Patient Presentation
A 5-year-old female came to clinic with her mother for her health supervision visit. She was starting kindergarten in the fall and had not been in a childcare or an educational setting before. Her mother described her as a sociable child whom other children and adults liked. She was a very trusting child and therefore her mother was concerned that she would be vulnerable to a stranger abduction. The pertinent physical exam showed a well-developed child with normal vital signs and growth parameters in the 90-95%. Her pertinent physical examination was normal. She was quite gregarious with advanced speech content. Her other development was on track for her age.
The diagnosis of a healthy female was made. The pediatrician talked with the girl about a couple of potential scenarios for when a child should be wary of strangers. It was obvious that she needed some more information and practice regarding stranger safety. The pediatrician gave the mother some ideas about how to practice stranger safety with her daughter over the next few months in addition to information about developmental readiness for kindergarten.
Discussion
Fortunately, when a child goes missing it is usually for short periods of time and is often because of miscommunication or expectations. Familiar examples are a child wandering away, or not returning at the proper time. Unfortunately, child abduction does occur.
Data from the U.S. Department of Justice’s Office of Juvenile Justice and Delinquency Prevention provides the statistics below. Problems with definitions and reporting make these statistics more difficult to gather.
- ~340,500 children (43%) reported in 1999 as missing, were because of benign causes and no harm occurred to the child. Most were because of communications problems such as failing to come home or coming home later than expected.
- ~43,700 missing children in 1999 were injured but only 10,200 were reported to authorities to help locate the child.
- There were ~58,200 child victims of non-family abductions in 2002.
- ~ 105 children in 2002 were victims of stereotypical kidnapping in 2011. Most of these were teenage, white females and most ended with recovering the child alive.
- Cellphone, Internet and other technologies helped law enforcement solve ~2/3 of these crimes.
A missing child, emergency reference guide is available here.
Tips for getting ready to go to Kindergarten can be reviewed
here.
Learning Point
Parents can help their child be safe from strangers by:
- What is a stranger?
- Stranger are people that the child or your family doesn’t know or doesn’t know well.
- Strangers can look like anyone. Nice looking strangers can be as dangerous and strangers who look “bad” or “mean” can be safe strangers.
- Remind the child that if they need help, most strangers are not bad. It is just that they are strangers and the child needs to decide whether or not to trust them.
- Most strangers actually can be trusted to help a child.
- What is a safe stranger? Where can you find a safe stranger?
- Safe strangers are people that can be asked for help if needed.
- Police and firefighters are common, recognizable safe strangers.
- Other common safe strangers would be teachers, librarians, and spiritual advisors.
- Public places are good places to teach children to find safe help. During your usual day, point out places you would choose as a safe place to find help such as a local store, restaurant, recreation center, school or house of worship.
- Point out that the workers in stores or restaurants usually have a uniform – all wearing a similar shirt and have a name tag.
- Point out homes of family friends in the neighborhood that children could go for help too.
- Make sure the child knows their name, parents first and last name, and street they live on. This information can help the safe stranger contact the parent or local police.
- How do you recognize potentially dangerous situations?
- Children should be taught to be wary of potentially dangerous situations and strangers. That doesn’t mean that they need to be scared of every stranger or situation but need to be taught to be cautious.
- Children should learn to recognize suspicious behavior. Examples include an adult who:
- Asks the child to do something the child knows is wrong to do
- Asks the child for help (adults ask other adults for help)
- Makes the child feel uncomfortable
- Asks the child to do something the child knows is wrong to do
- The child should be taught how to handle these situations – one way is “No, Yell, Go, Tell”
- No – in a dangerous situation the child should say No. Even better if they describe what they are saying No to. For example, “No. You are not my father” Or “No, I do not want any candy from you.”
- Yell – Yell very loudly to get others attention – Yell “Help” or “Fire” to attract attention.
- Go – Run away from the situation and go to a place that they feel is safe
- Tell – tell a trusted adult as soon as possible
- For example, a stranger asks for directions on your child’s way home from school. The child can say No – “No I’m not going with you, ” continue to yell while running back toward the school. Then finding a teacher and telling about the incident.
- A child should be taught they can do this inside (ex. a mall or hospital) or outside (ex. park, street, etc.)
- If they are grabbed, teach children to resist, kick, bite or hit to try to get away.
- Practice makes perfect
- Parents can talk about and model appropriate behavior with their children. When you get lost, how do you get directions from a safe stranger?
- Talk about different situations that could come up and practice what a child should do.
- Ask “If you got lost now in the grocery store, what would you do?” and tell, “That’s right, the safe strangers in our grocery store have a uniform with white shirts and a black name badge.”
- Ask “If that woman over there wanted to give you candy, or go outside to pet her dog, what would you do?” and tell, “Never take candy from a stranger or go with a stranger. You can just say No, yell real loud and run away until you can find a safe stranger.”
- Point out safe places and safe strangers in your community.
- Teach children to trust their instincts. If they feel uncomfortable they should “No, Yell, Go, Tell”
- If they are wrong about the situation, that is okay. Better to “No, Yell, Go, Tell” than to have a problem.
- Teach children play with other children and to have trusted adults around.
- Remind children that if they cannot see the trusted adult then the trusted adult cannot see them. They are too far away and need to come back to the trusted adult.
- Teach children to never accept any item from a stranger or go any place or accept a ride from a stranger.
- When can a child be left alone?
- That depends on many factors which can be reviewed here.
- Parents should know where their child is at all times.
- The child should know how to contact the parent.
- The parent should have a way to contact the child and check in with them such as a cellphone.
- Teach children how and when to dial 911 and how to use a cellphone or regular phone.
- Teach children about online/Internet safety – some recommendations can be reviewed here.
Questions for Further Discussion
1. What are safety tips for online/Internet safety?
Related Cases
- Disease: Safety Issues | Child Safety
- Symptom/Presentation:
Health Maintenance and Disease Prevention
- Specialty: General Pediatrics
- Age: School Ager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Child Safety
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
Finkelhor D, Hammer H, Sedlak AJ. Nonfamily Abducted Children: National Estimates and Characteristics. U.S. Department of Justice. Office of Juvenile Justice and Delinquency Prevention. Available from the Internet at https://www.ncjrs.gov/pdffiles1/ojjdp/196467.pdf (rev. 10/2002, cited 6/1/17)
Sedlak AJ Finkelhor D, Hammer H. National Estimates of Children Missing Involuntarily or for Benign Reasons. U.S. Department of Justice. Office of Juvenile Justice and Delinquency Prevention. Available from the Internet at https://www.ncjrs.gov/pdffiles1/ojjdp/206180.pdf (rev. 7/2005, cited 6/1/17)
Wolak J, Finkelhor D, Sedlak AJ. Child Victims of Stereotypical Kidnappings Known to Law Enforcement in 2011. U.S. Department of Justice . Office of Juvenile Justice and Delinquency Prevention. Available from the Internet at https://www.ojjdp.gov/pubs/249249.pdf (rev. 6/2016, cited 6/1/17)
National Crime Prevention Council. What to Teach Kids About Strangers.
Available from the Internet at http://www.ncpc.org/topics/violent-crime-and-personal-safety/strangers (rev. 2017, cited 6/1/17).
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa
Pediatric Education 