Research In Action

Moderator's note: This post is part of our ongoing series highlighting articles from the "Preventing Unintentional Injuries Among Children and Youth" issue of Pediatric Clinics of North America. Today’s entry, written by Dr. Lindsay Clukies, features the article “Pediatric Considerations for Home Safety”. Dr. Lindsay Clukies is a pediatric emergency medicine physician, associate medical director of trauma at St. Louis Children's Hospital, and Associate Professor of Pediatrics at WashU Medicine. 

In our recent review for the Preventing Unintentional Injuries among Children and Youth issue of Pediatric Clinics of North America, we examine the critical role of the home environment in pediatric injury prevention, highlighting a fundamental reality: many of the most common and serious childhood injuries occur in and around the home and are largely preventable.

We begin with the case of a young child who falls from a third-story window, a scenario that illustrates how everyday environments can pose significant, often unrecognized risks. This case underscores a central message: relatively simple, evidence-based interventions, such as window guards, can prevent devastating outcomes. However, awareness and implementation remain inconsistent.

Across injury types, prevention requires a multipronged approach that combines environmental modifications, caregiver education, and consistent supervision. Falls, burns, drownings, poisonings, and firearm-related injuries remain leading causes of morbidity, particularly among younger children whose developmental stage increases vulnerability. Falls alone account for millions of emergency visits annually, frequently involving common household features such as furniture, stairs, and windows. Even brief lapses in supervision during bath time can result in drowning in minimal water, underscoring how quickly these events can occur.

Importantly, many of these injuries follow predictable patterns tied to child development. Infants and toddlers are at higher risk for falls and drownings due to increasing mobility and curiosity, while older children face growing risks from environmental exposures and recreational activities. Effective prevention therefore depends on tailoring anticipatory guidance to developmental stage.

Several high-impact strategies have strong evidence for reducing risk, including installing window guards and stair gates, anchoring furniture, setting safe water temperatures, ensuring constant supervision during bathing, and promoting secure firearm storage (unloaded, locked, and stored separately from ammunition). Fire safety measures, including smoke and carbon monoxide detectors and practiced escape plans, are also critical yet inconsistently implemented. We also highlight persistent and emerging risks in the home, such as poisonings from medications and household products, injuries from backyard play equipment, and severe trauma related to lawn mowers and trampolines.

Despite this, gaps in caregiver risk perception persist. Many caregivers underestimate how quickly injuries can occur or rely on misconceptions, such as believing brief lapses in supervision are safe or that safety devices alone eliminate risk. Pediatric clinicians play a central role in addressing these gaps. Anticipatory guidance, when tailored, repeated, and paired with practical solutions, can improve caregiver behaviors, and reduce injury risk. However, barriers such as time constraints and competing priorities necessitate more efficient strategies, including standardized screening tools, electronic prompts, and technology-based education platforms.

From a clinical and systems perspective, one of the greatest opportunities moving forward is closing the gap between what we know works and what is consistently implemented in real-world settings. Ultimately, home safety is not a one-time intervention but an ongoing, dynamic process that must evolve as children grow. Clinicians, caregivers, and communities must work together to create safer environments through education, advocacy, and the consistent application of evidence-based safety practices. Advancing pediatric injury prevention will require not only generating evidence but designing systems that make the safest choice the easiest choice for every family.