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What is ALTER?


There are many ways to keep your child safe and prevent falls. ALTER can be used to help remember your choices.

Three steps for using ALTER:

  1. Remember, You Know Your Child Best
    You know what is best for your child, you know the home that your child spends their time in, and you know what you can do to help keep them safe. Please read the information provided below with your child and home in mind when looking for alternative ways to keep your child safe in the home.
  2. The Power of 5 Different Approaches to Safety
    ALTER is a shortcut for remembering 5 different ways to look at child safety in the home. The power of this shortcut comes from each strategy and how together they provide a number of options for keeping your child safe and preventing falls.
  3. Explaining ALTER
    Each letter of ALTER represents a specific way at looking at safety and preventing injuries in the home. Using ALTER is simple and improves with experience. The more you use ALTER, the easier it is to use and the more strategies you will think of for how to keep your child safe.

An Example – How to Use ALTER

We will use ALTER with each example as a way of demonstrating how each of the strategies work.

Example 1 – Doing the Laundry

Parents often need to take the time to do the laundry, but this chore can take you down stairs, to another room in your house or out of the apartment if you have laundry in the building. Whatever the circumstance, there are many options for maintaining supervision that can be suggested by using ALTER, here are just a few:

  • A = try turning the laundry into a fun activity for both you and your child. Make the chore of sorting laundry playful by asking your child to find all the white clothes, or stuffing the machine with the clothes.
  • L = few people can change the location of the laundry machines, but most parents can change where their child is playing. Find a new location near the laundry machines for your child to play so that you can monitor his or her activities. Or, bring the clothes to your child’s location and fold them there.
  • T = try to time when you do the laundry so that your child is taking a nap or when he or she has gone to bed. Sometimes it is too complicated to involve or supervise your child when you are doing the laundry, so schedule the task at a time that is best for both of you.
  • E = try making changes to the environment (your home) to help keep your child safe. Some parents have told us that they have created a small play area near the laundry machines that allows them to watch their children. Alternatively, developing a safe place where a child can’t climb or fall off of furniture while you leave to do or get the laundry can be another way to change the environment.
  • R = try using resources to help maintain your supervision of your child. Parents can make a point of having a spouse look after the child while doing the laundry. Alternatively, a single parent can invite a family member or friend over for a visit who can watch over a child while the parent does the laundry.

Example 2 – Using the Stairs

All children need to learn to use the stairs. So at some point all parents need to take the time to teach their child stairs are dangerous, and this includes how to move up and down the stairs safely. There are many options for maintaining supervision that can be suggested by using ALTER, here are just a few for both toddlers and preschoolers:

  • A = changing the activities on the stairs to match your child’s abilities. Toddlers lack stability so teach your child to climb the stairs by crawling up and down the stairs. Some children slide down the stairs one-stair-at-a-time on their bum. No matter which way they choose, stay close and BELOW your child in case they slip or fall. Preschoolers are more stable on the stairs, but need to be constantly reminded to use the railing. Try to count out loud, at a slow pace, for each stair they step on to keep them from moving too fast. Stay close or BELOW your child in case they slip or fall, never overestimate their ability.
  • L = be prepared to change the location of your child’s play space if it is near the stairs, the temptation to climb could be too much. Toddlers are more easily relocated, but they need to have limited access to stairs at all times. Preschoolers are very active and mobile. Teaching your child stair-safety and to not play on or near the stairs is very important.
  • T = plan the time for your daily activities so that your child is always supervised when there is a risk of him or her using the stairs. Toddlers take less planning; coordinating the daily activities so that you are available when they need to use the stairs is easily done. Preschoolers are active all day and, as such, are at risk of using the stairs at different times all day long. Ensure that you are always able to monitor your child’s activities and that they don’t play near stairs. It is important to try to organize your activities to maximize your ability to keep him or her safe. Please take the time to be with your child whenever they are on the stairs. For older children, walk BELOW your child in case they fall.
  • E = changing the environment is easily done by adding stair gates, or moving the location of the child’s room, or play space, away from the stairs. Toddlers always need stair gates because they are unable to understand danger. Stair gates are critically important no matter how many stairs are involved since even a small fall can lead to life-long injuries. Preschoolers should have stair gates, but all parents must decide when their child is able to be safe on stairs. Before removing gates, think carefully about if your child can manage stairs safely.
  • R = parents may have other people helping with childcare. Make sure you tell these people how to use your stair gates and that they should be directly below your toddler as the child goes up or down the stairs. These caregivers may assume your preschooler is better at handling the stairs than the child actually is. Again, inform them of your child’s need to be closely monitored on the stairs; it is easy for preschoolers to lose their balance on stairs.

Research Supporting ALTER

Morrongiello, B.A., Hou, S., Bell, M., Walton, K., A. J. Filion, & Haines, J. (2017). Supervising for Home Safety Program: A randomized controlled trial testing community-based group delivery. Journal of Pediatric Psychology, 42(7), 768–778. doi:  10.1093/jpepsy/jsw083

Morrongiello, B.A., Sandomierski, M., Zdzieborski, D., & McCollum, H. (2012). A Randomized Controlled Trial (RCT) evaluating the impact of the Supervising for Home Safety Program on parent appraisals of injury risk and need to actively supervise. Health Psychology, 31, 601-11. doi: 10.1037/a0028214

Morrongiello, B.A., Zdzieborski, D., Lasenby Lessard, J. & Sandomierski, M. (2009). Video messaging: What works to persuade mothers to supervise young children more closely to reduce injuries? Social Science & Medicine, 68, 1030-1037. doi: 10.1016/j.socscimed.2008.12.019

Morrongiello, B. A., Zdzieborski, D., Sandomierski, M., & Munroe, K. (2013). Results of a randomized controlled trial (RCT) testing the efficacy of the Supervising for Home Safety program: Impact on supervision practices. Accident Analysis & Prevention50, 587-595. doi: 10.1016/j.aap.2012.06.007