What You Need To Know About Children’s First Aid

Statistics suggest more than three-quarters of parents aren’t up to date with paediatric first aid and over half don’t know how to perform CPR on a child. While we all hope we’ll never be in a situation to need such skills, knowledge is power and learning the basics can give you confidence should an emergency present itself. To find out more, we asked Dr Deborah Lee of Dr Fox Online Pharmacy to share her best advice – from what to keep in your medicine cupboard, to the various situations worth preparing for…
MARTI SANS/STOCKSY UNITED

Let’s start with the obvious – tell us why first aid is so important as a parent?

“None of us like to think our babies or children will have an accident or become acutely unwell – but it’s a fact of life – it happens, and when it does, we all should be prepared. Every year, around two million babies and children in the UK are taken to A&E, with around 100,000 needing hospital admission, but the remainder are treated at home by their parents. Although we do our best as parents, a child’s environment is never 100% safe. Accidents at home are the most common cause of death in children under one. It’s why first aid is so crucial – learning a few of the basics also gives parents the confidence they need to treat their children should they need to recover from illness and injury. This way, a parent can distinguish a minor bump or bruise from something more sinister. Knowledge helps parents feel in control and gives them peace of mind.” 

Why might your child require emergency first aid?

“There’s a long list of possible reasons to need first aid in both babies and children. However, the top six are as follows: 

  • What to do if a baby is choking

  • What to do if a baby is unconscious and not breathing – how to do CPR

  • What do if a child has a seizure or a febrile convulsion

  • What to do if a child has a head injury

  • What to do if a child has a burn

  • What to do if a child is bleeding

How does treatment differ between babies and older children?

“If a baby or a child requires first aid, the principle of treatment stays the same, but the techniques differ for babies under one year of age compared to those for older children. This is because babies are smaller, their bodies are more delicate and they’re unable to co-operate with instruction. There are also some major differences in the recommendations for giving CPR and how to deal with choking in these two groups – it’s why dedicated training is so key.” 

Speaking of CPR, it’s the first thing that comes to mind with first aid. Can you tell us more about it?

“CPR stands for cardiopulmonary resuscitation. This is a potentially life-saving set of actions that have the possibility of reviving any baby, child, or adult who has stopped breathing. The techniques have been well-researched, and the skills need to be learned and performed properly to give the child the best chance of success. Any adult can do CPR, but you will feel more confident if you’re trained. The main steps are as follows:

For a child aged one or over…

  1. Check if the child is unresponsive – shake their shoulders, call their name, try and get a response. If they are unconscious and unresponsive, the first thing is to call for help. Get someone nearby to call 999.

  2. Lie the child flat on their back and tilt the head backwards by cupping the chin and extending the neck. This opens the airway. Check to see if they are breathing by looking at the chest for rise and fall and listening for any breathing sounds. 

  3. Start CPR. Tilt the head back, pinch the nose, place your mouth over their mouth and blow five times, forcefully, into their mouth – these are called rescue breaths and top up their bloodstream with oxygen.

  4. You should blow forcefully enough to see the child’s chest rise.

  5. Give 30 chest compressions. Put the heel of one hand in the centre of the child's chest, and push down firmly so the chest is compressed, then release. You should aim to compress the chest around five cm. This is squeezing blood around the circulation. This should be done quite fast – at around 100-120 compressions per minute. If you want a tempo to follow, the British Heart Foundation recommends doing chest compressions in time with the Bee Gees Staying Alive as it is just the right tempo.

  6. Give two more rescue breaths, then 30 more chest compressions and continue until help arrives.

For a baby under one…

1. CPR is essentially the same but gentler. There is no need to pinch the nose as you place your mouth over the baby’s nose and mouth. You only need to depress the sternum by four cm (not five cm). However, the regime of five rescue breaths, followed by 30 chest compressions, then a cycle of two rescue breaths and 30 chest compressions remains the same. You also need to stick to a chest compression rate of 100-120 compressions per minute.”

So, we’ve covered CPR, but at what point during it should you call 999 if your own first aid isn’t working?

“Before you even start CPR, call 999 right away. If you’re in public, you may find an AED – this is an Automated External Defibrillator. AEDs are now commonly found in public places like gyms and supermarkets. They are safe for use in children but will have a child mode button, and special defibrillator pads for children. While they can be used by the public, they are generally for the use of trained, nonmedical personnel at the site of the emergency.” 

In the event of first aid being required for your child, how can you maintain a level of calm?

“When an emergency happens, everyone tends to panic, but this is counterproductive. My advice is to first take a deep breath and count backwards – three, two, one – to give yourself time to think. Stay calm yourself and provide a good role model for your child. Practice deep breathing – breathe in through the nose and slowly out through your mouth. Ask your child to do the same, if they are able. You can practice by doing some role-play at home in advance, so that when an accident does happen, your child knows to try and breathe deeply and stay calm. The things that follow will then not come as such a surprise. When doing first aid, tell your child what you are doing as you do it. For example, I’m pressing on your finger tightly to stop the bleeding. From the age of four, children can start to learn about first aid and what to do in an emergency. Go through the first aid kit with your child and explain what everything is for. Show them how to ring 999 in an emergency. Praise them for their bravery. Children love to receive a sticker or a reward.”

Another big fear for parents is cot death – does having first aid knowledge reduce the risk? 

Sudden Infant Death Syndrome (SIDS) is a sudden, unexplained death in babies and young children (under age two). There were 170 SIDS in England and Wales in 2019. Up to 88% of SIDS occur in babies under six months old. To reduce the risk of SIDS, it’s important to follow safe sleep advice. Put your baby to sleep on their back – this is six times safer than putting them to sleep on their front. Keep the baby in the same bedroom as yourself for the first six months as this can reduce the risk of SIDS by 50%. Don’t smoke, or allow your baby to be exposed to smoke, during pregnancy and after birth – up to 60% of SIDS can be prevented by keeping your baby smoke-free. Don’t allow yourself to fall asleep with your baby on a sofa or in an armchair, this increases the risk of SIDS by 50 times. If your baby was born prematurely or had a low birthweight, this puts them in a higher risk category for SIDS, so following this advice is particularly important.”

Choking is another common, but huge, concern. How can a parent combat this? 

For a baby aged under one…

  1. Turn the baby on their front and lay them on your thigh with the head lower than their bottom. Continue to support their head.

  2. Thump them firmly between the shoulder blades five times to try and dislodge the blockage.

  3. If this is unsuccessful turn the baby over and put two fingers on the centre of their chest, in line with the nipples. Push downwards forcefully five times to try and dislodge any blockages.

  4. If this doesn’t work, call 999. Continue with this cycle of back thrusts and chest thrusts until help arrives.

For a child aged one or over…

  1. Give them five sharp blows between the shoulder blades to try and dislodge the blockage.

  2. If this doesn’t work, stand behind the child, put your arms around their upper abdomen under the ribs, and pull upwards and inwards forcefully five times.

  3. If this doesn’t work, call 999. Continue with this cycle of back thrusts and chest thrusts until help arrives.”

Choking is a risk for babies and small children who only have a small airway, and this can become relatively easily blocked by milk, mucus, food or vomit. If the airway is completely blocked, a baby or young child may be unable to cry, breathe, cough or make any sort of noise.

Let’s discuss childhood seizures. These can be frightening for any parent – what’s your advice?

“If a child is having a seizure, first, lay them on the floor, and remove any nearby objects that could be harmful. Lie them on their side, to protect the airway. If they vomit, use a finger to clear the vomit from their mouth. Don't try to stop them from shaking as you will not be able to. Watch their breathing. Don't force anything into their mouth, just try and keep them on their side. Call 999 if this is the first-ever seizure they have had and if it lasts more than five minutes, or your child is very slow to recover afterwards. That said, it’s worth noting that it is normal for them to feel drowsy immediately after a seizure. Also, if they fell and hit their hit during the seizure, or you have specific concerns, always seek out advice from a GP. Children who suffer from seizures must have their regular medication on time.”

Children often put things in their mouth – is it true you should never retrieve them with your fingers?

“Toddlers often put things in their mouths. Try to emphasise the difference between food – which they can eat – and toys which they can’t. Don’t try to push your fingers down their throat as you may just push any objects stuck in there, further down. If a child has swallowed an object, such as a coin, this will likely just pass through the digestive tract and come out in due course. If you think something might be stuck in the throat, watch for signs of choking and take them to A&E. Do not try and make them vomit.”

Is it true 24 babies choke to death every year – how can you stop this happening?

“It’s true – 24 babies choke to death every year in England and Wales, where choking is the third most common cause of death in babies. Up to 40% of parents have seen their baby choke. There is a difference between gagging and choking. When a baby gags, they are bringing food back into the mouth so they can chew it again. When they choke, the food is not coming up and is stuck, blocking the airway. Gagging is a normal part of learning to eat. To prevent choking, always cut food into very small pieces. Introduce solid foods gradually, removing things like skin, pips, bones and so forth. Don’t let older children give the younger children things to eat – always supervise mealtimes. Avoid hard foods like raw carrots, nuts and peanuts in young children.”

Speaking of choking, can you explain the Heimlich manoeuvre & how to do it properly?

For children aged one to twelve… 

“Stand the child in front of you. You may need to get down on your knees to be more at the correct height. Bend the child forwards with one hand, while putting the other arm around the child’s waist. With the free hand, give five sharp blows between the shoulder blades with the heel of your hand. If this is unsuccessful, put the other hand around the child's waist, grab your other hand and make a fist, then pull sharply inwards and upwards making sharp abdominal thrusts. Don't lift the child off the floor while doing this. Continue doing this – five back blows and five abdominal thrusts in cycles until help arrives. If a child is choking, always let them try and cough up the offending object first as this is the most likely to be effective. If, however, coughing is not working, you can then progress to the Heimlich manoeuvre. Phone 999 right at the start, if things are not improving, and you are concerned about their breathing.”

The Heimlich manoeuvre is a recommended emergency method to dislodge anything stuck in the airway when a child, or an adult, is choking. It cannot be done on babies.

Let’s discuss falls & head banging – what are the key points every parent should know? 

“After a head injury, a child may feel dizzy and unwell. Apply a cold compress such as ice or frozen peas to the site of the injury for around 20 minutes. Concussion is associated with symptoms such as drowsiness, headache, confusion, nausea and vomiting. The child may have visual problems and find it hard to remember what happened. Don’t leave your child unsupervised for 24 hours after a head injury. Keep a close eye on them for several days after, as it can take a few days for the symptoms to develop. They can be harder to spot in babies, who may cry incessantly, become apathetic and stop feeding. If you think their symptoms are not improving, take them to A&E.”

Same question for rashes – when do they become dangerous & require further examination? 

Rashes in babies and children are very common. They can be divided into the following groups: 

Rash with fever: Common viral causes are chickenpox, slapped cheek, and hand, foot and mouth disease. These usually settle with supportive treatment only.

Scarlet fever: This is a serious infection that causes a raised red rash on the chest, along with a white-coated tongue, and it requires antibiotics.

Meningococcal meningitis: This can cause a specific type of rash due to bleeding under the skin. The meningitis rash consists of little red pinpricks, often on the legs, which if you press on it with a glass, does not disappear. If you suspect your baby or child could have this, phone 999 immediately.

Rash with itching: Common causes are heat rash, eczema, an allergic reaction (hives), and ringworm.

Rash without fever and itching: Babies commonly get small white spots in the face known as milia. They also often get small red and white spots soon after delivery – known as erythema toxicum. These are all self-limiting and get better by themselves. Molluscum contagiosum is a viral infection that causes small, firm, raised spots, often on the face. Nappy rash is an allergic reaction to urine which is common on the buttock and genital area.

It can be hard to know what to do when your baby or child has a skin rash. The key questions to ask yourself are: is your child unwell, and do they have a fever? If so, they should always see a doctor without delay. If not, I advise you watch and wait while seeking out advice from your pharmacist.” 

Rashes are common, but so are allergic reactions – what should you do if your child has one to food, or even a bite? 

“If your baby or child has been bitten or stung by an insect, follow the below steps:

  1. Remove the sting if it still in the skin with a hard-edged tool – like a credit card

  2. Wash the area with warm water and pat it dry

  3. Apply a cold compress to the area for 20-minutes 

  4. Elevate the limb and get them to rest

  5. Make sure they don’t pick at or scratch off the roof of any blisters

  6. Give your child paracetamol or ibuprofen at the appropriate dose. You could also give them antihistamines – crotamiton or hydrocortisone cream can be applied to help soothe itching 

  7. Contact your GP if the site of the bite or sting fails to improve with signs of infection. Likewise, if your baby or child shows signs of anaphylaxis you should ring 999 immediately. It is, however, worth noting that it’s rare for young children to develop these reactions.” 

In terms of first aid courses, are there any that stand out?

“The British Red Cross runs first aid courses for anyone aged over 16, who want to learn first aid for babies and children. They are especially suitable for parents and grandparents, and they cover how to deal with all common emergencies. The course lasts four hours and includes practical hands-on learning, and you will be given a free first aid workbook. The course can be followed at any time, including during pregnancy before the baby is born, and is very suitable for expectant parents. Nannies and childminders are required to have attended a registered first aid course. The British Red Cross, for example, runs an accredited Paediatric First Aid Course, which is valid for three years.”

Finally, let’s end on medicine cupboards – what should be in every parent’s kit?

“A parent’s first aid kit should include the following to ensure you’re prepared for every eventuality: 

  • Pain relief for babies and children – liquid paracetamol and/or liquid ibuprofen.

  • Be sure to always follow the correct dosage instructions – aspirin should not be given to children aged under 16

  • Calamine lotion for sunburn and rashes

  • Antiseptic cream for any cuts and grazes

  • Antihistamine cream for insect bites and stings

  • Tweezers to help remove splinters or thorns

  • Gel ice packs – these are best kept in the freezer

  • Saline solution and an eye bath for washing eyes

  • Antiseptic wipes, for cleaning wounds

  • Scissors and gauze to apply a dressing

  • Insect repellent

  • A range of sticky plasters

  • A range of bandages

  • Safety pins

  • Adhesive tape

  • Disposable sterile gloves

  • A first aid manual

  • A digital thermometer”

 

For more information download The British Red Cross Baby & Child First Aid App

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