Alarmingly, surveys show that only a small percentage of us knows what to do in a health emergency. That’s why the Daily Mail has teamed up with St John Ambulance to produce this first aid series to give you the confidence and skills to act in a crisis. Today, we address common health hazards affecting babies and children.
Would you know what to do if your child started choking on a strawberry during a picnic in the park? Or if your neighbour knocked at your door with her unresponsive toddler in her arms?
Childhood presents its own set of first aid emergencies to contend with — occasionally life-threatening, usually less serious, all potentially terrifying for family and friends.
We all want to help, yet surveys show that many of us either don’t know what to do or are too fearful of getting something wrong. But knowing what steps to take in an emergency can improve a child’s chances of making a quick recovery — and could even save a life.
Many first aid situations involving children occur because of their immaturity. They may stumble and hurt themselves because they are not yet steady on their feet, for instance, or choke because they have put an object into their mouths out of natural curiosity.
Alarmingly, surveys show that only a small percentage of us knows what to do in a health emergency. That’s why the Daily Mail has teamed up with St John Ambulance to produce this first aid series to give you the confidence and skills to act in a crisis. Today, we address common health hazards affecting babies and children
‘Many of the accidents that befall children come about as part of life’s rich tapestry, as they grow up and explore the world around them,’ says Alan Weir, head of clinical operations at St John Ambulance.
Accidents that might be unpleasant and painful for an adult — such as knocking a hot cup of tea over themselves — can be more serious for a child. Because they are small, the scald affects a much larger proportion of their bodies.
And, as their bodies are still developing, they can respond differently to things such as having a high temperature. Some children will experience convulsions, as the part of their brain that deals with temperature regulation is not yet sufficiently developed. Here’s how to cope when a little one has an emergency.
All children suffer high temperatures from time to time. A normal temperature for a baby or child is between 36.4c and 37c, depending on where it is taken from — a fever is a temperature of 38c or above.
- He or she feels clammy or sweaty and has flushed cheeks n he or she feels hotter than usual to the touch (on their forehead, back or stomach)
WHAT TO DO
- You can usually look after your child at home — the important thing is to give them plenty of fluids to avoid dehydration. If you are breastfeeding, offer more feeds than usual.
- Check their temperature — use a digital thermometer, as they are the most accurate.
Seek urgent medical advice or take them to hospital if:
- Your child has other worrying symptoms such as a rash (see back page of this supplement for how to deal with possible meningitis and sepsis).
- Your baby or child’s temperature is 39c or higher and your child is under the age of four.
Sometimes babies and young children can suffer a seizure or convulsion as a result of having a temperature, often following an infection. This is most common in children aged between six months and three years.
This type of seizure, known as a febrile seizure, occurs because the brain is not mature enough to cope with the body’s high temperature.
Suffering from febrile seizures does not necessarily mean a child will develop epilepsy later on. Occasionally, a seizure can follow a head injury.
- High temperature
- Clenched fists
- Muscle contraction and tensing
- Jerking movements
WHAT TO DO
- Clear away objects that may cause injury.
- Put soft padding such as blankets or pillows around them to protect them.
- Do not restrain them.
- Cool them, if appropriate, by removing a layer of clothing.
- When the seizure has stopped, put them in the recovery position (see page 3 of this supplement).
- Call 999 or 112 for help.
- Monitor their level of responsiveness while you wait for help to arrive.
The best devices to take an infants’ temperature
DR Judith Holmes, an NHS GP at Warwickshire and Spire Parkway Hospital, selects her top child-friendly thermometers.
BRAUN THERMOSCAN 3
I use this in my clinics. It measures ‘tympanic’ [ear] temperature in one second, giving four beeps if it’s too high. Tympanic is more reliable than skin temperature as it’s less affected by environment, such as clothing or a hot bath.
JELLYWORKS PEPPA PIG
I like the addition of the character to this simple choice. It measures oral or armpit temperature in ten seconds and has a handy memory function to store previous readings so you can track changes in your child’s temperature. Make sure you clean it between uses.
BROTHER MAX 6-IN-1 PROJECTION
This is a no-touch device so is very hygienic. You hold it an inch from a child’s forehead. It uses infrared to take the temperature in seconds, which it then projects on to the forehead.
BRANNAN FOREHEAD STRIP
You hold this plastic strip across the forehead for 15 seconds to get a reading. It is simple and pretty non-invasive so won’t upset a child. Results are not as accurate as a digital thermometer, but it is good as a short-term solution such as for holidays.
From choking to concussion
If the airway is completely blocked, a choking baby or child may suffer a cardiac arrest and die before an ambulance arrives. But quick reactions can save their life.
- Difficulty breathing, talking or crying
- Red, puffy face
If the airway is completely blocked, a choking baby or child may suffer a cardiac arrest and die before an ambulance arrives. But quick reactions can save their life
As your baby starts eating solid foods and playing with small objects, they may be at risk of choking. This advice will help you know what to do if a baby aged one or under chokes.
What to do
Slap it out:
- Lie the baby face down along your thigh and support their head.
- Give up to five back blows between the shoulder blades, checking to see if there is anything in the baby’s mouth afterwards.
Squeeze it out:
- Using two fingers, give up to five sharp chest thrusts on the lower part of the breastbone. Check the mouth afterwards.
- Call 999/112 for emergency help, taking the baby with you to make the call.
- Repeat slapping and squeezing steps until help arrives.
A choking child may be able to clear a blocked airway by coughing.If they can’t, you will need to help them immediately.
WHAT TO DO
- Ask if the victim is choking. If they can breathe, they may be able to clear their own throat — if not, they need help.
Cough it out:
- Encourage them to cough and remove any obvious obstruction from their mouth.
Slap it out:
- Ask them to lean forwards, supporting their upper body with one hand.
- With the heel of your hand, administer up to five sharp blows between their shoulder blades, checking to see if there’s anything in their mouth afterwards.
A choking child may be able to clear a blocked airway by coughing.If they can’t, you will need to help them immediately
Squeeze it out:
- If the obstruction is still there, stand behind the child and put your arms around their waist.
- Place one hand in a clenched fist between their belly button and the bottom of their chest.
- With your other hand, grasp your fist and pull sharply in and upwards, up to five times. Check the mouth again afterwards.
- If the obstruction has not been cleared, call 999 or 112 for emergency help.
- Repeat five back blows and five thrusts until help arrives.
- If the person becomes unresponsive, prepare to start CPR (see box, right, for how to do this).
OBJECT IN THE EYE, EAR OR NOSE
Foreign objects such as grit, a loose eyelash, or sand that lie on the surface of the eye can easily be rinsed out, but sharp fragments like metal or glass may become embedded. If this happens, do not attempt to remove the fragment yourself but cover the eye and seek medical help as soon as possible.
- Pain in the eye or eyelid
- Redness, watering eyes
- Bloodshot or visible wound
- Blurred vision
WHAT TO DO: EYE
- Tell them not to rub the eye.
- Ask them to sit down facing a light. Stand behind them and, with their head tilted back, gently open the eyelid with your thumbs. Inspect the eye by asking them to look up, down, left and right.
- If there is something on the surface of the eye, wash it out by pouring clean water from the inner corner.
- If this doesn’t work, remove the object with a moist piece of gauze.
- If you still can’t remove it, seek medical advice.
WHAT TO DO: EAR OR NOSE
- If you think a baby or child has an object in their ear or nose, take them to hospital straight away. Do not attempt to remove it yourself, as you could push it further in.
- Keep the child calm.
- If there is an insect in their ear, support the child’s head with the affected ear facing upwards. Gently flood the ear with tepid water, which should allow the insect to float out.
- If that fails, seek medical advice.
- If you think the child or baby has ingested a button battery or pushed one up their nose or into their ear, dial 999 immediately, as these can cause chemical burns.
DIARRHOEA OR VOMITING
This is more serious in a child than an adult, as dehydration sets in sooner. Keep them topped up with fluids and seek medical advice if they don’t improve after 24 hours.
The joints of babies and young children are delicate and can become dislocated if too much force is exerted on them. Dislocations can be serious.
- Inability to move the joint
- Swelling, bruising or deformity
WHAT TO DO
- Try to keep your baby or young child still. Don’t try to replace the dislocated bone in its socket, as this can cause further injury.
- Immobilise the injury.
- Call 999 or 112 for emergency help or take them to hospital.
- Treat them for shock if necessary (see below).
- While waiting for help to arrive, monitor their responsiveness.
In an open fracture, the bone may pierce the skin; in a closed fracture, the skin is intact. Broken bones may cause internal bleeding and shock (see above).
- Deformity, unusual bend, swelling or bruising on limb
- Pain in moving
- Grating noise or sensation caused by the ends of the broken bones rubbing together
WHAT TO DO
- Cover any wound with a sterile dressing or clean, non-fluffy cloth.
- Apply pressure to the wound — but not to the protruding bone — to control any bleeding.
- Secure with a dressing.
- Try to prevent the child from moving. Stop the limb moving and place padding around it.
- Secure an arm fracture with a sling; a leg fracture with a broad-folded triangular bandage.
- Call 999 or 112.
Children are naturally curious with animals, so they are prone to being bitten. Bites allow germs in, so you must prevent infection.
WHAT TO DO
- Wash the wound thoroughly.
- Raise and support the wound. Cover with a sterile dressing.
- Seek medical help if you are not sure the child has had a tetanus jab.
- Call 999 or 112 straight away if there is a risk of rabies.
All head injuries, even minor ones, are potentially serious as they can damage the brain. Concussion is common.
- Briefly unresponsive
- Scalp wound
- Dizziness or nausea
- Loss of memory of events before or during the injury
WHAT TO DO
- Sit the patient down and provide something cold to hold to the injury.
- Treat scalp wounds like a bleed, applying pressure.
- If they’re not responsive, and are suffering from persistent headaches, vomiting or visual disturbances, call 999 or 112.
I stopped a scald scarring Archie’s ankles
Burns and scalds
Laura Chambers, 30, is a part-time estate agent. She lives in Cheshire with her partner, Sam, 30, a joiner, and their son, Archie, 20 months. She says:
We were in a cafe on a break in the Lake District last month when Archie pulled a cup of coffee over and the hot drink scalded his legs.
You never think something like that will happen to you, and had it happened two weeks earlier, I’d have frozen in panic, looking for someone to help me. Fortunately, a week before the accident I’d been to a mini first aid class in Warrington, where I’d learned basics such as CPR and how to treat burns.
I’d nipped to the bathroom after ordering drinks, and my partner, Sam, had taken our drinks and Archie to a table outside. When I returned a minute later, I found Archie screaming and Sam had jumped out of his seat.
I knew immediately what had happened, and grabbed Archie and ran to the bathroom. I yelled to Sam to bring the nappy bag as I had packed a simple first aid kit.
Laura Chambers, 30, is a part-time estate agent. She lives in Cheshire with her partner, Sam, 30, a joiner, and their son, Archie, 20 months
I got him under the water with all his clothes on for a bit before I tried to take his clothes off. I learned on the course that if it’s a bad burn the clothes will be stuck to it, so taking them off can take the skin off too. I got his legs under the cold water for a while before I tried to take his trousers off.
Thankfully his trousers had protected most of his legs. But his ankles had been exposed and were red and swollen. I put Archie’s legs back under the cold water.
He was being sick and screaming in pain but I was surprisingly composed as I tried to calm him.
I kept Archie under the cold water for about 20 minutes, while Sam went to get the car to take him to hospital.
When Sam arrived, I took Archie out of the sink, applied burn gel on his ankles and covered them loosely in cling film.
I’d learned that it was important to keep the burn clean, so I asked the cafe staff for the cling film — they looked a bit confused. Then we got him in the car; this all happened within half an hour of the coffee being spilt.
The 40-minute journey to hospital seemed so long — I remained calm but Archie was crying and I had to stop him touching his legs.
When we got to the hospital, Archie had calmed down. The nurses checked his ankles, which were still red, but they said I’d done all the right things. Cooling the skin had really helped and he didn’t need to be admitted.
The burn covered a 5cm diameter on both ankles. They bandaged him up and we were told to come back every 48 hours to check the wound. A week later, they took the bandages off and Archie has healed incredibly well.
The hospital staff said that everything I’d done had helped prevent scarring.
It was only after we’d come out of hospital that first time that I broke down in tears, the emotion of it hitting me. But I’m so thankful I took that first aid course.
I’d seen an advert on Facebook that it was taking place at the local church and it was only £20 for a two-hour course. I’d always wanted to do one, but when I checked they were always too expensive.
Cool under pressure: Archie, with mum Laura and, inset, Archie’s feet, bandaged for his trip home from hospital
I don’t like to think what would have happened if I hadn’t done it. The hospital staff said that by keeping him under the cold water for 20 minutes, I’d ensured the burn hadn’t gone into the deeper layers of the skin.
And now the skin looks normal and Archie is toddling about, happy as ever.
treating burns and scalds
Burns and scalds are damage to the skin caused by heat. A burn is usually caused by dry heat, such as from the sun or a hot iron. A scald is caused by wet heat, such as steam or a hot cup of tea. One of the most common causes of burns in children is accidentally scalding themselves with a hot drink. This can be very serious for a very young child because of the relative size of the surface area involved.
- Red skin
- The skin may appear white or scorched, and may peel
- Blisters may form later on
WHAT TO DO
- Move the casualty away from the source of heat immediately.
- Start cooling the burn as quickly as possible. Run it under cool water for at least ten minutes.
- Don’t use ice, creams or gels — these can damage tissues and increase risk of infection.
- Assess how bad the burn is. It is serious if it is:
• larger than the size of the casualty’s hand
• on the face, hands or feet
• a deep burn
- For a serious burn, call 999 or 112 for emergency medical help. If in doubt, seek medical advice.
- Remove any clothing near the burn (unless it is stuck to it).
- Cover the burned area with cling film or another clean, non-fluffy material, such as a clean plastic bag. This will protect it from infection.
- n If necessary, treat for shock as detailed below (shock is a life-threatening condition, not to be confused with emotional shock).
A child suffering a serious burn or scald will develop shock, which is a potentially life-threatening condition requiring urgent medical intervention.
WHAT TO DO
- After tending the burn and calling 999, lay the child down with their legs raised to improve blood supply to their vital organs.
- Cover them (excluding any burnt areas) to keep them warm.
- Loosen tight clothing to avoid constricting the blood flow around the body.
- Try to encourage them to keep calm and breathe regularly.
- If they become unresponsive, perform CPR (see right).
HOW TO: RECOVERY POSITION AND CPR
If a baby or child is not responding but is breathing, use the recovery position to keep their airway open and prevent choking.
WHAT TO DO: BABY
- Cradle them in your arms with their head tilted downwards
- Call 999 or 112 for emergency help
- Monitor the baby’s response
If a baby or child is not responding but is breathing, use the recovery position to keep their airway open and prevent choking
WHAT TO DO: CHILD
- Put the child’s nearest arm at a right angle to their body, with the elbow bent
- Place the back of their far hand against their cheek and hold it there
- Pull the far knee up until their foot is flat
- Pull on the bent leg to roll them towards you
- Tilt their head back to open airway
- Call 999 or 112 for help
- Monitor their response
GIVING CPR TO A BABY OR CHILD
IF a child is not responsive and not breathing, start CPR (cardiopulmonary resuscitation) straight away.
WHAT TO DO
- If someone is with you, get them to call 999 or 112.
- If you’re on your own, give one minute of CPR before you call 999 or 112.
- Kneel down beside the baby or child on the floor, level with their chest.
- Give five rescue breaths to begin with, before starting the classic sequence of 30 chest compressions followed by two rescue breaths.
- Perform rescue breaths on a child by putting your mouth over their mouth to form a seal. For a baby under one, cover the mouth and nose. Blow steadily so that the chest rises. Remove your mouth, allowing the chest to fall. Then repeat.
- Now give 30 chest compressions. Place the heel of one hand towards the end of their breastbone, in the centre of their chest, making sure you keep the fingers off the ribs.
- For a baby, place two fingertips of your lower hand on the centre of the baby’s chest.
- Lean over the child, with your arm straight, pressing down vertically on the breastbone, and press the chest down by at least one-third of its depth.
- Release pressure without removing your hand from their chest. Allow the chest to come back up fully — this is one compression.
- Repeat this 30 times, at a rate of about twice a second — mentally repeating the Bee Gees song Stayin’ Alive or the children’s rhyme Nellie the Elephant can help you maintain this rhythm.
- Repeat the sequence of two breaths and 30 compressions until help arrives.
- If the baby or child begins breathing, put them in the recovery position until help arrives.
A drowning child may not scream for help or thrash around, and does not always realise they are in trouble. This is why many drownings can go unnoticed, even if family and friends are nearby.
WHAT TO DO
- Once out of the water, check if they are breathing and responsive. If they are not, begin CPR and call 999 or 112.
- If the child begins breathing, put them in the recovery position and keep them warm while waiting for help.
It’s not just accidents such as falls and fractures that children may encounter. They can also suffer allergies and infections that could become serious. Here’s how to react to five common concerns.
The signs of sepsis and other serious reactions
An allergy is an abnormal reaction to an allergen or ‘trigger’. One of the most common is pollen, causing hay fever. Others include animal hair, bee stings, medication (especially penicillin) and food such as nuts and shellfish.
Allergies are when the body has an abnormal immune reaction to a normally harmless substance, mistaking it for a threat.
- Red blotchy skin
- Difficulty breathing
- Swelling of hands, face or feet
- Abdominal pain, vomiting and diarrhoea
- WHAT TO DO
- Assess the child’s symptoms. If they are old enough to talk, ask if they have a known allergy.
- Separate them from the trigger.
- Treat the symptoms. If it’s a known allergy and the child has medication, help them take it.
- Seek medical assistance.
During an asthma attack, the muscles of the air passages go into spasm and the airways narrow, making breathing difficult. Sometimes, but not always, there is a known trigger, such as a cold, a drug or an allergy.
- Wheezing and coughing
- Difficulty breathing or speaking
- Blue-grey tinge to lips, earlobes or nailbeds
- A severe attack will also result in exhaustion
WHAT TO DO
- Reassure them and help them use their reliever inhaler.
- If no inhaler, call 999 or 112.
- Sit them down and ask them to breathe slowly and deeply.
- If the attack does not ease, advise one to two puffs of the reliever inhaler every two minutes for up to ten puffs.
- If they don’t improve, call 999 and monitor until help arrives.
Croup is an inflamed windpipe and voice box, often developing from a cold or cough.
- Distinctive short barking cough — often likened to a seal’s bark
- Difficulty breathing
- Flushed appearance
- Blocked or runny nose as it often follows a cold
WHAT TO DO
- Sit the child on your knees, supporting their back in order to reassure them and help them breathe regularly.
- If croup is severe, with a high temperature, call 999 or 112.
- There is a small risk they may have a rare but similar condition called epiglottitis. The epiglottis is a flap of tissue at the base of the tongue which keeps food from going down the windpipe when swallowing. If this gets infected and swollen it can block the airway. If you suspect epiglottitis you should call 999 or 112.
- Monitor breathing and responsiveness until emergency help arrives.
Sepsis (also known as septicaemia or blood poisoning) is a potentially life-threatening condition affecting 25,000 children in the UK each year. It is the immune system’s over-reaction to an infection or injury. If not treated immediately, sepsis can result in organ failure and death. Yet with early diagnosis, it can be treated with antibiotics.
Sepsis is most commonly caused by a bacterial infection. It can develop as a complication of meningitis but sometimes doctors cannot find the source of the infection.
Sepsis can initially look like flu, gastroenteritis or a chest infection.
If your child is ill with a fever, very low temperature, or has had a fever in the last 24 hours, it is possible they have sepsis. There is no one sign, and symptoms in children can appear different from those in adults.
SYMPTOMS: UNDER FIVE
- Not feeding
- Vomiting repeatedly
- Has not passed urine for 12 hours
SYMPTOMS: FIVE AND OVER
- Rapid breathing
- Has a ‘fit’ or a convulsion
- Mottled, blue-ish or pale
- Has a rash that does not fade when you press it
- Lethargic or hard to wake
- Feels abnormally cold to the touch
WHAT TO DO
- Call 999 or 112 immediately.
- Try to reassure the child.
- Cover them with a blanket if they feel cold while waiting for help to arrive.
Meningitis is an infection of the linings surrounding the brain and spinal cord. Babies, children and teenagers are particularly susceptible to certain strains.
Meningitis can be successfully treated with antibiotics if it is identified quickly. However, it can be fatal or lead to life-changing complications including brain damage, epilepsy, amputations and blindness if not caught in time.
Many parents associate meningitis with a distinctive purple rash, but often this does not appear until the disease is very advanced, by which point it may be too late for antibiotics to work. This is why it is vital not to wait for this symptom but to seek urgent medical help if you have any concerns.
A rash of red or purple spots may develop as the infection progresses. These will not fade when pressed and viewed through a glass
A child may have some but not all of the following symptoms:
- Feeling very unwell, ‘flu-like’ and with a high temperature
- Mottled or pale skin
- Hands and feet may feel cold to touch
- Joint and limb pain
- A severe headache
- Neck stiffness
- Eyes sensitive to light
- Babies may have a high-pitched moaning or whimpering cry. They may be floppy and the soft spot on the top of the skull (known as the fontanelle) may be tense or bulging
- A rash of red or purple spots may develop as the infection progresses. These will not fade when pressed and viewed through a glass
WHAT TO DO
- Call 999 or 112 immediately
- While waiting for help, try to treat the fever by keeping the child cool.
- While waiting, check any rash with a glass test to see if the spots don’t fade.
- Reassure the child and keep them as cool as possible, monitoring their responsiveness.
Book a baby first aid course at sja.org.uk/babyfirstaidcourse
COMPILED BY: JUDITH KEELING, JILL FOSTER AND CAROLINE JONES