The study found that:

• 97 percent of homes had smoke detectors but only half had a working one on each level of the home.

• None of the homes had staircases blocked correctly.

• Only 17 percent of homes had adult medications stored safely in a locked place.

• Nearly two-thirds of the homes had staircases too narrow and banister design that wouldn’t allow a gate to be fitted across the top of the stairs; one-third would not accommodate a gate at the bottom of the stairs.

• Nearly 20 percent had recognized environmental hazards such as using a gas stove to heat the home.

• Two of the 32 homes had exposed wires in the walls.

• Two homes had broken banisters or railings.

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 include poverty and the structural design of older urban homes that often doesn’t allow for proper installation of such devices, they point out.

“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, M.D., M.P.H., 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 first-hand 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. The study, albeit small, probably reflects patterns typical of Baltimore City’s impoverished urban pockets, researchers suspect.

“The take-home message for us as primary-care pediatricians is that we can’t simply ask parents if their homes are child-proof,” 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 home.”

The problem should be addressed on a macro level as well.

“We need to do more than hand out a free fire alarm and a pamphlet,” Stone added. “We need legislators, housing authorities, landlords and manufacturers of safety products to step up to the plate and help ensure compliance.”

For example, 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 stairs cases 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: Emmanuella Eastman, B.S., Johns Hopkins Children’s Center; Janet Serwint, M.D., Johns Hopkins Children’s Center; Andrea Gielen, Sc.D., Sc.M., Johns Hopkins Bloomberg School of Public Health; Barbara Squires, Baltimore City Health Department; Glenda Hicks, Baltimore City Healthy Start Program.

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Founded in 1912 as the children’s hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children’s Center offers one of the most comprehensive pediatric medical programs in the country, from performing emergency trauma surgery, to finding causes and treatments for childhood cancers, to delivering a child’s good bill of health. The Johns Hopkins Children Center’s Pediatric Trauma Service and Burn Unit are Maryland’s state-designated trauma and burn centers for children. With recognized Centers of Excellence in 20 pediatric subspecialties including cardiology, transplant, psychiatric illnesses and genetic disorders, Children’s Center physicians, nurses and staff provide compassionate care to more than 90,000 children each year. For more information, please visit: www.hopkinschildrens.org