Infants and young children living in Baltimore's
inner-city houses are at risk for serious perils,
including fires, falls and poisoning, according to a small
but revealing study from the Johns Hopkins
Children's Center. A survey of 32 urban homes and their
residents found that many lacked functioning
fire alarms, staircase gates and safe storage for
medications, researchers report in the August issue
of Pediatrics. Fires, falls and poisonings are the top
causes of childhood home injuries in Baltimore.
The study of homes found that:
Ninety-seven percent had smoke
detectors, but only half had a working one on each
None had staircases blocked
Only 17 percent had adult
medications stored safely in a locked place.
Nearly two-thirds had staircases
too narrow and a banister design that wouldn't allow a gate
be fitted across the top of the stairs; one-third would not
accommodate a gate at the bottom of the
Nearly 20 percent had recognized
environmental hazards such as using a gas stove for
Two of the 32 had exposed wires in
Two had broken banisters or
Not using home-safety devices such as stair-blocking
gates, fire detectors and medicine-
cabinet locks makes these homes dangerous for youngsters,
researchers said. Barriers, they point out,
include poverty and the structural design of older urban
homes that often doesn't allow for proper
installation of such devices.
"There are many factors that come into play here, and
parental knowledge and financial
situation are just part of the problem," said study lead
author Kimberly Stone, a pediatrician at the
Johns Hopkins Children's Center. "Clearly, the design
of older urban homes and the lack of uniform
measures to ensure home safety also play a role."
Study participants — 32 low-income, mostly
unemployed pregnant women or mothers of children
younger than 1 year from inner-city Baltimore —
received information on safety products and practices
and were given coupons to buy fire alarms, stair gates and
medicine-cabinet locks. Researchers then
interviewed the mothers about their home-safety practices
and visited their homes to observe
firsthand the use of safety products. Researchers found
that parents tended to over-report their use
of fire and smoke alarms, stair gates and cabinet locks,
and many failed to use or install these
products correctly. Researchers said they suspect that the
study, albeit small, probably reflects
patterns typical of Baltimore City's impoverished urban
"The take-home message for us as primary-care
pediatricians is that we can't simply ask parents
if their homes are childproof," Stone said. "We need to be
probing and ask specific questions about
stair gates, fire alarms, medication storage, as well as
about the state of repair and design of the
The problem should be addressed on a macro level as
well, she said.
"We need to do more than hand out a free fire alarm
and a pamphlet," Stone said. "We need
legislators, housing authorities, landlords and
manufacturers of safety products to step up to the
plate and help ensure compliance."
For example, she said, laws should require landlords
to provide medication lock boxes, and install
and maintain smoke alarms with lifelong lithium batteries,
which may improve safety. Also, requiring
manufacturers to design gates that fit narrow staircases in
urban homes may help reduce falls.
Past research indicates that more than 90 percent of
fatal injuries of children younger than 1
year happen in the home.
The study was funded in part by the Thomas Wilson
Sanitarium of Baltimore and by the U.S.
Department of Health and Human Services.
Other researchers in the study are Emmanuella Eastman
and Janet Serwint, both of the Johns
Hopkins Children's Center; Andrea Gielen, Johns Hopkins
Bloomberg School of Public Health; Barbara
Squires, Baltimore City Health Department; and Glenda
Hicks, Baltimore City Healthy Start Program.