SCRIPT. Injury Prevention and Child Safety in Child Care Settings Wendy B. King, M.Ed.

Slide #1 Introduction SCRIPT Injury Prevention and Child Safety in Child Care Settings Wendy B. King, M.Ed. Welcome to Injury Prevention and Child Safety in Child Care Settings. This 1- hour course will help you better understand the subject of child safety and how to prevent injuries to children in your care. This course was developed and produced by the Texas AgriLife Extension Service of the Texas A&M University System. Funding support was provided by Office of Title V and Family Health, Texas Department of State Health Services using Title V Maternal and Child Block Grant Funds. Slide #2 Learning Objectives Before we move into the training, let s take a few moments to review the learning objectives for this course. After completing the training, you should be able to: Describe common injuries to children in their early years, Identify when and where injuries generally occur in child care settings, and Discuss practical ways to modify the environment to promote child safety. Slide #3 Learning Objectives (continued) You should also be able to: Explain the importance of age appropriate equipment, Describe appropriate supervision practices, and Identify primary injury prevention resources to use. Slide #4 Advancing to Next Section Please click on the Next Section button at the bottom of this page to continue with this course. You will follow this procedure after each section. Slide #5 Injuries Leading Cause of Death among Children Injuries are a serious threat to the health and well-being of children. Young children are at high risk for many injuries that can lead to disability and even death. 1

Across the United States, injuries are the leading cause of death among children ages 19 and younger. About 33 children die every day because of injuries. Each day, more than 39,000 children are injured seriously enough to require medical treatment, totaling more than 14 million children each year. Children ages 4 and under are at greater risk of unintentional injury-related disability and death. They account for 49 percent of the deaths among children of all ages. Slide # 6 Unintentional Injuries The Centers for Disease Control and Prevention (CDC) studied the ten leading causes of death that occurred in 2006. Unintentional injury was the 5 th highest cause of death in infants under the age of 1 with 1,147 infant deaths recorded. Unintentional injuries were the leading cause of death for children 1 to 4 and 5 to 9 years of age. What is meant by "unintentional" injuries? They are injuries that result from an unplanned or accidental incident such as a child drowning in a bucket of water, choking on a small toy, or getting burned by formula heated in a microwave. While the causes may not have been deliberate, the results were still serious and even deadly. Slide # 7 Magnitude of the Problem According to a study by the Consumer Product Safety Commission (CPSC), child care centers accounted for: 2% of all injuries sustained by children two years old and younger, 54% of all injuries sustained by children 2-4 years of age, and 42% of all injuries sustained by children 5-9 years of age. Since the majority of children in the U.S. are enrolled in out of home child care programs, child safety and injury prevention is a real concern for child care providers. Slide #8 Contributing Factors Research indicates that playgrounds are the most frequent site of injuries in child care centers. Other factors that contribute to injuries include unsafe furniture and toys and the actions of other children such as pushing and throwing things. Items in the physical environment such as radiators, glass doors, fences, gates, and vegetation can contribute to injuries as well. Slide #9 Reality Is 2

In a recent national study, the Consumer Product Safety Commission found that twothirds of child care settings have one or more potentially serious hazards. We all want to keep children safe and secure and help them live to their full potential. Knowing how to prevent the causes of child injuries is a step toward this goal. While it is unrealistic to expect you to prevent all injuries, you can take many steps to significantly reduce the risk and impact of childhood injuries. It is estimated that as many as 90 percent of unintentional injuries can be prevented (Safe Kids USA). You can play a large role in preventing injuries. Slide #10 Facts about Falls Falls are the leading cause of non-fatal injuries for all children. Approximately 8,000 children are treated in U.S. emergency rooms for fall-related injuries every day. This adds up to almost 2.8 million children each year. Thankfully, many falls can be prevented. Let s look at how this can be done. Slide #11 Preventing Falls Babies wiggle and move and push against things with their feet soon after they are born. Even these very first movements can result in a fall. As a baby grows and is able to roll over, he or she may fall off of things unless protected. Never leave a baby alone on changing tables, beds, sofas, or chairs. Use the safety straps on any baby equipment, including changing tables, high chairs, strollers, and swings. Never use a baby walker. A baby walker is the activity device that has wheels so a baby can move around. There are Exersaucers or baby activity centers that do not have wheels and are acceptable. Baby walkers have been linked to many injuries. They can tip over, and they allow children get to places where they should not be. As infants and toddlers become more mobile, they will fall often while their gross motor skills are developing. However, you can help prevent serious falls and injuries by using gates at the top and bottom of stairs and rails on decks and balconies to protect young children from falling. Because infants and toddlers love to climb, furniture needs to be low and arranged in such a ways so as not to invite climbing. Move furniture away from windows and counters so children cannot climb to dangerously high places. Teach children of all ages to play safe. Rules for indoor and outdoor play are important for child safety. Even young children can understand simple rules such as walking feet and feet belong on the floor. 3

Slide #12 Airway Obstruction Another type of injury that is common with children is that of airway obstruction. The term airway obstruction includes suffocation, choking, and strangulation, all of which deprive a child of oxygen. It can result in permanent brain damage or death for children whose airways are blocked, internally or externally, by foreign objects. Remember, young children do not understand the dangers that exist as they explore. Slide #13 Seriousness of the Problem Each year, in the United States, approximately 890 children ages 14 and under die from airway obstruction injuries. Of these deaths, more than 720 children die from accidental suffocation or strangulation, and nearly 170 die from choking on foreign objects such as food, toy parts, and other small objects. In addition, each year, an estimated 900 suspected Sudden Infant Death Syndrome (SIDS) cases are actually cases of suffocation related to soft bedding. Slide #14 Preventing Suffocation How do you prevent suffocation? Keep plastic wrappers, plastic bags, latex gloves, and balloons away from young children. They can form a tight seal if placed over the mouth and nose and become a suffocation risk. Another suffocation danger is entrapment in poorly ventilated spaces such as laundry machines and toy chests. Children under age 3 are especially vulnerable because they cannot easily escape from tight places. Young children should not have access to small, enclosed spaces. Slide #15 Safety Tips for Sleeping Babies For babies under 12 months of age, there are specific steps you can take to help prevent SIDS and suffocation. Place the baby to sleep on his or her back. Since three out of five cases of infant suffocation involve bedding, remove all soft bedding from the crib. No items such as pillows, soft toys, or down comforters should be in the bed with the baby. Always put the baby to sleep in a safe crib, not on a waterbed, pillow, or bean bag. Crib mattresses should always fit snugly. Slide #16 Preventing Strangulation 4

Children can be strangled in the slats or frames of cribs, strollers, high chairs and other devices. A safe crib has no more than 2 3/8 inches of space between the slats. Children have been strangled by drawstrings in clothing, mostly by getting tangled in playground equipment. Do not allow drawstrings, hanging jewelry or loose clothing on the playground. Pacifiers attached to strings or ribbons must not be placed around infants' necks or attached to infants' clothing. Children and window cords do not mix. When window cords are accessible to small children, they may become strangulation hazards. Be sure window blinds do not have looped cords. Check that vertical blinds and drapery cords have tension or tie-down devices to hold the cords tight. They should meet the latest blind cord safety standards and all window coverings with cords made before 2001 should be replaced. For more information on the latest blind cord safety, visit the Window Covering Safety Council s website at www.windowcoverings.org. Slide #17 Why Is Choking an Issue? Small children have small airways, and it doesn't take much to choke them. As you well know, young children are always putting small objects in their mouths. Therefore, every child is at risk of choking. Slide #18 Injury Prevention for Choking Caregivers should avoid giving small, round foods such as hot dogs, candies, gum, nuts, grapes, carrots and popcorn to children under age 3. Other common choking hazards include small objects such as coins, small balls and beads, jewelry, marbles, and balloons. Styrofoam cups and plates should not be used with children under 4 years of age since they can bite off pieces and choke on them. Teach children that they should not eat while walking, running, playing, and lying down. Model and reinforce eating while sitting down. Also teach children not to put non-food items in their mouth. Most importantly, learn CPR and first aid for airway obstruction. These essential skills can make the difference between life and death for a choking child. Slide #19 Prevention of Drowning Children love to play in water. Never leave a child alone in or near a bathtub, pail of water, wading or swimming pool, or any other water, even for a moment. Empty all the water from tubs, pails, wading pools, and other containers immediately after use. A 5-5

gallon bucket is extremely dangerous to young children. Top heavy infants and toddlers cannot get out of a bucket this size if they accidentally fall in. Drowning can happen in less than 2 inches of water. If there is a swimming pool on the property, it must be fenced in on all 4 sides. Most children drown because they fall into a pool that is not fenced off. Knowing how to swim does NOT make a child water safe. Stay within an arm's length of children around water. Knowing rescue breathing for infants and young children can save a child s life. Slide #20 Risk of Poisoning Each year, approximately 2.4 million people, more than half under age 6, swallow or have contact with a poisonous substance. In fact, every year more than 40 children, ages 4 and under, die from unintentional poisoning from household products and medicines. Children, especially those under age 6, are more likely to experience unintentional poisonings than older children and adults. Slide #21 Why Kids Are at Risk of Poisoning Young children naturally put objects into their mouths, even if they don t taste good. This natural curiosity places children at a considerable risk for poisoning. Children can be poisoned by many common household products, including cleaning supplies, plants, pesticides, art supplies, foreign bodies and toys, cosmetics, medicines and vitamins. Slide #22 Preventing Childhood Poisoning Put the toll-free nation-wide poison control center number, 1-800-222-1222, near every telephone. Store potentially poisonous products including medicine, cleaning fluids, and pesticides in childproof cabinets completely out of children s sight and reach. Use safety latches or locks on drawers and cabinet doors. Caregivers' personal items should also be stored safely where children cannot reach them. Backpacks, coat pockets, and purses may contain aspirin, medications, cosmetics, and other toxic items. Always use household products in child-resistant packaging. Keep all products in their original containers. Never transfer pesticides to other containers, and never place poisonous products in food or drink containers. Always read the product labels FIRST! Never leave children alone with household products or drugs. Return the product to its childproof storage as soon as you are finished with it. 6

Avoid using pesticides and other toxic chemicals whenever possible. Only use pesticides or other chemicals when children are not present. When pesticides are used, children should not be allowed in the areas until they have had time to air out. Slide #23 Preventing Poisoning (continued) Use child safety caps on all medicine and drugs. Keep the safety caps on at all times or find safer substitutes to use. Avoid taking medicine in front of children because they often copy adults. Do not call medicine candy or other appealing names. All art and craft supplies used by children should be labeled nontoxic. Check the labels for any age restrictions. Avoid poisonous plants indoors and outdoors. If you are not sure what to plant, use herbs since they are edible. There are many resources on poisonous plants including the website on your screen: http://aggie-horticulture.tamu.edu/plantanswers/publications/poison/poison.html/ Slide #24 What to Do If a Poisoning Occurs The American Academy of Pediatrics (AAP) has some important tips to treat exposure to poison. First and most important, remain calm. If the child is unconscious, not breathing, or having convulsions or seizures due to poison contact or ingestion, call 911 immediately. If the child has come in contact with poison, and has mild or no symptoms, dial 1-800- 222-1222. Try to have the following information ready: The victim s age and weight, The container or bottle of the poison (if available), The time of the poison exposure, and The address where the poisoning occurred. Stay on the phone and follow the instructions from the emergency operator or poison control center. Different types and methods of poisoning require different, immediate treatment. If the child swallowed poison, remove the item from the child, and have the child spit out any remaining substance. Do not give the child anything unless directed by the 7

emergency operator. Do not make the child vomit. Do not use syrup of ipecac. If the poison burned going down, it will also burn coming up. For skin poisoning, remove the child s clothes and rinse the skin with lukewarm water for at least 15 minutes. If the child gets poison in the eye, flush the child s eye by holding the eyelid open and pouring a steady stream of room temperature water into the inner corner. For poisonous fumes, take the child outside or into fresh air immediately. If the child has stopped breathing, start cardiopulmonary resuscitation (CPR) and do not stop until the child breathes on his or her own, or until someone can take over. Slide #25 Burn Prevention While most burn accidents happen in the home, care must be taken so burn injuries do not take place in child care settings. Water heater thermostats should be set to 120 degrees Fahrenheit or below. Check the temperature of all warm food before serving it to children. Infant bottles and infant foods should be warmed under running tap water or placed in a container of water that is no warmer than 120 degrees F. After warming, bottles should be mixed gently and the temperature tested. Microwaves should NOT be used for this purpose since they heat unevenly and can heat food and bottles to an unsafe temperature. Avoid electrical burns and shock by ensuring safety covers are on unused electric outlets and electric cords are kept out of reach of children. Consider installing tamper-resistant outlets, also known as child-safety outlets, if your child care center or home does not have them. Avoid plugging multiple items into the same electrical socket. Replace old or frayed electrical wires and appliance cords. Teach children how to "stop, drop and roll" and what the fire escape routes are. Post fire escape routes where they are visible and can be easily located in an emergency. Slide # 26 Toy-Related Injuries Due to tough government regulations and efforts by U.S. toy makers to test products, most toys on the market are safe. Still, thousands of children suffer toy-related injuries every year. The U.S. Consumer Product Safety Commission estimates that each year there are approximately 150,000 toy-related injuries serious enough to require hospital emergency room treatment. Many serious injuries result from children swallowing small parts or placing tiny toys in noses or ears, from flammable products, and from sharp edges. 8

Each year, about 5,000 new toys enter the marketplace. Despite the efforts of manufacturers, retailers, safety inspectors, and others, it is impossible to examine every toy. It is possible, however, for caregivers to check every new toy bought and every old toy donated for possible hazards. By knowing what to look for when buying toys, and following a few simple practices for the safe use of toys, you can help prevent problems before they occur. Slide #27 Choose Safe and Age-Appropriate Toys Let s discuss the preventive measures you can take to be sure the children in your care are safe from toy-related injuries. First, and most importantly, choose safe, age-appropriate toys. Consider the children s interests and skill levels. A toy that is too advanced or too simple for a child may be misused, which could lead to injury. Also, toys that are meant for older children may be dangerous for younger children. Abide by the age designated on the safety label. Toys for children under the age of 3 should not have small pieces that could become choking hazards. Tiny toys and toys with small, removable parts can be swallowed or become lodged in a child's windpipe, ears, or nose. The squeakers in some squeeze toys can come loose and be swallowed. The seams of poorly constructed stuffed dolls or animals can break open and release small pellets that can be inhaled. Infant and toddler toys must be large enough not to be swallowed, at least 1¼ inches wide and 2 ¼ inches long. They must be free of parts that might break off and become lodged in noses, ears, or throats. Consider purchasing a small parts tester to determine whether or not small toys and objects may present a choking hazard. If the object can fit through a standard toilet paper tube or a small parts tester, don't let children under the age of 3 play with it. Look for quality in the design, materials, and construction of toys. The toy should be made of washable nontoxic materials and be free of parts that could pinch or pierce children. Look to see if hinges and joints are covered. Doll and stuff animal heads and limbs should be attached securely and facial features should be molded in, rather that sewn on. If made of cloth, it should be nonflammable or flame retardant, not flame resistant. Slide #28 Toy Safety Practices All toys should be checked regularly for damage that could create small pieces and choking hazards. Toys made of brittle plastic can break easily, exposing sharp points and edges. Wooden, metal, and plastic toys sometimes have sharp edges if not well made. Check often for broken parts, sharp edges, and exposed nails, wires, pins, or splinters. Make any necessary repairs immediately, or discard damaged toys out of children s 9

reach. Visit the website on this slide for an example of a toy safety checklist that you can use. http://www.ucsfchildcarehealth.org/pdfs/forms/toysafetychecklist.pdf Watch for toys that create hazards. Young children should never play with toys with strings, straps or cords longer than 7 inches. Children can be accidentally strangled with longer strings or cords. Electrical toys can be potential burn hazards. Children under age 8 should not use toys with electrical plugs. Electric toys that are improperly constructed, wired, or misused can shock or burn. Therefore, these toys must meet mandatory requirements and must have prominent warning labels. Children should be taught to use electric toys carefully and be under adult supervision. Do not let children under age 8 blow up balloons. Use Mylar balloons instead of latex balloons. As discussed earlier, latex balloons are choking and suffocation hazards. Make sure toys are stored safely so they do not become trip hazards. Teach children to put toys away after playing. Ensure that toys intended for younger children are stored separately from those for older children, especially if children of different ages play in the same area. Toy storage furniture should be checked for safety. Toy chests should have no lids or have safety hinges. Shelves, book cases, and cabinets should be sturdy. All furniture should be smooth and free of splinters and sharp edges. Check the U.S. Consumer Product Safety Commission s website (www.cpsc.gov) regularly to obtain information on recent toy recalls and to ensure no recalled products are being used. Display a list of recalled products to remind caregivers and parents to remove or repair potentially dangerous children's toys and products. Return the manufacturer s warranty and product registration forms for new toys to ensure that you will be notified of any recalls. Slide #29 Playground Injuries Each year in the United States, emergency departments treat more than 200,000 preschool and elementary children for playground-related injuries. Of those injuries, approximately: 45% occurred on school playgrounds, 10% occurred on playgrounds of commercial child care centers, and 3% occurred in home child care yards. 10

The U. S. Consumer Product Safety Commission (CPSC) reports that fatal injuries involved falls, entanglement of clothing or other items, entanglement in ropes, head entrapment in openings, and impact from equipment tipping over or structural failure. Slide #30 Seek Information All playgrounds, equipment and outdoor structures should meet the CPSC standards, state licensing standards, and local codes. The Handbook for Public Playground Safety by the United States Consumer Product Safety Commission (CPSC) sets the standards and guidelines for playgrounds. It can be found online at the website on this slide: http://www.cpsc.gov/cpscpub/pubs/325.pdf. The National Program for Playground Safety provides safety information for outdoor play areas. Their website is also listed on the screen: http://www.playgroundsafety.org. The American Society for Testing & Materials Standards (ASTM) sets the standards and specification for playground equipment for public use including child care facilities and schools. All playground structures and safety surfaces should meet, or be repaired to meet, the CPSC standards and be properly maintained. All structures that cannot be changed to follow CPSC standards should be removed. It is also important to remember that developmentally appropriate equipment is essential to promote a safe environment for children. Knowing the risks associated with each age can help prevent accidents. Slide #31 Playground Practices Be proactive in preventing injuries on the playground. Be alert and observant. Ensure the playground is free from unsafe materials and conditions such as broken glass, sharp sticks and splinters, plastic bags and other trash, broken toys, beehives/wasp nests, tripping hazards, and standing water. Maintain separate play areas for the different ages of children served. Since the type and height of the equipment should be age-appropriate, younger children should not play on equipment designed for older children. Safe play equipment for toddlers should be less than 3 feet high above the cushioning material and play equipment for preschoolers should be no higher than 6 feet. Prohibit children from playing on equipment that is not appropriate for their age (Safety First: Preventing & Managing Childhood Injuries). 11

Prevent unsafe behaviors like pushing, shoving, crowding and inappropriate use of equipment. Review playground rules with children both in the classroom and on the playground. Slide #32 Playground Supervision Be aware of the entire playground. Position yourself so that the whole playground is supervised at all times. Move around the playground so you can see all children. Always supervise the children who are using playground equipment. Stand where you can see and hear them. Stay near a child who is carrying out a challenging activity, especially if the child is trying the activity for the first time. Make sure that your view of one play piece is not blocked by another. Plan ahead to avoid distractions. Be prepared by have all necessary items such as a first aid kit and materials for planned activities ready and available when you get outside. Toilet children before going outside. Count and count again. You must always know the number of children you are responsible for, so count heads often. Account for all children before going onto the playground and before leaving it. Remember - outside time is not teacher recess. Attentive supervision is basic to preventing injury and harm. Slide #33 Supervision Is Key Supervision is key throughout the day, not just outdoors. Your primary responsibility as a child care provider is to make sure the children in your care are safe. Even when the highest safety standards are followed, children need close supervision. Children explore their world, often in unexpected ways, as they test newfound skills and abilities. Therefore, you must supervise young children by closely watching, guarding, and overseeing their activities. You should be able to see and hear the children at all times. You must be ready to rescue a child in an emergency, redirect a child to use equipment safely, or ask a child to use her words instead of hitting. You must position yourself so that the whole classroom is supervised at all times. Rotate through the classroom. When working with one child or a small group, make sure that your back is not to the rest of the classroom. Always be aware of what is happening in the rest of the room. Active supervision needs to happen at all times during the day no matter what the activity is. When children are sleeping, you should be present and position yourself so you can see the children. You can monitor sleeping children by sound for short periods of time. 12

However, you should walk through the room periodically. Sleeping infants should be visually checked often. All meals and snack times must include adult supervision. Supervise meals to be sure that the children do not eat while talking, crying, laughing, or playing, which could cause choking. Toileting, including diapering, often requires one-on-one supervision. While diapering a child, you should be positioned so as to see all the children in your care. Toilet areas must allow for supervision by caregivers. If the restroom is not in the classroom, staff must accompany children to the restroom. You should be free from duties not directly involving the teaching, care, and supervision of children. You should not be involved in administrative and clerical tasks that take your attention away from the children. Janitorial duties, such as mopping, vacuuming, and cleaning restrooms, should not be done while supervising children. Limited sweeping after an activity or mopping up spills may be necessary for the children s safety and are not considered janitorial duties. You should know how many children you have at all times and who you are directly responsible for. It is important to count and identify the children periodically throughout the day, especially during transition times. Do not assume that co-workers are supervising the classroom. Work as a team. Adults who are attentive and who understand young children s behaviors are in the best position to safeguard their well-being. So, always have a watchful eye and a listening ear. Slide #34 Know Your Facility Injury prevention in child care involves constant attention to setting up and maintaining a safe environment, so know your facility. Daily inspections of both indoor and outdoor play areas should be completed to ensure safety. These inspections are best if in the form of written checklists. Any broken or dangerous equipment should be reported immediately and children should be prohibited from playing on it. In the next section, there are links to some excellent health and safety checklists that you can use in your facility. Please download and/or print these documents for your review and potential use. More detailed safety checks should be done monthly or quarterly and include maintenance reports. The daily and monthly playground inspections and maintenance reports should be reviewed to insure issues are being addressed. An annual inspection should be completed on the entire facility. 13

Having different people do the safety checks will usually result in finding more hazards. The more people who are involved in watching for hazards, the more they will help report or fix hazards whenever they see them. Safety is everyone s business! Slide #35 Conclusion This concludes the informational portion of this course. Please click on the Next Section button at the bottom of this page to proceed to the post-test. If you would like to review any of the previous sections, click on the desired title in the left menu bar. 14

References Administration for Children and Families (2002). Safety First: Preventing & Managing Childhood Injuries. Available online: http://www.headstartinfo.org/publications/safety _first/mod3.htm American Academy of Pediatrics (2009). Poison Prevention and Treatment Tips. http://www.aap.org/advocacy/releases/poisonpreventiontips.cfm American Academy of Pediatrics (2001). The Injury Prevention Program (tipp): Age- Related Safety Sheets. http://www.aap.org/family/tippmain.htm Centers for Disease Control and Prevention. 10 Leading Causes of Death by Age Group, United States 2006,produced by Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC. www.cdc.gov/injury/images/lc- Charts/10lc%20-%20By%20Age%20Group%202006-7_6_09-a.pdf Centers for Disease Control and Prevention (2009). Playground Injuries: Fact Sheet. www.cdc.gov/homeandrecreationalsafety/playground-injuries/playgroundinjuriesfactsheet.htm#pl Centers for Disease Control and Prevention (2009). Tips to Prevent Poisonings. http://www.cdc.gov/homeandrecreationalsafety/poisoning/preventiontips.htm Children s Safety Network (2009). Child Care Safety. Available online: http://www.childrenssafetynetwork.org/topics/showtopic.asp?pktopicid=4 Children s Safety Network (2009). Injury Topics. Available online: http://www.childrenssafetynetwork.org/topics/showtopic.asp?pktopicid=28 Early Childhood Learning and Knowledge Center (ECLKC), Administration for Children and Families (2009). Safety for Children. Available online: http://eclkc.ohs.acf.hhs.gov/hslc/ecdh/health/environmental%20health%20and%20safet y/environmental%20healthy%20and%20safety%20program%20staff/health_fts_11014 _022706.html#infants National Program for Playground Safety (2006). Child Care - S.A.F.E. Tips. Available online: www.playgroundsafety.org Safe Kids USA (2007). Injury Fact Sheets with Data Sources. Available online: www.usa.safekids.org/tier3_cd_2c.cfm?content_item_id=25251&folder_id=540 Safe Kids USA. Poison: Why Kids Are at Risk. Available online: www.usa.safekids.org/tier3_cd.cfm?content_item_id=337&folder_id=176 15

Safe Kids USA. Preventing Injuries to Children on Playgrounds. Available online: www.usa.safekids.org/content_documents/playground_tips.pdf Safe Kids USA. Safety Tips. Available online: www.usa.safekids.org/tier3_cd_2c.cfm?content_item_id=20773&folder_id=4080 U.S. Consumer Product Safety Commission. Be Sure Your Child Care Setting Is As Safe As It Can Be, Document #242. Available online: www.cpsc.gov/cpscpub/pubs/chldcare.html U.S. Consumer Product Safety Commission (2008). Handbook for Public Playground Safety, Publication #325. Available online: - www.cpsc.gov/cpscpub/pubs/325.pdf * This course was developed and produced by the Texas AgriLife Extension Service of the Texas A&M University System through funding support was provided by Office of Title V and Family Health, Texas Department of State Health Services using Title V Maternal and Child Block Grant Funds. Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating 16