV
  specific health needs, or if
  you are planning to take your       • MenC, and
  child abroad.                       • MMR.
• Most common childhood illnesses
  are easy to treat and have no
  lasting effects.
                                      Why do we need immunisation?
• You can help your child avoid
  accidents by teaching them          Our immune system is a natural      Remember, it’s never too
  some basic safety rules and         defence against disease.            late to have your child
  setting a good example.             The immune system produces          immunised. Even if your child
• Following the safety checklist      substances called antibodies        has missed an immunisation and
  will help make your home – and      which usually fight off infection   is well above the recommended
  the wider world – a safer place     and prevent disease. In some        age for the vaccine, it’s probably
  for your child.                     cases, though, our immune           still worth getting it done. Ask
                                      systems need a bit of help.         your GP, practice nurse or health
• Be sun smart – sunscreen, hats
                                      Vaccines are given to strengthen    visitor for advice and to arrange
  and sensible clothes will protect
                                      your child’s immune system to       an appointment for you.
  your child from burning and
                                      fight off diseases that could
  damaging their skin.
                                      cause lasting damage to their
                                      health or even kill them.

      routine immunisations                  When to immunise
      Your doctor’s surgery or
      clinic will usually send you an
                                             age            immunise against
      appointment to take your baby
      for immunisation. If you think your
                                             Two months     Diphtheria, tetanus, pertussis (whooping cough),
      child is due for an immunisation,
                                                            polio, Haemophilus influenzae type b (Hib),
      but you have not received an
                                                            pneumococcal infection – DTaP/IPV/Hib and PCV
      appointment, contact your
      health visitor or GP.
      Most surgeries and health centres      Three months   Diphtheria, tetanus, pertussis, polio,
      run special immunisation or baby                      Haemophilus influenzae type b (Hib), meningitis C
      clinics. If you cannot get to the                     (meningococcal group C) – DTaP/IPV/Hib and MenC
      clinic, contact the surgery to
      make another appointment.
      All childhood immunisations are        Four months    Diphtheria, tetanus, pertussis, polio,
      free. It’s important that your baby                   Haemophilus influenzae type b (Hib), meningitis C,
      has their immunisations at the right                  pneumococcal infection – DTaP/IPV/Hib,
      age, to keep the risk of disease and                  MenC and PCV
      any side effects as low as possible.
                                             Around         Haemophilus influenzae type b (Hib),
      The doctor or nurse will explain       12 months      meningitis C – Hib/MenC
      the immunisation process to you
      and answer any questions you
      have. The vaccine will be given        Around         Measles, mumps, rubella (German measles),
      by injection into your baby’s thigh    13 months      pneumococcal infection – MMR and PCV
      or upper arm. Babies have two
      injections at two, three and
      13 months and three injections         Three years    Diphtheria, tetanus, pertussis, polio, measles,
      at four months.                        and four       mumps, rubella – DTaP/IPV or dTaP/IPV
      For more information on                months         and MMR
      immunisations, go to

        immunisation and
        premature babies
        Premature babies are at
        greater risk of infection.
        They should be immunised
        according to the
        recommended schedule
        from two months after
        birth, regardless of how
        premature they were.

It is recommended that your baby
                                         After the immunisation, your
                                         baby may experience the following
                                                                                 Side effects may include a mild
                                                                                 fever. Your baby could also have        7
has the DTaP/IPV/Hib vaccine at          side effects, but these will usually    some swelling and redness at the
two months, three months and             be mild:                                site of the injection.
four months. The vaccine protects        • It’s quite normal for your baby       menc

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against the following diseases:            to be a bit miserable for up to       It is recommended that your baby
• Diphtheria. This a serious               48 hours after the injection.         has meningococcal vaccine (MenC)
  disease that usually begins with       • Your baby could develop               at three months, four months
  a sore throat and can quickly            a mild fever (see page 118).          and again at 12 months. The
  cause breathing problems. It can       • You might notice a small lump         vaccine protects your child against
  damage the heart and nervous             where your baby had the               meningitis and septicaemia (blood
  system. Severe cases can be fatal.       injection. This may last for a few    poisoning) caused by meningococcal
• Tetanus. Tetanus affects the             weeks but will slowly disappear.      group C bacteria. It does not protect
  nervous system, leading to muscle                                              against meningitis caused by other
                                         If you think your baby has had any      bacteria, such as meningococcal
  spasms, breathing problems and,
                                         other reaction to the DTaP/IPV/Hib      group B bacteria, or by viruses
  in severe cases, death. It is caused
                                         vaccine, talk to your GP, practice      (see page 127).
  when germs in soil and manure
                                         nurse or health visitor.
  get into the body through open                                                 Babies who have the vaccine may
  cuts or burns. Tetanus cannot be       PcV                                     become irritable, and about 1 in 20
  passed from person to person.          It is recommended that your             could get a mild fever.
• Pertussis (whooping cough).            baby has pneumococcal conjugate
                                         vaccine (PCV) at two months
  Whooping cough can cause long
  bouts of coughing and choking          and four months, and again at           It is recommended that your baby
  which can make it hard to              13 months. This vaccine protects        should be immunised with their
  breathe. It can last for up to three   your child against one of the           booster dose of Hib/MenC vaccine
  months. Babies under one year          commonest causes of meningitis,         at 12 months. This booster dose
  are most at risk. At this age, the     and also against other conditions       provides longer-term protection
  disease is very serious and can be     such as severe ear infections (otitis   against two causes of
  fatal. It is not usually serious       media) and pneumonia caused             meningitis and
  in older children.                     by pneumococcal bacteria.               septicaemia.
• Polio. Polio is a virus that attacks
  the nervous system and can
  permanently paralyse the muscles.

  If it affects the chest muscles or
  the brain, polio can kill.
• Haemophilus influenzae type b
  (Hib). Hib is an infection caused
  by Haemophilus influenzae type
                                                               your child
  b bacteria. It can lead to a number
  of major illnesses, including
  blood poisoning (septicaemia),
                                         against disease
  pneumonia and meningitis,
  serious bone and joint infection
  and a serious form of croup.
  The Hib vaccine only protects your
  baby against the type of meningitis
  caused by the Haemophilus
  influenzae type b bacteria,
  not against any other type
  of meningitis. Illnesses caused
  by Hib can kill if they are not
  treated quickly.
      mmr                                       glands that produce saliva on the
      It is recommended that your baby          side of the face and under the
      has their first dose of the MMR           jaw. It can result in permanent
      vaccine at around 13 months and           deafness, viral meningitis (swelling
      their second at three years and four      of the lining of the brain) and
      months, although it can be given          encephalitis. Rarely, it causes
      earlier. Since its introduction in the    painful swelling of the testes           mmr, autism and
      UK in 1988, MMR has almost wiped          in boys and ovaries in girls. Mumps      allergies
      out the following three diseases          lasts about seven to 10 days. It is
                                                spread in the same way as measles.       Some years back, a number
      among children:                                                                    of newspaper stories appeared
                                               • Rubella. Rubella, or German             suggesting a possible link
      • Measles. Measles is caused by a          measles, is caused by a virus.
        very infectious virus. Children are                                              between MMR and autism.
                                                 It causes a short-lived rash and        Some parents opted to delay their
        usually very unwell with a high          swollen glands. In children, it’s
        fever and rash. Children often                                                   children’s MMR immunisation or
                                                 usually mild and can go unnoticed,      not to have it at all, leading to
        have to spend about five days in         but in unborn babies rubella can be
        bed and could be off school for                                                  outbreaks of measles. There is
                                                 very serious, damaging their sight,     no credible scientific evidence for
        10 days. Adults are likely to be         hearing, heart and brain. Rubella
        ill for longer. Around 1 in 15                                                   the link, and a large amount of
                                                 infection in the first three months     evidence exists showing that there
        children will be affected by             of pregnancy causes damage to
        complications, which can include                                                 is no link. MMR is the best way to
                                                 the unborn baby in nine out of          protect your child against measles,
        chest infections, fits, encephalitis     10 cases. This condition is called
        (swelling of the brain) and brain                                                mumps and rubella. It’s also safe
                                                 congenital rubella syndrome (CRS).      to give to children with a severe
        damage. In very serious cases,           In many of the cases, pregnant
        measles can kill. Measles is one                                                 allergy (an anaphylactic reaction)
                                                 women catch rubella from their          to egg. If you have any concerns,
        of the most infectious diseases          own, or their friends’, children.
        known. A cough or a sneeze                                                       talk to your doctor, practice nurse
        can spread the measles virus           The three different viruses in the        or health visitor.
        over a wide area. Because it’s         vaccine act at different times.
        so infectious, the chances are         The first dose may cause the
                                               following side effects:                   develop a measles-like rash and
        your child will get measles if
                                                                                         go off their food. For advice on
        they are not immunised.                • Six to 10 days after the                treating a fever, see page 119.
      • Mumps. Mumps is caused by                immunisation, as the measles
                                                 part of the vaccine starts to         • Rarely, children may get mumps-
        a virus which can lead to fever,
                                                 work, about 1 in 10 children            like symptoms (fever and swollen
        headache and painful and
                                                 may develop a fever. Some also          glands) about three weeks after
        uncomfortable swelling of the
                                                                                         their immunisation as the mumps
                                                                                         part of the vaccine starts to work.
                                                                                       • Very rarely, children may get a rash
                                                                                         of small bruise-like spots in the
                                                                                         six weeks after the immunisation.
                                                                                         This is usually caused by the
                                                                                         measles or rubella parts of the
                                                                                         vaccine. If you see spots like these,
                                                                                         take your child to the doctor to
                                                                                         be checked. He or she will tell you
                                                                                         how to deal with the problem and
                                                                                         protect your child in the future.
                                                                                       • Fewer than one child in a million
                                                                                         develops encephalitis (swelling of
                                                                                         the brain) after the MMR vaccine,
                                                                                         and there is very little evidence
                                                                                         that it is caused by the vaccine.

 Remember that, if a child catches
 measles, the chance of developing
                                        After the immunisation, a small
                                        blister or sore may appear where the                                             7
 encephalitis is much greater           injection is given. It’s best to leave
 (between 1 in 200 and                  this uncovered. It will heal gradually
 1 in 5,000).                           and may leave a small scar. If you
                                        are worried or think the sore has

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Side effects after the second dose
                                        become infected, see your doctor.
are less common and usually milder.
                                        hepatitis B
non-routine                             The hepatitis B vaccine is given         travelling abroad
immunisations                           to babies whose mothers are              If your child is going abroad, their
The following immunisations             hepatitis B positive or have acute       routine immunisations need to be
will only be given to babies and        hepatitis B infection in pregnancy.      up to date. They may also need
children whose background or            Hepatitis B will be picked up by         extra immunisations. Contact your
lifestyle puts them at particular       blood tests during pregnancy.            doctor or a travel clinic well in
risk of specific diseases:                                                       advance for up-to-date information.
                                        Hepatitis is an infection of the
• Tuberculosis (Bcg)                    liver caused by viruses. Hepatitis B     Courses of most travel vaccines
  Given at birth only to babies who     vaccine only protects against the        can be given over a four-week
  are likely to come into contact       B type of the virus, which is            period, but you will need to allow
  with tuberculosis.                    passed through infected blood            more time if your child also needs
• Hepatitis B (Hep B)                   from mothers to their babies.            a primary (first) course of the DTaP/
  Given at birth to babies whose        There is a risk that the baby could      IPV/Hib vaccine (see page 101).
  mothers are hepatitis B positive.     then become a carrier and develop
                                                                                 If you don’t have that much time
                                        serious liver disease later in life.
Bcg                                                                              before you leave, it’s still worth
The BCG vaccine protects against        The side effects of the hepatitis        going to a clinic.
tuberculosis (TB), and is offered to    B vaccine are usually quite mild.
                                                                                 For more information, pick up a
those babies who are more likely        There could be some redness and
                                                                                 copy of the Department of Health
than most to come into contact          soreness where the injection is
                                                                                 leaflet Health advice for travellers
with someone with TB or whose           given. This lasts for a few days.
                                                                                 from the post office, call the
parents or grandparents come from                                                Department of Health Publications
countries with a high incidence                                                  Orderline on 0300 123 1002
of TB. In some areas, this will mean                                             between 8am and 6pm and
all babies are offered the vaccine,                                              ask for leaflet T7, or go to
while in others it will be offered                                     
only to some babies. Often, you                                                  You can also get further information
will be offered the BCG vaccine
                                        immunise                                 from the Department of

while you and your baby are still                                                Health website at
in hospital, but it can also be
given later.
TB is an infection that usually

affects the lungs but can also affect
other parts of the body such as the
lymph glands, bones, joints and
kidneys. It can also cause a serious
form of meningitis. Most cases can
be cured with treatment.                 More information

                                          For more information, go to

      Q.      How do
              vaccines work?                  Q.      Will having an injection
                                                      upset my baby?
                                                                                       in some cases, collapse. A recent
                                                                                       study has shown that only one

      A.                                      A.
               Vaccines contain a small                Your baby may cry and be        anaphylactic reaction is reported in
               part of the bacterium or                upset for a few minutes,        about a million immunisations.
      virus that causes a disease, or tiny    but they will usually settle down        The people who give immunisations
      amounts of the chemicals that           after a cuddle.                          are trained to deal with anaphylactic
      the bacterium or virus produces.                                                 reactions and, as long as they are
      Vaccines work by encouraging the
      body’s immune system to make
                                              Q.      Will there be any side
                                                                                       treated quickly, children make
                                                                                       a complete recovery.
      antibodies (substances that fight
      off infection and disease) and          A.        Side effects are less
                                                        common than people
                                              think, and they are usually mild.
                                                                                       Anaphylactic shock is a very
                                                                                       serious condition and needs urgent
      memory cells. If your child comes                                                medical attention.
      into contact with an infection they     Some babies will have some
      have been immunised against, the
      memory cells will recognise it and
                                              redness or swelling in the place
                                              where they had the injection, but
                                              this will soon go away. Others
                                                                                       Q.    is there any reason
                                                                                             why my baby should not
                                                                                       be immunised?
      be ready to protect them.

                                              might feel a bit irritable or unwell,             There are very few
      Q.     if diseases like polio
             and diphtheria have
      almost disappeared in the
                                              or have a slight temperature. See
                                              page 102 for more information
                                                                                                reasons why babies cannot
                                                                                       be immunised. Vaccines should
                                              about the possible side effects of       not be given to babies who have
      uK, why do we need to                   routine immunisations.                   had a confirmed allergic reaction
      immunise against them?

                                              Q.     is it safe to take my baby        to a previous dose of that specific

      A.       In the UK, these diseases
              are kept at bay by high
      immunisation rates. Around the
                                                     swimming around the
                                              time of an immunisation?
                                                                                       vaccine or to something in the
                                                                                       vaccine. In general, children who
                                                                                       are ‘immuno-suppressed’ should
      world, more than 15 million people
      a year die from infectious diseases.    A.      Yes. You can take your baby
                                                      swimming at any time
                                              before and after their immunisation.
                                                                                       not be given live vaccines. This
                                                                                       includes children who are being
      Over half are children under the                                                 treated for a serious condition (like
      age of five.
                                              Q.      Are immunisations safe           an organ transplant or cancer) or
      Immunisation doesn’t just protect               for babies with allergies?       who have a condition that affects
                                                                                       their immune system, such as severe
      your child, it also helps to protect             Yes. Immunisations are
      your family and the whole                                                        primary immunodeficiency. If this
                                                       safe for babies with
      community, especially those                                                      applies to your child, always tell your
                                              asthma, eczema, hayfever and
      children who, for medical reasons,                                               GP, practice nurse or health visitor
                                              allergies. If you have any questions,
      cannot be immunised.                                                             before the immunisation. They will
                                              speak to your GP, practice nurse or
                                                                                       need to get specialist advice on
                                              health visitor.
      Q.      How do we know                                                           using live vaccines such as MMR

              that vaccines are safe?                 Are some babies                  and BCG.

      A.      Before they can be licensed,            allergic to vaccines?
              all medicines (including
      vaccines) are thoroughly tested to      A.       Very rarely, children can
                                                       have an allergic reaction
                                                                                       Q.    What if my baby is
                                                                                             ill on the day of the
      check their safety and effectiveness.   soon after immunisation. This will
      After they have been licensed, the
      safety of vaccines continues to be
                                              usually be a rash or itching affecting
                                              part or all of their body. The GP
                                                                                       A.       If your baby has a minor
                                                                                                illness without a fever, such
                                                                                       as a cold, they should have
      monitored. Any rare side effects        or nurse giving the vaccine will
      that are discovered can then be                                                  their immunisations as normal.
                                              know how to treat this. It is not
      investigated further. All medicines                                              If your baby is ill with a fever,
                                              a reason to avoid having further
      can cause side effects, but vaccines                                             put off the immunisation until they
      are among the very safest. Research                                              are better. It’s a good idea to book
      from around the world shows that        Even more rarely, children may have      a replacement appointment straight
      immunisation is the safest way to       a severe anaphylactic reaction within    away so the immunisation is not
      protect your child’s health.            a few minutes of the immunisation,       delayed by more than a week.
                                              leading to breathing difficulties and,

                                        become fluid-filled blisters within
                                        a day or so and eventually dry into         incubation period: seven to
                                        scabs which drop off. Spots appear          12 days.
                                        first on the chest and back and
                                        then spread. Spots will not leave           infectious period: From a few
                                        scars unless badly infected.                days before the rash appears until

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                                                                                    four days after.
                                        What to do: You don’t need to go
                                        to your GP or to A&E unless you are
                                        not sure whether it’s chickenpox,
                                        or your child is very unwell and/or
                                        distressed. Give them plenty to drink.
                                        Paracetamol or ibuprofen will relieve
                                        discomfort and fever. Baths, loose
                                        comfortable clothes and calamine
                                        lotion can all ease the itchiness. Try to
common                                  stop your child scratching or picking
childhood                               at their spots, as this will increase the
                                        risk of scarring. It’s hard for children
illnesses                               to do this, so give them lots of praise
                                        and encouragement. Distractions,            Symptoms: Begins like a bad cold
This section provides details about
                                        like TV, are good for taking their          and cough with sore, watery eyes.
some common childhood illnesses.
                                        mind off it. Let the school or nursery      Child becomes gradually more
In each case, it gives:
                                        know in case other children are             unwell, with a temperature. Rash
• the incubation period (the time       at risk.                                    appears after third or fourth day.
  between catching an illness and                                                   Spots are red and slightly raised;
  actually becoming unwell)                                                         they may be blotchy, but not
• the infectious period (the time         relieve                                   itchy. Begins behind the ears,
                                                                                    and spreads to the face and neck
  when your child can pass on the
  illness to someone else)              discomfort                                  and then the rest of the body.

• a list of common symptoms to                    and                               Children can become very unwell,
                                                                                    with a cough and high temperature.
  help you recognise the illness, and
• advice on what to do.                    fever                                    The illness usually lasts about a
                                                                                    week. Measles is much more serious
                                                                                    than chickenpox, German measles
chickenpox                                                                          or mumps, and is best prevented
incubation period: 10–23 days.                                                      (by the MMR immunisation).
                                                                                    Serious complications include
infectious period: From four days
                                                                                    pneumonia and death.
before the rash appears to five
days after.                               chickenpox                                What to do: Your child will be
                                          and pregnancy                             quite unwell, so make sure they
Symptoms: Starts with feeling
                                          Keep your child away from                 get lots of rest and plenty to drink.
unwell, a rash and maybe a slight
                                          anyone who is, or who is trying           Warm drinks will ease the cough,
temperature. Spots are red and
                                          to get, pregnant. If your child           and paracetamol or ibuprofen will
                                          was with anyone pregnant just             ease discomfort and fever. You
                                          before they became unwell, let            could also put Vaseline around their
                                          the woman know about the                  lips to protect their skin. If their
                                          chickenpox. In women who have             eyelids are crusty, wash it away with
                                          not previously had chickenpox,            warm water. If your child is having
                                          catching it in pregnancy can              trouble breathing, is coughing
                                          cause miscarriage or the baby             a lot or seems drowsy, see your
                                          may be born with chickenpox.              GP urgently.

                                                                                          or german measles
                                                                                          incubation period: 15–20 days.
                                                                                          infectious period: From one week
      mumps                                     Paracetamol or ibuprofen will             before the rash first appears until at
      incubation period: 14–25 days.            ease pain in the swollen glands.          least five days after.
                                                Check the package for the correct
      infectious period: From a few days        dosage. Give plenty to drink, but         Symptoms: Can be difficult to
      before starting to feel unwell until      not fruit juices as they make the         diagnose with certainty. Starts like
      the swelling goes down.                   saliva flow, which can hurt and           a mild cold. The rash appears in a
                                                make your child’s pain worse.             day or two, first on the face, then
      Symptoms: At first, your child may
                                                There is no need to see your GP           spreading. Spots are flat. On a light
      be slightly unwell with a bit of fever,
                                                unless your child has stomach ache        skin, they are pale pink. Glands
      and may complain of pain around
                                                and is being sick, or develops a rash     in the back of the neck may be
      the ear or feeling uncomfortable
                                                of small red/purple spots or bruises.     swollen. Your child will not usually
      when chewing. Swelling then starts
                                                                                          feel unwell.
      on the side of the face, in front of      Parvovirus B19
      the ear and under the chin.               (also known as fifth                      What to do: Give plenty to drink,
      Swelling often starts on one side,                                                  and keep your child away from
                                                disease or slapped
      followed (though not always) by                                                     anybody you know who is trying
      the other. Your child’s face will
                                                cheek disease)                            to get pregnant or is up to four
      be back to normal size in about a         incubation period: Anywhere               months pregnant. If your child was
      week. It’s rare for mumps to affect       between one and 20 days.                  with anyone pregnant before you
      boys’ testes (balls). This happens        infectious period: For a few days         knew about the illness, you will
      rather more often in adult men with       until the rash appears.                   need to let the woman know. If an
      mumps. If you think your child’s                                                    unimmunised pregnant woman
      testes are swollen or painful see         Symptoms: Begins with a fever and         catches German measles in the first
      your GP.                                  nasal discharge. A bright red rash,       four months of pregnancy, there is
                                                like the mark left by a slap, appears     a risk of damage to her baby.
      What to do: Your child may                on the cheeks. Over the next two to
      not feel especially ill and               four days, a lacy type of rash spreads
      may not want to be in bed.                to the trunk and limbs. Although
                                                it is most common in children, the          Pregnancy
                                                disease can occur in adults. In the         and german measles
                                                majority of cases it has no serious
                                                                                            Any pregnant woman who
                                                consequences. Children with blood
                                                                                            has had contact with German
                                                disorders such as spherocytosis or
                                                                                            measles should see her GP.
                                                  sickle cell disease may become
                                                                                            The GP can check whether or
                                                    more anaemic and should seek
                                                                                            not she is immune and, if not,
                                                     medical care. Rarely, in pregnant
                                                                                            whether there is any sign of her
                                                      women who are not immune
                                                                                            developing the illness.
                                                      to the disease, it may affect the
                                                      baby in the uterus.
                                                     What to do: Paracetamol or
                                                    ibuprofen will relieve discomfort
                                                  and fever. Avoid contact with
                                                pregnant women or women
                                                planning to get pregnant. Pregnant
                                                women who come into contact
                                                with the infection or develop a rash
                                                 should see their GP or midwife as
                                                  soon as possible.

Whooping cough                           reducing                               Remember, children copy. If you or
                                                                                your family or their friends do risky
incubation period: Five to 21 days.      the risk oF                            things, they will think it is OK. It is
infectious period: From the              accidents                              worth emphasising to your child
first signs of the illness until about                                          that if they feel uncomfortable
six weeks after coughing first           Accidents are one of the leading       and are being pressured to do

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starts. If an antibiotic is given,       causes of death among children         something silly or dangerous, it’s
the infectious period will               aged between one and five years.       OK to say no, and encourage them
continue for up to five days             Every year, about 500,000 children     to talk to you if this happens.
after starting treatment.                under five go to hospital because
                                         of an accident in the home.            There are a few basic things you
Symptoms: Begins like a cold and                                                can teach even young children
cough. The cough gradually gets          Children need to explore and to        to help keep them safe:
worse. After about two weeks,            learn about the things around
extended bouts of coughing start.        them. You can help them to do          • Teach your child their surname
These are exhausting and make            this by making your home as safe         early on.
it difficult to breathe. Younger         as possible so they don’t hurt         • Teach them their address as
children (babies under six months)       themselves. It’s not so easy to make     soon as they are old enough
are much more seriously affected         the world outside your home a            to remember it.
and can have breath-holding or           safe place, but by getting together    • Once they are old enough to
blue attacks, even before the cough      with other parents you can make a        understand danger, teach them
symptoms. Your child may choke           difference, for example by putting       about calling 999, especially if
and vomit. Sometimes, but not            pressure on your local council to:       you are epileptic, diabetic, blind
always, there will be a whooping         • make road crossings safer              or have any other condition that
noise as the child draws in breath                                                means they may need to call for
after coughing. The coughing fits        • provide essential home safety
                                                                                  help. Young children may need
may not die down for several weeks         equipment such as smoke alarms,
                                                                                  to be taught what a ‘9’ looks like.
and can continue for three months.         safety gates and fireguards
                                                                                • Teach them to stay where they
                                         • provide safe and accessible play
What to do: Whooping cough                                                        are if they get lost (for example,
                                           areas, and
is best prevented, through                                                        when you are out shopping) and
immunisation. If your child has          • mend stairs and walkways and           to tell another mummy who has
a cough that gets worse rather             improve lighting.                      other little girls and little boys.
than better and starts to have                                                    This is safer than telling them not
                                         teaching children
longer fits of coughing more                                                      to talk to adults at all and risking
and more often, see your GP.
                                         about safety                             them wandering off.
It’s important for the sake of other     Children under three cannot
children to know whether or not          always understand or
it’s whooping cough. Talk to your        remember safety advice
GP about how best to look after          so they need to have an
your child and avoid contact with        adult nearby at all times.
babies, who are most at risk             From the age of three,
from serious complications.              children can start learning
                                         how to do things safely
                                         but will sometimes forget,
  More information                       especially if they are
                                         excited or distracted.
  general baby                           Even if they repeat your
  and child safety                       instructions back to you,
  Talk to your health visitor            they might not be able
  or the staff at your local Sure        to understood them or
  Start Centre.                          be able to follow the
                                         instructions all the time.

      safety checklist                         safety for all under-fives
      The following safety advice is           House fires
      provided by the Children Accident        If your home catches fire, you
      Prevention Trust (CAPT). It is divided   and your child could breathe in
      into three sections:                     poisonous smoke. It’s especially
                                               dangerous if the fire breaks out             Fire safety
      • safety for all under-fives             at night while you are all asleep.           All fire and rescue services have
      • safety for babies before they can      • Fit smoke alarms on every level            community fire safety teams.
        walk, and                                of your home. Test the batteries           You can find your local fire
      • safety for under-fives who are able      every week.                                and rescue service, and get
        to walk.                                                                            advice about home safety risk
                                               • Change the batteries every year
                                                                                            assessments and fire safety
      This is because accidents tend to          or, even better, get alarms that
                                                                                            generally from the government’s
      relate to what a child can do, rather      have 10-year batteries, are wired
                                                                                            ‘Fire kills’ website (www.
      than to their age alone, and all           into the mains or plug into light
      children develop at slightly different     sockets.
                                                                                            You can also phone your local
      rates. Children have a knack of          • At night, switch off electrical items      fire and rescue service and ask
      doing things – crawling, walking,          wherever possible before going to          for ’community fire safety’.
      climbing, opening a bottle, or             bed and close all doors to contain
      whatever – before you expect it.           any fire. Make sure that you
      Children of different ages need            always put cigarettes right out.
                                                                                         in the car
      different approaches. Very young         • Practise how you will escape if         By law, all under-fives must always
      babies are completely dependent            there is a fire, so you know what       ride in proper baby or child car
      on adults for all their needs. They        to do if the alarm goes off.            seats when travelling by car – even
      have absolutely no control over their    Your local fire and rescue service        on short local journeys. The road
      environment and what is happening        can give you the right advice for         safety officer at your local council
      to them, and need an adult to            your own home and may be able             will be able to give you detailed
      keep them safe. When they start to       to provide and fit smoke alarms           advice. Call your town or county
      wriggle and then crawl, they can         free of charge.                           hall (see the phone book) or read
      get themselves into trouble, and                                                   the Department for Transport advice

      this is why you need to take some                                                  at
      simple precautions. Toddlers are

      keen to explore their surroundings                                                 • Always use a baby or child car seat
      but don’t understand what might                                                      that is right for your child’s height
      hurt them. They may repeat                                                           and weight.
      warnings back to you so you think                                                  • When buying a seat, try it
      they understand, but it doesn’t                                                      in your car before buying it.
      always mean that they do.                                                            A badly fitting seat can make a
      Exploring and playing are                                                            big difference to the protection
      an essential part of learning,                                                       it provides in a crash.
      and children should not be                                                         • Make sure the seat is fitted
      ‘wrapped in cotton wool’.                                                            properly in the car and your baby
      Bumps and bruises are                                                                or toddler is securely strapped in.
      inevitable but you can do                                                          • It’s illegal – and very dangerous
      some simple things to                                                                – to carry a baby in a rear-facing
      make sure that your                                                                  baby seat in a front seat with an
      child doesn’t get                                                                    active airbag. While it’s not
      seriously injured.                                                                   illegal, it’s not ideal for toddlers
                                                                                           in forward-facing seats either.
                                                                                           Use the back seat for all
                                                                                           under-fives if you can.

• Don’t buy a second-hand baby
  or child seat from a car boot sale
                                                                                   safety for babies
                                                                                   before they can walk                        7
  or small ad – it may have been                                                   At this stage of development,
  damaged in a crash, may not                                                      babies are completely dependent
  have all its parts (including the                                                on you for their safety. Here is what
  instructions), may not be the

                                                                                                                               PRoTecTing youR cHilD
                                                                                   you can do to keep them safe.
  safest and most user-friendly
  model, and may not fit your                                                      Falls
  car properly.                                                                    Babies soon learn to wriggle and
                                                                                   kick, and it’s not long before they
• Never leave your baby or toddler                                                 can roll over, which means that they
  alone in the car. It can get very     Strangulation                              can roll off things. Once they learn
  hot in summer. Also, they may         • Make sure any cot toys have very         to crawl, some babies may try to
  play with window and door               short ribbons and remove them            climb on to things, which increases
  switches and the cigarette lighter.     when your baby goes to sleep.            the risk of falling. Here are some
  It’s especially dangerous if you      • Never hang things like bags with         things you can do:
  have left the keys in the ignition.     cords or strings over the cot.
                                                                                   • Change your baby’s nappy on
Bathwater scalds                        • Cut or tie-up curtain or blind             the floor.
These can be very serious injuries,       cords well out of your baby’s
needing prolonged treatment and                                                    • Don’t leave your baby unattended
                                          or toddler’s reach.
care, and can even kill a child.                                                     on a bed, sofa or changing table –
                                        Poisonings                                   even for a second – as they could
Toddlers may play with the hot tap,
                                        • Fit carbon monoxide alarms                 roll off.
scalding themselves and any other
                                          wherever there is a flame-burning        • Don’t put your baby in a
children who are sharing the bath
                                          appliance (such as a gas boiler)           bouncing cradle or baby car
with them.
                                          or open fire. Carbon monoxide              seat on a table or kitchen worktop
• Never leave an under-five alone         is poisonous, but you cannot see it,       – their wriggling could tip it over
  in the bath, even for a moment.         smell it or taste it. Also, make sure      the edge.
• Fit a thermostatic mixing valve to      that your appliances are serviced
                                          regularly and that ventilation outlets   • Use the handrail when carrying
  your bath hot tap to control the                                                   your baby up and down stairs
  temperature at which the water          in your home are not blocked.
                                                                                     in case you trip.
  comes out, to stop your child         • Remember that child-resistant
  being badly scalded.                    devices, such as bottle tops, strips     • Watch where you are putting your
                                          of tablets and cigarette lighters,         feet while carrying your baby – it’s
• Put cold water into the bath first,                                                easy to trip over something like a toy.
  then add the hot water. Always          are not child-proof. Some children
  test the temperature of the             can operate these products,              • Use a five-point harness to secure
  water before you put your baby          so store medicines, household              your baby in a high chair.
  or toddler in the bath. Use your        chemicals (including cleaning
  elbow – the water should not feel       products) and lighters out of
  either hot or cold.                     sight and out of reach, or locked
                                          away safely.
Burns and scalds
• Fit fireguards to all fires and
  heaters and use a sparkguard too
  if you have a coal or wood fire.
                                           housing safety
  Guards can prevent under-fives
  falling or reaching into fires.          If you live in rented
• Don’t leave hot drinks in easy           accommodation, and are
  reach of little hands – babies and       worried that your housing
  toddlers may grab at cups and            might be unsafe for you
  mugs on low tables or the                and your child, contact
  floor and pull the contents              your housing association
  over themselves.                         or your landlord.

                                                                                       More information
                                            • Remove cot toys and cot bumpers
                                              as a baby can use them to climb
                                              on and may fall out of the cot.
                                                                                       product safety
                                            Burns and scalds
                                                                                       For advice on product safety,
                                            A baby’s skin is much thinner than
                                                                                       including issues to do with unsafe
                                            an adult’s and will burn much more
                                                                                       products, contact Consumer
                                            easily. This means taking extra care
                                                                                       Direct on 08454 04 05 06 or go
                                            at bath time. Also, remember that
                                            babies will grab at brightly coloured
                                            objects, like mugs.

      When your baby can crawl              • After warming milk, shake              • Don’t use pillows or duvets
      • Fit safety gates to stop them         the bottle well and test the             with babies under one as they
        climbing stairs and falling down      temperature of the milk by placing       can suffocate if their face gets
        them. Close them properly after       a few drops on the inside of your        smothered. They will not be able
        you go through the gate.              wrist before feeding. It should feel     to push the duvet away.
                                              lukewarm, not hot.
      • If the gaps between banisters                                                Strangulation
        or balcony railings are more        • If you are having a hot drink, put     • Don’t tie a dummy to your baby’s
        than 6.5cm (2.5 inches) wide,         it down when you are holding             clothes as the tie or ribbon could
        cover them with boards or safety      your baby. A wriggly baby can            strangle them.
        netting. Small babies may be able     cause you to spill the drink on
                                              them if you are holding both at        Drowning
        to squeeze their bodies through,                                             Babies can drown in as little as 5cm
        but not their heads.                  the same time.
                                                                                     (2 inches) of water and drowning
      • Make sure low furniture is kept     choking and suffocation                  is silent – you will not necessarily
        away from windows and that          Babies can choke very easily, even       hear any noise or struggle.
        windows are fitted with locks       on their milk. They will also put
                                            small objects that can choke them        • Stay with your baby all the time
        or safety catches to restrict the
                                            in their mouths, even when they are        they are in the bath – never leave
        opening to less than 6.5cm
                                            quite young.                               them even for a moment, even
        (2.5 inches) to stop babies
                                                                                       if there is an older brother or sister
        climbing out. However, make
                                            • If you give your baby a bottle,          in the bath with them.
        sure adults know where the
                                              always hold the bottle and your
        keys are kept in case of fire.                                               • If you use a bath seat, remember
                                              baby during feeding.
                                                                                       that it’s not a safety device. You
      • Try not to use a baby walker,
                                            • Keep small things like buttons,          will still need to stay with your
        as more accidents and injuries
                                              coins and small parts from toys          baby all the time.
        happen in baby walkers than
                                              out of reach.
                       in any other                                                  Poisoning
                             form of baby   • Once your baby has started on          From about six months, babies will
                               equipment.     solid food, always cut it up. Babies   start to put things in their mouths.
                                              can choke on something as small
                                              as a grape.                            • Keep all medicines locked away

                                      think safe
                                                                                       or high up out of reach and sight.
                                                                                     • Keep cleaning products high
                                                                                       up out of reach or, if this is not
                                                                                       possible, fit safety catches to low
                                                                                       cupboard doors. Try to choose
                                                                                       cleaning products that contain a
                                                                                       bittering agent. This makes them
                                                                                       taste nasty, so children are less
                                                                                       likely to swallow them.
                                                                                     • Make sure bottle tops and lids
                                                                                       are always firmly closed when
                                                                                       not in use.

safety for under-fives
who can walk
                                                                                 House fires, burns and scalds
                                                                                 Toddlers will play with anything       7
At this stage of development,                                                    they can reach, and they learn
children can climb and do simple                                                 very quickly.
things like open containers. They
                                                                                 • Keep matches and lighters out of

                                                                                                                        PRoTecTing youR cHilD
will also put things in their mouth
                                                                                   young children’s sight and reach.
to explore taste and texture. This is
all perfectly normal, but it can lead                                            • Use a kettle with a short or curly
to injuries if you don’t take care.                                                flex to stop it hanging over the
                                        • Use a harness and reins when out         edge of the work surface where
out and about                             walking, or hold your child’s hand       it could be grabbed.
• There will come a time when you         tightly. It only takes a few seconds   • When cooking, use the rings at
  need to start using a forward-          for them to run into the road.           the back of the cooker and turn
  facing child car seat. But you
                                        • Set a good example when                  saucepan handles towards the
  should carry on using your rear-
                                          crossing the road by choosing a          back so they cannot be grabbed
  facing seat for as long as you can
                                          safe place and talk to your child        by little fingers.
  as these provide better protection
                                          about what you are doing.              • It’s best to keep your toddler out
  in a crash.
                                        • Under-fives are too young to be          of the kitchen, well away from
• When taking your toddler out
                                          allowed to play in the street.           kettles, saucepans and hot oven
  of the car or putting them in,
                                          Find a safe place for them to            doors. You could put a safety gate
  do it from the pavement side
                                          play outside, such as the garden         across the doorway.
  of the vehicle.
                                          or a playground.                       • Keep hot drinks well away from
• Use a five-point harness to secure
                                        Falls                                      young children – a hot drink can
  your child in a pushchair.
                                        When babies start to walk, they can        still scald 20 minutes after it’s
                                        be unsteady on their feet but can          been made.
                                        move very quickly. They tend to trip     • When you have finished using
                                        and try to climb.                          your iron or hair straighteners,
                                                                                   put them out of reach while they
                                        • Until your baby is at least two
                                                                                   cool down. Make sure your child
                                          years old, carry on using safety
                                                                                   cannot grab the flex while you are
                                          gates to stop them climbing stairs
                                                                                   using them.
                                          and falling down them. Close
                                          them properly each time you go
                                          through the gate.
                                                                                    More information
                                        • Teach your child how to climb
                                          stairs but never let them go
                                          up and down on their own.                road safety
                                          Even four-year-olds may need             Contact the road safety officer
                                          some help.                               at your local council. Phone the
                                        • Don’t use the top bunk of a bunk         town or county hall and ask for
                                          bed for under-fives – they can           ‘road safety’. The Department
                                          easily fall out.                         for Transport website has advice
                                        • Make sure low furniture is kept          on all aspects of road safety.
                                          away from windows and that               Go to
                                          windows are fitted with locks or
                                          safety catches. Make sure adults
                                          know where the keys are kept
                                          in case of fire.
                                        • Carry on using a five-point
                                          harness when your child is
                                          in their high chair.

                                                 Drowning                                 cuts, bumps and bruises
                                                 Toddlers can drown in quite shallow      Toddlers just don’t understand
                                                 water, for example in baths or           about danger and while minor
                                                 ponds. Remember, drowning is             cuts, bumps and bruises are part
                                                 silent. You will not necessarily hear    of growing up, there are things
      choking and suffocation                    any noise or struggle.                   you can do to protect them from
      At this stage, children will put                                                    serious accidents or injuries.
      everything and anything they can in        • Never leave young children alone
      their mouths. It’s all part of learning,     in the bath – even for a second.
      but even something as small as a           • Empty the bath as soon as you
      grape can choke them.                        have taken your child out.
      • Cut large food up so it’s small          • Fence off, fill in or securely cover
        enough for little mouths, and              your garden pond if you have one.
        don’t give young children hard           • Watch toddlers in paddling
        food like boiled sweets.                   pools or playing near water.
      • Don’t give peanuts to children             Empty paddling pools straight
        under six months of age.                   after use.
      • Don’t leave your children when they      • Make sure your garden is secure
        are eating, and encourage them             so your child cannot get into
        to sit still, as running around while      neighbouring gardens where
        eating could make them choke.              there may be ponds or other
      • Keep small objects like coins,             drowning hazards.
        buttons or small parts from older        Poisoning
        children’s toys away from toddlers.      Toddlers like putting things in their
      • Keep plastic bags of all types           mouths to see what they taste like.
        out of reach and sight of                They will also find all sorts of ways
        young children so they cannot            to reach things they think look
        play with them and put them              like sweets.
        over their head.
                                                 • Keep all medicines locked away
      Strangulation                                or high up out of reach and sight.
      Toddlers can strangle themselves           • Keep cleaning products high
      playing with cords. They are also            up out of reach or, if that is not
      prone to getting their heads stuck           possible, fit safety catches to low
      when they squeeze their body                 cupboard doors. Try to choose
      through small gaps. This can be              cleaning products that contain
      particularly dangerous if their feet         a bittering agent. This makes
      are off the ground.                          them taste nasty, so children
      • Cut back or tie up curtain or blind        are less likely to swallow them.
        cords so they are well out of your       • Make sure bottle tops and lids
        toddler’s reach.                           are always firmly closed when
      • Don’t leave any type of rope               not in use.
        or cord lying around, including          • Check your garden for
        dressing gown cords.                       poisonous plants and teach
      • Stop them from trying to squeeze           children not to eat anything they
        through rails or banisters.                pick outdoors until they have
                                                   checked with an adult.
      • Keep garden play equipment well
        away from washing lines.

• Use safety glass in low glass       saFety in the sun                                                            7
  doors and windows or cover
  panes with safety film.             Exposing your child to too much sun may increase their risk of skin
• Keep scissors, knives and razors    cancer later in life. The following tips will help you protect your child:
  out of reach.                       • Keep your child out of the sun between 11am and 3pm when

                                                                                                                   PRoTecTing youR cHilD
• You can get special devices that      the sun is at its highest and most dangerous.
  stop doors from closing properly.   • Keep babies under the age of six months out of direct sunlight,
  This helps to prevent your            especially around midday.
  child’s fingers being trapped in
                                      • Encourage your child to play in the shade – for example under trees.
  doors. But at night, you should
  remember to close doors to stop     • Don’t let your child run around all day in a swimsuit or without
  fire spreading.                       any clothes on.
                                      • Cover your child up in loose cotton clothes such as an oversized
                                        T-shirt with sleeves.
                                      • Cover exposed parts of your child’s skin with a
                                        sunscreen, even on cloudy or overcast days.
                                        Use one with a sun protection factor (SPF) of 15
                                        or above and which is effective against UVA and
                                        UVB. Don’t forget their shoulders, nose, ears,
                                        cheeks and tops of feet. Re-apply often.
                                      • Be especially careful to protect your child’s
                                        shoulders and back of neck when playing, as
                                        these are the most common areas for sunburn.
• You can get corner protectors
  to protect your child’s head from   • Get your child to wear a ‘legionnaire’s hat’ or a floppy
  sharp corners on furniture.           hat with a wide brim that shades the face and neck.
                                      • Protect your child’s eyes with sunglasses with an ultraviolet
                                        filter made to British Standard 2724.
                                      • Use waterproof sunblock factor 15 or above if your child is
                                        swimming. Re-apply after towelling.

For more information about safety,
call the Child Accident Prevention
Trust on 020 7608 3828 or go to

  More information

  information and
  advice on treating
  You can get health advice
  and information, including
  on treating injuries, from
  NHS Direct. Call 0845 4647
  or go to NHS Choices at


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