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Child care back injury prevention

Bending, stooping, twisting, reaching, lifting, and carrying are all activities that increase the risk of a back injury. Do any of these activities sound familiar? The fact is that childcare workers are just as likely to suffer work-related back injuries as workers in other industries.  Throughout the day, you and your co-workers are regularly picking up toys and other objects off the floor, reaching for objects from cupboards and bookcases; and of course, lifting and carrying children. Every one of these tasks poses a significant risk of back injury, but that risk can be minimized or eliminated through awareness and safe behaviors.

Safety guidelines for the most common tasks encountered in childcare centers.

Steps / stools / furniture heights

The best way to avoid back injuries from lifting children is to reduce the need to lift them whenever possible. Adding steps or stools that allow the children to get to water fountains, sinks or changing tables will eliminate the need to lift many of them. Lowering furniture heights on cribs, beds and changing tables will also make it easier on your back and shoulders. If the child is old enough, always ask them to participate in the activity and reduce the need to lift them

Bending / stooping

When you pick up something off the ground, especially when it is a small object like a pencil, it is almost an automatic reflex to bend over to retrieve it. When you bend forward at the waist while both feet are on the ground, tremendous forces are applied to the discs in your lower spine. Keep in mind that before lifting any object, your lower back is already sustaining the weight of your upper body, which for most individuals is about 70 to 100 pounds. Commonly accepted safety practices recommend that we try to keep our back straight and bend at the knees thus reducing these additional stresses to your spine. This is a more balanced position and helps prevent lower back strain. Children who are just learning to walk, will exhibit this same posture when they retrieve objects from the ground. The American Physical Therapy Association (APTA) recommends that you keep your head and back straight, bending at your waist, and extend one leg off the floor straight behind you when picking small objects up from the floor. In this way, the other leg acts as a counterbalance to your trunk and when you straighten, your lower back muscles don’t have to work as hard to bring you back to an upright position.

Lifting a child

The first thought should be “Do I REALLY need to lift this child?” The best way to avoid a back injury from lifting is don’t lift! If it is necessary, consider this: When we lift a child, most of us simply lean forward, grasp the child’s body under the arms and lift them. While this technique can certainly help you develop strong biceps and forearms, it can also injure your shoulders and upper back area. When lifting a child up off the floor the APTA recommends that you use a half-kneel lift. First, stand close to the child. While keeping your back straight, place one foot slightly forward of the other foot and lower yourself onto one knee. Grasp the child with both arms and hold them close to your body. Push with your legs, and slowly return to the standing position. The same half-kneel technique should be performed to place the child onto the floor.

Carrying / holding a child

While holding or carrying a child, always hold them close and centered to your body. Avoid holding them in one arm and balanced on your hip. The straight-arm technique, which is seemingly necessary when dealing with a child who has applesauce all down the front of his shirt, is not recommended as it can also contribute to shoulder and back injuries. You should also avoid twisting while lifting. Complete your lift then move your feet in the direction you want to go. This will greatly reduce the chances of injury.

Wheeled toys, strollers & furniture

When pushing a child on a wheeled toy, in a wheel chair or in a stroller, stay as close as possible, allowing your back to main straight and your shoulders back. The pushing force should come from your legs, not your arms. When moving a table or other heavy object, the best advice is to get help or use a dolly or hand truck.


Keeping play areas as clean and as orderly as possible is a good practice for both you and the children. It certainly lessens the potential for trips and falls. Teaching children to put toys away when play is over can benefit everyone. Consider designating play areas and instructing children to keep toys within those areas. Specific play areas can be “designated” using rugs, painted floors, or tape.

Final thoughts

Avoid storing heavier objects above shoulder height. If the concern is with keeping things from children, lock those items safely away. The probability of back injury goes up when lifting items above the shoulders as well as lifting between floor level and the knees. Practice good lifting techniques. It’s a good habit to get into.