Start with the things that kill, not the things that worry
Among children under five at home, suffocation and strangulation account for more deaths than anything else, and the specific causes are ones almost nobody has on their list.
Looped blind cords have killed at least thirty-three young children in the UK since 2001. A looped cord at the side of a window is at exactly the height of a standing toddler, and a child who becomes tangled cannot free themselves and makes no noise doing it. Blinds sold new now come with safety devices fitted; the ones already hanging in most houses do not. The fix is to cut the loop or fit a cleat or tensioner high on the wall, and to keep cots, beds and anything climbable away from the window.
Nappy sacks have killed at least fourteen babies over the same period. They are thin enough to cling, unperforated, silent, and almost always stored within arm's reach of the changing mat or cot. They belong in a drawer or a high cupboard, not in the cot-side caddy where they are convenient.
Both of these are cheap and permanent to fix, which puts them first.
Falls, stairs and windows
Falls are the commonest accident at home by a wide margin, and the ones that do damage are falls between two levels rather than trips on the flat.
- Stair gates at the top and the bottom. The top gate prevents the serious fall; the bottom gate prevents the climb that leads to it. Pressure-fit gates are not suitable at the top of stairs — a screw-fitted gate is.
- Raised surfaces. The classic fall is off a changing mat, a bed, a sofa or a highchair, and it happens the first time a baby rolls or pushes up. Changing on the floor removes the hazard entirely and is the single easiest change on this list.
- Windows. Restrictors that stop a window opening more than about ten centimetres, and no climbable furniture under a window. A child who can reach a sill can get through an open window, and upstairs windows are the ones to deal with first.
- Highchairs. The harness matters more than the tray, which is not a restraint.
Furniture and televisions
Chests of drawers, bookcases and flat-screen televisions tip over onto children who climb or pull on them, and a loaded chest of drawers with an open bottom drawer is a lever. Anchoring straps come with most flat-pack furniture and are the part most often left in the bag.
The items to secure are the tall ones, the top-heavy ones, and anything a child could use as a staircase. Televisions on low units or on top of chests are worth particular attention, since they are heavy, the mounting points are at the back, and a toddler pulling on the screen edge has excellent leverage.
Hot water, and the instruction to ignore
Bath water causes the most severe and most often fatal scalds in young children, and hot drinks cause the largest number of less severe ones.
Older advice, written in the United States, says to turn the hot water heater down — usually to 120°F. That is the wrong instruction here, for two reasons. The units are not the ones on any UK thermostat, and more importantly the stored temperature is not what should be lowered: hot water is kept hot deliberately, and a cylinder running cool has its own problems.
The UK arrangement works at the other end. Under building regulations the hot water delivered to a fixed bath must not exceed 48°C, achieved with an in-line blending valve or equivalent control fitted close to the bath tap. That requirement applies to new dwellings and conversions, so an older house may well have nothing of the kind, and fitting a thermostatic valve to the bath is the change worth making. A general tempering valve limiting distribution to 60°C covers the rest of the system.
Day to day: run cold into the bath first and hot second, test with an elbow rather than a hand, never leave a small child in the bath unattended even briefly, and keep hot drinks away from the edges of tables and out of reach of a pram or highchair. A cup of tea is still hot enough to scald a baby a good fifteen minutes after it was made.
Medicines, cleaners and cosmetics
Poisoning sends tens of thousands of children for treatment every year, and the sources in order are medicines, household products and cosmetics. Cosmetics surprise people and should not — a handbag on the floor is an accessible container of interesting liquids.
A high cupboard beats a low cupboard with a latch, because a latch is a delay rather than a barrier and children solve them. Laundry detergent capsules deserve separate mention: they are soft, brightly coloured, the right size for a mouth, and the contents are concentrated. Iron tablets and children's paracetamol are both more dangerous than their packaging suggests.
Keep things in their original containers, because that is what the label and the child-resistant closure belong to, and so that anyone calling 111 can say what was swallowed.
The kitchen
The kitchen produces the most serious accidents of any room. Kettle and appliance flexes trailing over a worktop edge, pan handles turned outwards, the oven door, the dishwasher with its detergent compartment at toddler height, and the cupboard under the sink are the recurring ones. A stair gate across the kitchen doorway during cooking is less effort than making the whole room safe.
What not to buy
One product deserves singling out because it is sold everywhere for this exact purpose and is not recommended in the UK.
Plastic plug socket covers. RoSPA does not recommend them, on the grounds that BS 1363 sockets already have shutters covering the live and neutral connections when no plug is in. The Electrical Safety Council does not rely on them. Health and Safety Executive and Trading Standards guidance is blunter still: the covers "provide a false sense of security and can fail to danger", and in some designs inserting one the wrong way round holds the shutters open and exposes the contacts. A sound installation with working RCD protection is the actual safeguard. The covers are at best unnecessary and at worst make a safe socket less safe.
The wider point is that the childproofing aisle sells a great deal that substitutes for the few structural changes that matter. Anchoring a chest of drawers is worth more than a drawerful of latches.
Do it again in three months
Most incidents involve a precaution that was perfectly adequate a fortnight earlier. A baby who could be left on a bed last week rolls off it this week; a toddler who could not reach the worktop can now climb to it; a three-year-old goes downstairs alone. Childproofing done once at eight months is childproofing for an eight-month-old.
Looking at a room from a crawling child's height genuinely works for finding what has changed, and it is worth repeating every few months rather than treating the job as finished.
And its limits
Supervision prevents more accidents than any device, and no arrangement of gates and latches substitutes for it. But supervision has gaps by definition — the answered door, the other child, the two minutes in the next room — which is the argument for making the house safe rather than relying on attention being continuous.
The aim is not a house with nothing in it. Children learn to judge risk by meeting some of it, and a home organised entirely around hazard is anxious rather than safe. Deal with the cords, the stairs, the windows, the furniture, the bath and the cupboards, and then let a child climb on the sofa.