First Aid Fast for Babies and Children

FIRST AID FAST for Babies and Children



FIRST AID FAST for Babies and Children Emergency procedures for all parents and caregivers Medical Editor Dr. Gina M. Piazza, FACEP

DK LONDON DK INDIA Consultant Editor Jemima Dunne Art Editors Konica Juneja, Anjali Sachar Senior Art Editor Sharon Spencer Senior DTP Designers Vishal Bhatia, Sachin Singh Managing Editor Rohan Sinha Project Editor Miezan van Zyl Deputy Managing Art Editor Anjana Nair Jacket Designer Mark Cavanagh Pre-production Manager Balwant Singh Managing Editor Angeles Gavira Production Manager Pankaj Sharma Managing Art Editor Michael Duffy Jacket Designer Dhirendra Singh Pre-Production Producer Andy Hilliard Managing Jackets Editor Sreshtha Bhattacharya Producer Jude Crozier DK US Art Director Karen Self US Editors Jill Hamilton, Dr. Gina Piazza, Lori Hand Publisher Liz Wheeler Publishing Director Jonathan Metcalf First American Edition, 1994 This edition published in the United States in 2017 by DK Publishing, 345 Hudson Street, New York, New York 10014 Copyright © 1994, 1999, 2002, 2006, 2012, 2017 Dorling Kindersley Limited DK, a division of Penguin Random House LLC 17 18 19 20 21 10 9 8 7 6 5 4 3 2 1 001–300132–Jun/2017 All rights reserved. Without limiting the rights under the copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form, or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of the copyright owner. Published in Great Britain by Dorling Kindersley Limited A catalog record for this book is available from the Library of Congress. ISBN 978-1-4654-5952-7 DK books are available at special discounts when purchased in bulk for sales promotions, premiums, fund-raising, or educational use. For details, contact: DK Publishing Special Markets, 345 Hudson Street, New York, New York 10014 [email protected] Printed and bound in China All images © Dorling Kindersley Limited For further information see: www.dkimages.com A WORLD OF IDEAS: SEE ALL THERE IS TO KNOW www.dk.com Disclaimer: First Aid Fast for Babies and Children provides information and guidance on initial care following an incident or if a child is unwell, but should not be regarded as a substitute for medical advice. The publisher and medical editor do not accept responsibility for any claims arising from the use of this manual.

Foreword Being a parent, grandparent, or caregiver to a child can be extraordinarily rewarding, but it can also be terrifying if a child in your care becomes ill or injured. If that were to happen, would you know what to do? Do you have the skills to render immediate lifesaving aid? Do you know how to access advanced care to help you rescue an ill or injured child? Are you prepared to act if the need arises? Children are curious, and as they set out to learn they may endure injuries—from minor cuts, scrapes, and bruises to more serious injuries like fractured bones or head injuries. And, as children grow and are exposed to the environment and people around them, they will undoubtedly contract a variety of illnesses. When illness or injury strikes, should you call 911, visit the doctor, or simply provide care at home? This revised edition of First Aid Fast for Babies and Children can help you learn how to respond appropriately to a variety of injuries and illnesses. It contains the latest guidelines for lifesaving emergency care laid out in an easy-to-follow format. After reading this book, I hope you will feel more confident in your ability to provide immediate care when a child falls ill or is injured while in your presence. Keep it handy and refer to it if you if have a question about how to correctly render aid in a given circumstance. You have the ability to reduce suffering and to save a life. Dr. Gina M. Piazza, FACEP

Introduction 8 Contents Crush injury 49 Chest wound 50 How to use this book 9 Suffocation and Abdominal wound 51 strangulation 33 Action in an Fume inhalation 33 Burns and Scalds 52 Emergency 10 Burns and scalds 52 Croup 34 Electrical burn 54 Fire 11 Asthma 35 Electrical injury 12 Chemical burn to skin 55 Water incident 13 Wounds and Bleeding 36 Chemical burn to eye 56 Checking vital signs 14 Shock 36 Poisoning 57 Unresponsiveness 16 Severe bleeding 38 Swallowed chemicals 57 Unresponsiveness 16 Embedded object 40 Drug or alcohol poisoning 58 Unresponsive baby 19 Cuts and abrasions 41 CPR: baby 20 Infected wound 42 Plant poisoning 58 Unresponsive child 22 CPR: child 24 Blisters 43 Head, Face, and Recovery position 26 Eyebrow or eyelid wounds 44 Spine Injuries 59 Scalp wound 59 Breathing Difficulties 28 Nosebleed 45 Choking baby 28 Ear wound 46 Head injury 60 Choking child 30 Mouth wound 47 Nose or cheekbone injury 62 Breath holding 32 Amputation 48 Hiccups 32 Internal bleeding 49 Jaw injury 62 Spine injury 63 Bone, Joint, and Muscle Injuries 64 Pelvic injury 64 Leg injury 64 Knee injury 66 Foot injury 66 Ankle injury 67 Collarbone injury 68 Rib injury 69 Arm injury 70 Elbow injury 70

Hand injury 71 Diabetic emergency 92 Garage and car safety 119 Finger injury 72 Fainting 93 Out and about 120 Fever 94 Cramp 73 Traveling with children 122 Bruises and swelling 74 Meningitis 95 Febrile seizures 96 Index 123 Foreign Objects 75 Epileptic seizures 97 Acknowledgments 127 Splinter 75 Vomiting and diarrhea 98 Stomachache 99 Useful Telephone Numbers 128 Object in eye 76 Object in ear 77 Earache 100 Object in nose 78 Toothache 101 Swallowed object 78 First Aid Kit 102 Bites and Stings 79 First aid kit 102 Animal and human bites 79 Dressings 104 Bandaging 105 Insect sting 80 Triangular bandages 106 Poison ivy rash 80 Useful household items 108 Tick bite 81 Home Safety 109 Jellyfish sting 82 Safety at home 109 Marine puncture wound 82 Hall and stairs 110 Snakebite 83 Living Room or Family Room 111 Effects of Heat and Cold 84 Kitchen 112 Bedrooms 114 Hypothermia 84 Bathroom 116 Frostbite 86 Toys and playthings 117 Sunburn 87 Heat rash 87 Yard 118 Heat exhaustion 88 Heatstroke 89 Medical Disorders 90 Allergy 90 Anaphylactic shock 91

8 INTRODUCTION Introduction This book has been compiled primarily for parents but also for others—grandparents, teachers, playgroup leaders, and babysitters—who may regularly, or even just occasionally, find themselves in charge of babies and children. The content has been set out in a clear and logical way and the information is presented largely in pictorial form using simple words and captions to make it very easy to follow and to understand. The first aid advice given can be used to treat any age child and follows the most up-to-date clinical guidance at the time of publication. Emergencies are, by their very nature, unexpected events and can be extremely frightening and stressful for anyone caring for a child. First Aid Fast for Babies and Children will help you learn various practical skills that will help you manage a wide range of first aid emergencies and everyday incidents, building your confidence and ensuring that you respond in the best way possible. The calmer you are, the more effective your help will be, and by listening and talking to the child you will be able to make the best decision for both of you, greatly improving the outcome. In addition, there is reference information at the back of the book. A section on first aid kits and bandaging techniques also lists useful items to have at home and how to use them. The pages on Home Safety highlight potential danger areas around the home and how to fix them to minimize the risk of incidents in the first place.

INTRODUCTION 9 How to use this book This book covers first aid treatment for everything from or illustrations shows you exactly what to do in an minor cuts and abrasions to treating a child who is not emergency. Key pieces of information are indicated on responding. For every condition a series of photographs the photographs, and supplementary advice can be Key signs and Annotations Clear photographs found alongside in the step-by-step text. symptoms help highlight illustrate every The injuries are organized by type, in colored you recognize the essential action step of treatment conditions sections such as Breathing Difficulties or Wounds and Bleeding. However, in an emergency, the thumbnail index on the back cover will direct you straight to the 56 BURNS AND SC ALDS POISONING 57 relevant page.There are also sections, such as Action in an Emergency, Bandages and Dressings, and Home IMPORTANT Chemical burn to eye Swallowed chemicals IMPORTANT Safety, that contain information for general reference. ● Do not let your child Splashes of chemicals in the eye can cause scarring or even blindness. If you think your child has swallowed a poison, try to find out what, ● Do not try to make IMPORTANT boxes touch his eye. The eye Your child may have a chemical burn if he complains of fierce pain in when, and how much she has taken. Be aware too that some chemicals your child vomit draw attention to will be shut in spasm the eye; he has difficulty opening the affected eye; the surface of the also give off dangerous fumes. because this can areas of concern and pain, so gently pull eye is watery; or there is redness and swelling in and around the eye. cause further harm. the eyelids open. ● If your child becomes Using pitcher 1 Protect yourself Wash your 1 Wipe away any unresponsive, open her of water from the chemical child’s lips and residual chemical airway and check for with rubber gloves. Hold mouth gently from around your child’s breathing. If breathing, If you can’t hold your your child’s head over a mouth and face. put her in the recovery child under a faucet, sink, with the unaffected position. If not you may find it easier Wear eye uppermost. Gently breathing, begin CPR to use a pitcher to protective run cool or tepid water immediately. CALL 911. pour water over the gloves over the contaminated affected eye. Get a eye for at least 10 minutes. ● If you need to give helper to support your Make sure that both rescue breaths and there child with her head sides of the eyelid are are chemicals on the tilted down and to thoroughly washed and child’s mouth, protect one side. Do not splash yourself by using a face the unaffected eye that the contaminated shield or pocket mask. with the contaminated water drains away from water. your child’s face. 2 Her lips may be burned by a Rinse eye with Help her take corrosive substance or cold water for sips of cold discolored, so give her 10 minutes water frequent sips of cold water or milk to cool them. Cover eye with clean pad ☎ CALL THE POISON CONTROL CENTER 2 Once the injured Keep container 3 Find out what ❯❯ see also eye is thoroughly to show chemical your child washed, cover it with a emergency swallowed, when, and if ● Chemical burn to large sterile dressing. Hold services possible how much, then eye, opposite the dressing in place until call the Poison Control you get medical aid. Center (800-222-1222) ● Fume inhalation, for guidance on p.33 TAKE YOUR CHILD appropriate treatment. TO THE HOSPITAL ● Unresponsive baby, ▲ pp.19–21 OR ▲ ● Unresponsive child, ☎ CALL 911 OR YOUR pp.22–27 LOCAL EMS Symbols highlight Cross references direct the action necessary you to pages with information for medical help about associated injuries Guide to the symbols The following symbols and instructions appear if your child needs further medical attention: ✆ SEEK MEDICAL ADVICE Depending on your area, call your doctor’s office, nurse practitioner, or on-call service for advice. TAKE YOUR CHILD TO THE HOSPITAL Take your child to the nearest hospital emergency department if you have help and transportation. ☎ CALL 911 OR YOUR LOCAL EMS Your child needs urgent medical attention and is best transported by trained medical experts to the hospital.

10 ACTION IN AN EMERGENCY Action in an emergency In any emergency, particularly one involving children, it is important to remain calm and act logically. Remember four steps: 1 Assess the situation ● Is there anyone who can help? ● Do you need emergency ● What happened and how did it happen? medical services? ● Is it safe for you to approach? ● Is there more than one injured child? 2 Safety is important ● Do not risk injuring yourself—you cannot help if you become a casualty. ● Remove any source of danger from your child. Move your child only if it is safe for you and it’s essential for her safety, and do so very carefully. 3 Treat serious injuries first IMPORTANT The primary considerations that immediately threaten life are: ● If more than one child is ● Serious bleeding, which can result in life-threatening shock (see p.36). injured, go to the quiet one; ● Obstructed airway, which prevents breathing, can result in the heart she may be unresponsive and stopping (see p.16). not breathing. 4 Get help ● Help with first aid. ● Move a child to safety, if necessary. Shout for help early and ask others to: ● Make the area safe. ● Seek medical advice or call 911. Telephoning for help When you call 911 or your local EMS, use a hands-free phone so that you can treat the child at the same time. Provide the following: ●Your telephone number. ● Details of injuries. ● The location of the incident. ● Information about ● The type of incident. hazards such as gas, ● The number, sex, and ages of the casualties. power lines, or fog.

Fire 11ACTION IN AN EMERGENCY Write down an escape plan for your home Action for a frying pan fire and make sure everyone knows what to do. ● How would you get out of each room? ● Turn off heat source, then cover pan with lid, ● How do you help babies and young children? wet dishtowel, or fire blanket. Leave this on for ● Where will you meet when you’ve escaped? half an hour—NEVER throw water over the flames. ● If fire is not under control, get out of the house, close doors behind you, and call the fire department. Escaping from a fire IMPORTANT 1 Feel the door. If the door OR 2 If the door is hot, don’t open ● Carry babies and toddlers. is cool, leave the room. it. Go to the window. ● Don’t ask children to do anything other than look Shut the door Open window, after themselves. behind you call for help ● Close all doors behind you. ● Meet outside your house. Cover gaps ● Never go back inside. with a blanket ● Phone for help from to keep elsewhere. smoke out If you have to escape Leave quickly Stay low down through a window: DO NOT GO BACK where air is clearest ● If you have to break the glass, put a blanket over the frame before you escape. ● Slide your child out, hang onto him, then ask him to drop down, if it is safe to do so. ● Slide out yourself, hang from the ledge, then drop. Clothing on fire IMPORTANT If clothing is on fire: ● Do not let your child run Stop your child from moving; around; rapid movement will movement will fan the flames. fan the flames. Drop him to the floor and wrap him in a coat or blanket, if available, ● If water is available, lay to help smother the flames. him down, burning side Roll him on the ground. uppermost, and douse him with water or a nonflammable liquid.

12 ACTION IN AN EMERGENCY IMPORTANT Electrical injury ● You can safely Children are at risk of injury from domestic electricity if they play with approach the child if he electrical sockets or cords, or if cords are worn. Electrical current causes is no longer in contact muscle spasms that keep a child from letting go of an electric cord and with the electric cable. may cause burns both where the current enters and where it leaves the child’s body. The current may also cause breathing and heart to stop. ● If your child is no longer in contact with ☎ CALL 911 OR YOUR the electricity and is LOCAL EMS unresponsive and not breathing normally, 1 Do not touch the child. Break the begin CPR immediately contact with electricity by turning with 30 compressions. the current off at the main switch. If breathing, place in the recovery position. CALL 911 OR EMS. High-voltage Stand on 2 If you cannot turn off the current, current insulating stand on dry insulating material such material as large paperback books or a wooden box. Contact with Use a wooden broom handle or electricity from power chair to separate your child’s lines and overhead cables is usually fatal. limbs from the source. Severe burns result and the child may be Use nonconducting thrown some distance object from the point of contact. DO NOT Push the approach the child source away unless you are officially informed that the 3 If you still cannot break the contact power has been cut off. without touching your child, wrap ❯❯ see also a dry towel or rubberized exercise band ● Checking vital signs, around his feet and pull him away from p.14 the source. 4 Once the contact ● Electrical burn, p.54 is broken, treat Wrap a dry towel any injuries. If the child ● Unresponsive baby, around his feet appears unharmed, pp.19–21 monitor his breathing, ● Unresponsive child, pp.22–27 pulse, and response while waiting for help.

13ACTION IN AN EMERGENCY Water incident IMPORTANT Babies and young children can drown quickly if they slip into a pool ● Do not put yourself or pond or are left unattended in a bath. Even 1in in a bath, or several in danger when inches in a bucket of water is enough to cover a baby’s nose and mouth attempting a rescue; if he falls forward. don’t enter the water unless you have to Hold a sturdy Lie on bank 1 Get the child out of in order to save the branch and tell so you don’t the water as quickly as child’s life or you are child to grab it fall in possible. If the child is conscious a trained lifesaver. and able to follow directions, hold out a branch or rope for ● If the child is too the child to grab, or throw him small to follow anything that will float. commands, or unable, you may have to go in Start warming 2 Once the child is out and rescue the child child as soon as he of the water, protect if possible. is out of water him from cold and get him to a shelter.Treat him for ● Always seek medical ▲hypothermia and replace any advice even if the child wet clothes with dry ones as appears to have soon as possible. Even if the recovered because he child seems to have recovered, may have inhaled some water, which can cause TAKE YOUR CHILD lung damage. TO THE HOSPITAL ● If your child becomes OR unresponsive and is not breathing normally, ☎ CALL 911 OR YOUR begin CPR with LOCAL EMS 30 compressions immediately. CALL 911 OR YOUR LOCAL EMS. ● Be prepared to roll the child onto his side to clear airway because it is possible that he may regurgitate his stomach contents. DROWNING CHAIN OF SURVIVAL FOR UNTRAINED RESCUER ❯❯ see also Prevent Recognize Provide Remove Give first ● Hypothermia, p.84 drowning from water aid Stay safe and distress flotation Attempt this Treat as ● Unresponsive baby, supervise your only if it is safe appropriate and pp.19–21 child in and Ask someone Getting a to do so. seek medical around water. advice. ● Unresponsive child, to call for help float to a child pp.22–27 if the child is in can prevent distress. submersion.

14 ACTION IN AN EMERGENCY IMPORTANT Checking vital signs ● Do not move your When you are looking after a baby or child who is sick or injured, you child unnecessarily. need to check her vital signs—breathing, pulse, level of response, and fever—as part of assessing the severity of a condition. Then continue to ● Stay calm and monitor the signs while you are looking after your child or waiting for reassure the child. medical help to arrive, because the information can indicate whether a child’s condition is changing (either improving or deteriorating). ● Write down your Note that here you are checking and monitoring for quality of pulse findings each time you or breathing, not the presence or absence of them. check the child. Breathing ● If you suspect serious illness or injury, TAKE When assessing breathing you are looking at how many times a child YOUR CHILD TO THE breathes in a minute, as well as the quality of the breaths—for example HOSPITAL or CALL 911 depth and ease. A baby may breathe as many as 40 breaths a minute; a OR YOUR LOCAL EMS. toddler or child up to five years, 20–30 times; a child up to 12 years old, 12–25 times a minute; and an older child, about 12–18 breaths. You can sit with the child and watch and listen for breaths, or for a baby or younger child it may be better to place your hand on the chest. Make a note of the breathing rate (the number of breaths in a minute) and as well as whether they are deep or shallow, easy or difficult, painful and/or quiet or noisy—and if the latter, what do they sound like? Time the breaths with your watch Check breathing rate Sit your child down or on your lap. Place one hand on her chest. Count the number of times she breathes in a minute and listen to the breaths.

15ACTION IN AN EMERGENCY Pulse Body Temperature Every time the heart beats, a wave of pressure passes along the blood vessels that carry blood from the heart to the body (arteries). This “wave” ● Viral and bacterial can be felt where the arteries lie close to the skin. For a baby check the infections, including pulse in the upper arm; for older children check it at the wrist. The normal colds, flu, bronchitis, pulse rate for an infant is 100–140, but it decreases with age. A toddler has and gastrointestinal and a heart rate of 85–130; at ages 2–5, 80–115; for 5–12-year-olds, 75–110; urinary tract infections, and over 12 years, 60–100. Count the rate (number of beats in a minute), are the most common and note whether it is strong or weak and regular or irregular. causes of a raised body temperature. Use the pads of your fingers ● A body temperature below 95ºF (35ºC) BRACHIAL PULSE RADIAL PULSE indicates hypothermia. Place the pads of two fingers against Place the pads of two or three the inner side of the baby’s upper arm. fingers on the forearm just ● The temperature that below the wrist creases at the should be checked by base of the thumb. a doctor increases with age. For infants under Level of response three months of age, seek medical advice Some illnesses and injuries can affect your child’s level of response and for a fever of 100.4ºF she may be fully alert or totally unresponsive or somewhere between. (38ºC), measured Assess your child right away and then again at regular intervals. rectally. In toddlers, a •Child is fully alert Her eyes will be open and she responds normally rectal temperature over when you ask questions. 102.2ºF (39ºC) should • Responds only to voice Does your child answer simple questions and be checked. In older obey instructions? Can she open her eyes? children, a temperature • Responds only to pain Does your child open her eyes or move if you over 103.3ºF (39.6ºC) tap her shoulder or flick her foot? should be investigated • Unresponsive The child does not respond to any stimulus. by a doctor. ● A child with a temperature above 104ºF (40ºC) is at risk of a febrile seizure.

16 UNRESPONSIVENESS Unresponsiveness A baby or child needs to inhale oxygen into his unresponsive and his breathing is abnormal or lungs. This oxygen passes into the bloodstream absent, you need to help pump some blood by and is pumped around the body by the heart. doing chest compressions. If circulation stops, If a baby or child is unresponsive, the air blood cannot travel around the body and vital passage, or airway, to the lungs may be organs such as the brain and heart are deprived blocked, which means oxygen can’t enter of oxygen. Start CPR immediately with 30 chest the body. Lack of oxygen slows down the compressions, followed by opening the airway heartbeat until it stops altogether (cardiac so that you can breathe into the lungs. The arrest) and no oxygen will reach the brain. combination of rescue breaths and chest compressions is known as cardiopulmonary What you can do to help resuscitation (CPR). An AED can be used to restore a normal heartbeat (see p.23). Always make sure it is safe to approach the baby or child; you can’t help him if you become Chain of survival a casualty too. If you are certain you are safe, first assess whether he is responsive. If he is An unresponsive baby or child’s chances of survival are greater if: For a baby ● You call for expert help; ● CPR is given as soon as possible; Call his name and ● An AED is used early; tap foot to check ● Advanced care by for response healthcare professionals is received as soon as possible. For a child Call your child’s name and tap shoulder to check for a response

UNRESPONSIVENESS 17 When to call 911 or your local EMS If there is somebody else present to help, always ask him or her to call 911 as soon as you realize that your child is not breathing. If you are on your own, give a combination of 30 chest compressions and 2 rescue breaths (CPR: baby p.20, child p.24) for two minutes before stopping to make the call.Then continue CPR until help arrives or the child recovers. Maintain blood circulation For a child If your baby or child’s heart has stopped beating, giving chest compressions will drive blood containing oxygen around the body.These will be more effective if alternated with rescue breaths.The combination of techniques is known as cardiopulmonary resuscitation (CPR). For a baby Press on center of Press on center the chest with of the chest two fingers with one hand

18 UNRESPONSIVENESS Open the airway Airway You need to open the airway before you can give breaths. Place one hand on the If a child is on his back forehead and gently tilt the head to bring the tongue away from the back of the tongue may fall the throat. Place one or two fingers of your other hand on the chin to lift. If you back and may block suspect a neck injury, use the jaw thrust method to open the airway (see p.61). the airway. For a baby Tilt head back and lift For a child Tongue chin with one finger fallen back to open airway Head not tilted— airway blocked Tongue forward Head tilted— airway unblocked Tilt head back and lift chin with two fingers to open airway Breathe for the baby or child For a child If your baby or child is not breathing, take a breath and blow oxygen into the child’s lungs.This is known as rescue breathing. For a baby Pinch child’s nose and blow Blow into mouth into mouth and nose until chest rises

Unresponsive baby UNRESPONSIVENESS 19 Assess your baby before calling for help. If you are Resuscitation alone and the baby is not breathing, begin chest summary compressions and rescue breaths. Unresponsive baby 1 Check for response No breathing or just ● Call her name and tap her foot gently. Never shake a baby. gasping ● If there is no response, Send helper to ☎ CALL 911 OR YOUR LOCAL EMS ☎ CALL 911 OR YOUR LOCAL EMS Tap foot Start CPR: give 30 chest compressions Open airway and give 2 rescue breaths Repeat 30:2 for two minutes If not already done, ☎ CALL 911 OR YOUR LOCAL EMS Continue CPR until help arrives IMPORTANT ● If you are unable or unwilling to give rescue breaths, you can give chest compressions only.

20 UNRESPONSIVENESS Resuscitation CPR: baby summary This is to be used for an unresponsive baby who is not breathing. Always Unresponsive baby start with 30 chest compressions, followed by two breaths. If you are alone, continue sets of 30 compressions and two breaths for two No breathing or just minutes before calling 911 or your local EMS. gasping Press down by Place a towel roll 1 Begin chest Send helper to at least one-third under baby’s compressions. Place of the depth of shoulders two fingers of your lower ☎ CALL 911 OR YOUR the chest hand on the center of LOCAL EMS Lift point of the baby’s chest. Press chin with down vertically on the Start CPR: give 30 chest one finger breastbone to depress it compressions by at least one third of its depth. Release pressure, Open airway and give 2 but don’t move your rescue breaths fingers; allow the chest Repeat 30:2 for to come back up fully. two minutes Repeat to give 30 compressions at a rate of 100-120 per minute. If not already done, 2 Make sure that her airway is open. Put ☎ CALL 911 OR YOUR your fingers on the point LOCAL EMS of the chin and lift it.Take care not to press on the Continue CPR until soft part of the neck help arrives under the chin because that can block the airway. IMPORTANT Tilt head 3 Pick out any visible back obstruction from ● If you are unable or the mouth and nose with unwilling to give rescue Pick out visible your fingertips. breaths, you can give obstructions chest compressions only.

UNRESPONSIVENESS 21 Repeat 30 chest Blow into the 4 Take a normal IMPORTANT compressions baby’s mouth breath, then seal and nose your lips tightly around ● Do not sweep the your baby’s mouth mouth with your and nose. Blow gently finger to search for until you see the baby’s an obstruction. chest rise—Do NOT blow the whole adult ● If there is more than human breath into one rescuer, one gives the baby. Do NOT 15 chest compressions remove mouth from followed by the other baby’s for this stage; just giving 2 breaths. There watch chest fall out of should be minimal the corner of your eye. pause between groups of compressions 5 Continue CPR and breaths. with 30 chest compressions. ● If your baby shows signs of becoming responsive (see left) and she is breathing normally, cradle her in your arms with head tilted down until the ambulance arrives (below). Monitor breathing, pulse, and level of response (see p.14) until the help arrives. 6 Return to the The recovery baby’s head and position give two rescue breaths, followed by another Hold the baby in your 30 chest compressions. arms with her head Continue at a rate of tilted downward and 30:2 until the emergency supported. This keeps services arrive; your baby her airway open and shows signs of becoming clear and allows fluid responsive (coughing, to drain away. opening her eyes, and Follow with two moving) and she is rescue breaths breathing normally; or you are too exhausted to continue.

22 UNRESPONSIVENESS Resuscitation Unresponsive child summary Assess a child (aged one year to puberty) before you Unresponsive child call for help. If you are on your own and the child is not breathing or just gasping, begin CPR. No breathing or 1 Check for response just gasping ● Call his name, or tap his shoulder gently. Send helper to Never shake a child. ☎ CALL 911 OR YOUR ● If there is no response, LOCAL EMS ☎ CALL 911 OR YOUR LOCAL EMS Start CPR: give 30 chest compressions followed by two rescue breaths Repeat 30:2 for Tap his two minutes shoulder gently If not already done, ☎ CALL 911 OR YOUR LOCAL EMS Continue CPR until help arrives IMPORTANT ● If you are unable or unwilling to give rescue breaths, you can give chest compressions only.

UNRESPONSIVENESS 23 Using an AED on a child LOCAL EMS.Ask a helper to find an AED and use it as soon as it arrives—don’t leave the child to look Machines called AEDs can be used to analyze the for one yourself.The machine will give you audible heart rhythm and if necessary correct it by delivering prompts to follow. If a shock is needed, the machine an electric shock. If a child is unresponsive and not will deliver it; if not, it will not be given. breathing, start chest compressions, followed by rescue breaths (CPR, see p.24), CALL 911 ORYOUR 1 Turn on the machine. Pads may be connected IF A SHOCK IS ADVISED to the machine (if not, the machine will tell you ● The AED will start to charge up—make sure to connect them). If there are both adult and pediatric everyone is clear of the child, then follow the pads in the kit, use the right ones for the child’s size. machine’s prompts to deliver the shock. ● Continue CPR for 2 minutes or until the machine 2 Place the pads directly onto the child’s chest. Peel off the backing paper and put asks you to stop. one on the upper right side of the child’s chest ● The AED will reanalyze the child’s heart rhythm at and the other on her lower left side. regular intervals; listen to the prompts. 3 Once the pads are attached, IF A SHOCK IS NOT ADVISED make sure no one is ● Continue CPR.The AED will reanalyze the touching the child.The AED will child’s heart rhythm at regular intervals. analyze the heart rhythm and may recommend delivering a shock. Ask all helpers to stay Listen to the machine’s instructions. clear of the child during analysis and shock Place one pad on left side of chest so that long axis is vertical AED Place one pad center of the chest. Both pads should be vertical. on upper right side of chest ● If she starts coughing, opening her eyes, speaking or moving purposefully, and is breathing normally, leave IMPORTANT pads attached and put her in the recovery position. ● If there are both adult and pediatric pads in the AED, use the pediatric ones, but adult pads can be used if pediatric pads are not available. ● If the child is very small, place one pad in the center of her back and the other one in the

24 UNRESPONSIVENESS Resuscitation CPR: child summary This is to be used for an unresponsive child who is not breathing. Always Unresponsive child start with 30 chest compressions, followed by two breaths. If on your own, give CPR for two minutes before calling 911 or your local EMS. No breathing or just gasping Overhead view 1 Begin chest compressions. Send helper to Press down by at Place the heel of one least one-third of the hand over the center of ☎ CALL 911 OR YOUR depth of the chest the child’s chest (on the LOCAL EMS breastbone). Lean forward over the child so that your Start CPR: give shoulder is directly above 30 chest compressions, your hand. Press down followed by two rescue vertically to depress the breastbone by at least breaths one-third of its depth. Repeat 30:2 for two 2 Release the 3 Make sure that the minutes pressure but don’t child’s airway is move your hand; let open. Put your fingers on If not already done, the chest come back the point of the chin and up. Repeat to give 30 lift it.Take care not to ☎ CALL 911 OR YOUR compressions at a rate press on the soft part of LOCAL EMS of 100–120 per minute. the neck under the chin, because that can block Continue CPR until Tilt head back the airway. Pick out any help arrives visible obstructions from the child’s mouth with IMPORTANT your fingertips. ● If you are unable or unwilling to give rescue breaths, you can give chest compressions only.

UNRESPONSIVENESS 25 4 Pinch the child’s nose.Take a IMPORTANT normal breath, seal your lips around his mouth, and blow steadily ● Do not sweep mouth into the mouth; the chest should rise. with your finger to search for an obstruction. Blow into the child’s mouth ● If there is more than one rescuer, one gives 5 Remove your mouth, but not your 6 Continue at a rate of 30:2 until 15 chest compressions hands, and watch the chest fall— the emergency services arrive; followed by the other this is a rescue breath. Each complete your child shows signs of becoming giving 2 breaths. There rescue breath should take one second. responsive (coughing, opening eyes, should be minimal speaking, and moving purposefully) pause between groups and is breathing normally; or you of compressions are too exhausted to continue. and breaths. ● If your child shows signs of becoming responsive (see left), and is breathing normally, place him in the recovery position (see p.26). Monitor breathing, pulse, and level of response (see p.14) until help arrives. For a larger child or small rescuer Interlock Keep your your fingers fingers off the If the child is large or you are small, you can deliver child’s chest chest compressions with two hands. Place the heel of one hand on the breastbone, in the center of the child’s chest, then put your other hand on top and interlock your fingers.Then press down firmly to deliver compressions as above.

26 UNRESPONSIVENESS Eyeglasses Recovery position If the child is wearing Put your child in this position if she is unresponsive but breathing to eyeglasses, remove them prevent her tongue or vomit from blocking her airway. If the child is and keep them safe. found lying on her side or front, not all the steps will be needed. 1 Kneel beside your child. Place the arm closest to you up alongside her head with the elbow bent and palm of hand uppermost. Bend arm nearest to you at a right angle Move farthest arm 2 Bring her other across her chest arm across her chest and hold the Bend farthest leg at knee back of her hand against her cheek. Leave her foot on ground Hold hand against her cheek 3 With your other hand, pull up the knee of the leg farthest from you to bend the leg, leaving the foot on the ground. Leave this Hold her leg straight hand against her cheek

4 Pull the bent leg toward you to UNRESPONSIVENESS 27 roll your child onto her side. Keep your child’s hand against her cheek to Hold her hand support her head. against her cheek Roll her over onto her side by pulling bent leg 5 Adjust her uppermost leg so she Tilt head back to cannot fall forward, and tilt her make sure airway head back to make sure her airway is open. is still open ☎ CALL 911 OR YOUR LOCAL EMS Keep lower Bend top leg so that ❯❯ see also leg straight hips and knees form right angles to keep her ● Checking vital signs, 6 Check your child’s breathing, from rolling forward p.14 pulse, and level of response while you are waiting for help to arrive.

28 BREATHING DIFFICULTIES IMPORTANT Choking baby ● Do not shake a baby. If the baby has an incomplete airway obstruction, he may be coughing, ● Do not sweep the have noisy breathing, or be in distress. If he is choking, there will be no mouth with your noise. Give chest compressions then back blows to relieve a blockage. finger to search for an obstruction. Give up to five 1 If your baby is unable to back blows with cough, cry, or breathe, lay Rest your forearm heel of hand on your thigh for additional support him face down, head lower than his bottom, along your forearm and rest your arm on your thigh. Support the baby’s head with your hand. Give up to five back blows Keep between his shoulder blades with baby's the heel of your other hand. head low Turn him 2 Turn him face up along onto his back your other arm. Check the mouth. Pick out any obvious obstruction from the mouth with your fingertips. Look in 3 If the obstruction has mouth and not cleared, give chest remove visible compressions. Place two fingers object on the nipple line and push downward. Repeat to give up Support to five compressions; stop if the his head obstruction clears. Check his mouth again. If the obstruction Give up to five has still not cleared, chest compressions ☎ CALL 911 OR YOUR Place two fingers LOCAL EMS on breastbone, between the nipples 4 Continue back blows followed by chest thrusts until help arrives, the obstruction clears, or the baby becomes unresponsive.

29BREATHING DIFFICULTIES If your baby becomes unresponsive IMPORTANT If your choking baby becomes unresponsive, begin CPR. If he starts breathing at any ● If your baby shows stage, cradle him in your arms with his head down in the recovery position (see p.21). signs of recovery such as coughing, opening 1Place two fingers Give 30 chest his eyes, and moving compressions (this purposefully, and is breathing normally, on the center may dislodge obstruction). CALL 911 OR YOUR of the chest LOCAL EMS if not already done. Cradle 2 If your baby is not him in your arms with breathing, clear head tilted down any visible obstruction (recovery position) from his mouth; do not until emergency help do a fingersweep. arrives. Monitor breathing, pulse, and Remove visible level of response until obstructions help arrives. Give two rescue 3 Begin rescue breaths breaths. Give two rescue breaths by breathing into your baby’s mouth and nose. 4 Repeat 30 chest compressions, then two rescue breaths. Continue to give 30 compressions followed by two rescue breaths for two minutes. Give 30 chest ☎ CALL 911 OR YOUR compressions LOCAL EMS Follow with 5 Continue two breaths alternating 30 chest compressions with two rescue breaths until help ❯❯ see also arrives, your baby shows signs of recovery (see box, ● Checking vital signs, right), or you are too p.14 exhausted to continue. ● Unresponsive baby, pp.19–21

30 BREATHING DIFFICULTIES IMPORTANT Choking child ● Do not put a finger Start by asking your child if she is choking. If the blockage is mild, she blindly down the throat will be able to speak, cough, and breathe. If it is severe, she will not be to search for the cause able to speak, cough, or breathe. of choking. 1 If your child can cough, ● Any child who has encourage her to do so been given abdominal to remove the object. thrusts must be seen by a doctor. Get her to cough up obstruction if she can Press into her 2 Stand or kneel behind her, abdomen with and wrap your arms around quick upward her waist. Make a fist with one thrusts hand. Place the thumb side of your fist against the middle of her Stand behind her abdomen, just above her navel. and wrap your arms around her waist 3 Grasp your fist with the other hand and press into Press into her her abdomen with a quick abdomen with quick upward thrust. upward thrusts 4 Repeat step 3 until the Grasp fist with obstruction clears or your other hand the child becomes unresponsive. ☎ CALL 911 OR YOUR LOCAL EMS

31BREATHING DIFFICULTIES If your child becomes unresponsive The recovery position If your choking child becomes unresponsive, lower him to the floor, and treat as shown below. Send someone to CALL 911 ORYOUR LOCAL EMS. If the child starts breathing again but Place one hand 1 Begin CPR remains unresponsive, on center of with 30 chest place him in the the chest compressions (this may recovery position dislodge the obstruction). and CALL 911 OR YOUR LOCAL EMS. Give 30 chest compressions Tilt head to 2 Open his airway. If open airway your child is not breathing, clear any visible obstruction from his mouth. Do not do a blind finger sweep. Give two 3 Attempt two rescue rescue breaths breaths into the nose. Continue to give 30 Give 30 chest compressions followed by compressions two rescue breaths for 2 minutes. ☎ CALL 911 OR YOUR LOCAL EMS 4 Continue cycles ❯❯ see also of 30 chest compressions followed by ● Unresponsive child, two rescue breaths until pp.22–27 help arrives, your child resumes breathing, or you become too exhausted to continue.

32 BREATHING DIFFICULTIES IMPORTANT Breath holding ● Do not shake a baby This is the result of rage and frustration. Your child is holding his breath or young child. if he cries, then breathes in but does not breathe out. He may go blue ● If he becomes in the face and stiff and may even become unresponsive, open unresponsive momentarily. the airway and check breathing. If he is breathing, place him in the recovery position. CALL 911. Blow into 1 Try to stay calm. his face Do not shake him or make a fuss. He will usually start breathing again spontaneously. ❯❯ see also 2 Try blowing directly into his ● Unresponsive child, face; this often results pp.22–27 in a child starting to breathe again. IMPORTANT Hiccups ● If the hiccups go on These are very common and usually only last for a few minutes, but for longer than a few often seem to go on for a long time. Children can become distressed. hours, SEEK MEDICAL ADVICE. A long attack 1 Tell your child to can be worrying, tiring, sit still and hold and painful. her breath for 5–10 seconds, then encourage Urge her her to breathe out slowly. to hold her breath 2 Get her to repeat this until hiccups have stopped.

33BREATHING DIFFICULTIES Suffocation and strangulation Strangulation results from a constriction around the child’s neck that IMPORTANT prevents breathing. Suffocation occurs when there is an obstruction over the mouth or nose, a weight on the child’s chest or abdomen ● If your child is preventing normal breathing, or because the child is inhaling smoke- hanging, support his or fume-filled air, which prevents oxygen entering the lungs. body while you remove or cut the rope or cord. ☎ CALL 911 OR YOUR 1 Remove the ● Begin CPR LOCAL EMS obstruction quickly. immediately with 30 Be very careful if you chest compressions use scissors to cut the constriction if necessary. ❯❯ see also Breathing may restart. ● Unresponsive baby, Remove Look for chest 2 Open your child’s pp.19–21 constriction movements airway and check ● Unresponsive child, quickly his breathing. If he is pp.22–27 breathing, place him in the recovery position. Fume inhalation IMPORTANT Fume, gas, and smoke inhalation requires urgent medical attention as ● Do not enter the area the fumes prevent the child breathing in oxygen. Carbon monoxide if fumes, gas, carbon prevents tissues taking up oxygen from air breathed in. monoxide, or smoke are still present. CALL Look for chest ☎ CALL 911 OR YOUR FIRE DEPARTMENT movements LOCAL EMS and 911. Move your 1 Ensure that you do ● Begin CPR child into not put yourself at immediately with 30 fresh air risk.Then carry your child chest compressions away from danger area. ❯❯ see also 2 Open her airway and check her ● Burns and scalds, breathing. If breathing, p.52 place her in the recovery position, and treat any ● Unresponsive baby, injuries found. pp.19–21 ● Unresponsive child, pp.22–27

34 BREATHING DIFFICULTIES IMPORTANT Croup ● If the attack is severe This condition is caused by a viral infection. It can be alarming and often or prolonged, CALL 911 occurs at night, but usually passes quickly. Your child will have difficulty OR YOUR LOCAL EMS. breathing, and a short, distinctve barking cough when he breathes out. He may be making a crowing or whistling noise. In a severe attack, he ● If the attack is severe, may use muscles around his nose, neck, and upper arms in his attempts there is a risk that he is to breathe. IF HE HAS blue-tinged skin, CALL 911 OR YOUR LOCAL EMS. suffering from a rare crouplike condition 1 Help your child called epiglottitis. into a comfortable Suspect epiglottitis breathing position. Sit him if your child has a up in bed, propped by high temperature pillows, or sit him on your and is obviously in lap supporting his back. distress, and has Reassure him. not had the Hib vaccination. CALL 911 OR YOUR LOCAL EMS. Help him sit 2 Stay calm—if you up, supporting panic it could his back and frighten the child, which head can worsen the attack. Steam can ease 3 If it is safe to do his breathing so, create a steamy atmosphere.Take the child Keep your into the bathroom, and child clear of run a hot faucet or hot running shower, or boil some water water in the kitchen. ✆ SEEK MEDICAL ADVICE

35BREATHING DIFFICULTIES Asthma IMPORTANT If your child suffers from asthma, familiarize her with her medication so ● If it is a first attack, that she knows how to use it in an attack. You can recognize an attack CALL 911 OR YOUR if your child has difficulty breathing and is coughing; is wheezing, LOCAL EMS. especially when breathing out; is distressed and anxious. She may also ● If the attack is severe, be tired by efforts to breathe and have a bluish tinge to face and lips. medication has no effect, child is exhausted, Sit her in a 1 Give your child her breathlessness makes comfortable usual dose of the talking difficult, and/or position to ease medication as soon as an skin has a bluish tinge, breathing attack starts (see right). CALL 911 OR EMS. Stay calm and reassure her. Tell her to breathe slowly Using and deeply. medication Lean her 2 Help your child Give your child her forward relax. Sit her down medication as soon as against a in a comfortable position an attack starts. Usually table for breathing.This could if a child has an inhaler be leaning forward with she will also have a her arms resting on a spacer device to use table, or if she prefers, sit with it, so use that her on your lap. Make as well because it’s sure the room is well easier to take in the ventilated and smoke free. medication. Follow the instructions from your 3 If the attack does doctor carefully. not ease within a If she prefers, few minutes, give her 1-2 puffs from her medication sit her on every two minutes until your lap she has had 6 puffs. 4 If the attack still does not ease, ☎ CALL 911 OR YOUR LOCAL EMS

36 WOUNDS AND BLEEDING IMPORTANT Shock ● Do not move your The most likely cause is serious bleeding or a severe burn—injuries that child unnecessarily. must be treated without delay—dehydration, or a bacterial illness. There could be internal bleeding if shock develops with no visible injury. Early ● Do not give your signs are increased respiratory rate and agitation; later signs include child anything to drink pale, cold, and sweaty skin with purplish blotching, bluish lips, rapid pulse or eat because he may becoming weaker, yawning, and thirst; eventually he will be unresponsive. need an anesthetic. If he is thirsty, moisten Help your Reassure him 1 Treat any obvious his lips with water. child lie injury. Help your down Move child child lie down flat, on a ● If you suspect a as little as blanket or rug if possible, broken leg, only raise possible to protect him from the the uninjured leg. cold. Stay calm and reassure him. ☎ CALL 911 OR YOUR LOCAL EMS 2 Keep your child’s head low; don’t put a pillow under it. Carefully raise your child’s legs above the level of his heart to help blood flow to the vital organs; support them on pillows, a chair, or a pile of books padded with a cushion. Head must be Raise his legs kept low high above level of his heart

37WOUNDS AND BLEEDING Loosen any 3 To make breathing IMPORTANT tight clothing easier, loosen any buttons or tight ● Do not leave a child Reassure clothing at his neck, in shock alone. If you your child chest, and waist. can, ask someone else to call 911 OR YOUR Cover him 4 Put a blanket or LOCAL EMS while you to keep him coat over your stay with him. warm child to keep him warm. DO NOT give him ● If your child becomes a hot water bottle or unresponsive and is apply any other source not breathing normally, of direct heat. begin CPR immediately with 30 chest compressions. Check his pulse rate, and 5 Monitor his ❯❯ see also note whether it is strong or breathing, pulse, weak, regular or irregular and level of response ● Severe bleeding, p.38 while you wait for emergency help. ● Burns and scalds, Encourage him to talk or p.52 answer questions to help you assess any change in ● Unresponsive baby, his condition. Make a pp.19–21 note of any changes and tell the medical personnel. ● Unresponsive child, pp.22–27

38 WOUNDS AND BLEEDING IMPORTANT Severe bleeding ● Do not give anything Any incident that results in severe bleeding can be very distressing for you to eat or drink in case and your child. If it is not controlled quickly, a life-threatening condition anesthetic is needed. known as shock will develop. Large wounds may also need stitches. ● Remove or cut away Apply firm 1 Apply direct clothing to expose a pressure directly pressure over wound if necessary; over the wound the wound immediately, don’t remove anything with a clean pad if that is stuck to the available, but anything can wound because it may be used, even a bare hand. worsen the bleeding. Encourage the child to help with this. ● Do not apply direct pressure if there is an 2 While you object embedded in maintain direct the wound—press on pressure, ask a helper to: either side of the object to control bleeding. ☎ CALL 911 OR YOUR LOCAL EMS ● If the bleeding follows a head injury, Apply a bandage to 3 Secure the dressing and there is thin watery secure dressing and with a bandage fluid draining from the help maintain direct that is firm enough to ears, nose, or an open pressure maintain pressure, but skull wound, CALL 911 not so tight that it affects OR YOUR LOCAL EMS. the circulation beyond the bandage. Check the ● If your child becomes circulation in the hand or unresponsive and is foot by pressing the nail. not breathing normally, If color does not return begin CPR with right away, the bandage is 30 compressions too tight; if bleeding has immediately. CALL 911 stopped, loosen it. OR YOUR LOCAL EMS. ❯❯ see also ● Check circulation, p.105 ● Dressings, p.104 ● Embedded object, p.40 ● Shock, p.36 ● Unresponsive child, pp.22–27 ● Triangular bandages, p.106

39WOUNDS AND BLEEDING Raise legs 4 Shock is likely to When above level develop if bleeding bleeding stops of heart is severe. Support and elevate the injured part If the bleeding has Maintain direct and, while maintaining stopped and there is pressure on pressure, help her lie no risk of shock, help the wound down on a blanket. Raise the child sit down and her legs above the level of support an injured Keep head low; her heart. Cover her with hand or arm in an don’t put a pillow another blanket to keep elevation sling for under it her warm. extra comfort on the way to the hospital. Lay child on blanket 5 If bleeding shows to protect from cold through the first dressing, put another pad Put a second pad on top of the first and directly over first secure with a bandage. If one and secure bleeding continues, direct with a bandage pressure may not be over the right point. Remove both pads and start again, 6 Monitor child’s making sure the new pad breathing, pulse, is over the wound. If you and level of response while cannot stop the bleeding waiting for emergency by direct pressure and you help to arrive. have been trained in the use of tourniquets, one could be applied 2 inches above the wound.

40 WOUNDS AND BLEEDING IMPORTANT Embedded object ● Do not try to remove An object such as a piece of glass that becomes stuck in a wound is serious or dislodge objects that because it may be plugging the wound, preventing bleeding. Do not are embedded in a remove it. Protect it with padding and bandages and get medical help. wound because you may cause further Do not 1 Help your child damage and bleeding. move the lie down and keep object him calm. If pressure Bandaging is necessary to slow around larger bleeding, take care not objects to move the object and cause further damage. If the object is very big, build up padding Drape a piece 2 Loosely drape on either side, then of gauze over some gauze over bandage above and wound the wound and object below the object to minimize the risk of instead of over the top. Place padding infection. If the object is around the object small, build up padding so that it is slightly higher than the embedded object; spare roller bandages are ideal for this. If the object is large, see box right. Bandage over 3 Secure padding in padding and place by bandaging object over it, being careful not to press down on the embedded object. TAKE YOUR CHILD▲ TO THE HOSPITAL ❯❯ see also OR ● Severe bleeding, p.38 ☎ CALL 911 OR YOUR LOCAL EMS

41WOUNDS AND BLEEDING Cuts and abrasions IMPORTANT Children can be very upset by the tiniest abrasion. Reassure your child ● Do not clean or and wash the wound. Covering the wound with an adhesive bandage cover cuts with cotton keeps it clean and often makes the child feel better. wool or any fluffy material; it may stick Sit child down 1 Help your child sit to the wound and down and reassure delay healing. Wash her. Gently wash the abrasion abrasion with soap and ● Loosen particles water using a gauze of dirt by rinsing the pad or washcloth. If the wound under cool wound is very dirty, rinse running water. under cold running water. ● If particles are deeply embedded, see opposite and TAKE YOUR CHILD TO THE DOCTOR OR HOSPITAL. ● Check that your child’s tetanus immunization is up to date. Remove any 2 Try to remove any Tetanus loose dirt loose particles of dirt or gravel with the This is a dangerous Pat dry with corner of a piece of gauze infection that is present clean pad or cold running water. This in the soil. If it is may cause slight bleeding. transferred into a Protect abrasion wound, tetanus germs with an adhesive 3 Apply direct release toxins (poisons) bandage pressure with a into the nervous clean pad to stop any system.Tetanus is best bleeding. Pat the wound prevented through dry with clean pieces scheduled childhood of gauze. vaccination. Babies receive this as part of 4 Apply an antibiotic their immunization cream and cover program. Every child with an adhesive bandage should be given a that has a pad large tetanus booster before enough to cover the starting school. wound and the area around it. ❯❯ see also ● Infected wound, p.42

42 WOUNDS AND BLEEDING IMPORTANT Infected wound ● Do not try to A wound is infected if there is increasing pain and soreness; swelling, remove objects that redness, and a feeling of heat around the injury; or there is pus or are embedded in a oozing. If there is an absess or pus draining from the wound, cover wound because you it with clean gauze and take your child to the doctor. If there are signs may cause further of advanced infection, such as fever, swollen glands, and faint red lines damage and bleeding. extending from those glands, take your child to the hospital. Tetanus 1 If red and crusty, 2 Cover with clean ▲3 If there are other apply antibiotic gauze a wound that symptoms of This is a dangerous ointment and cover has pus or oozing. advanced infection, infection caused by the wound with an a bacterium present adhesive dressing. ✆ TAKE YOUR CHILD TAKE YOUR CHILD in the soil. If these TO THE DOCTOR TO THE HOSPITAL bacteria are transferred into a wound, they Bandage may multiply and dressing release toxins (poisons) in place into the nervous system.Tetanus is best Cover prevented through wound with vaccination. Babies a clean pad receive this as part of their immunization program. Every child should be given a tetanus booster before starting school.

43WOUNDS AND BLEEDING Blisters IMPORTANT If a blister is caused by friction (for example, a badly fitting shoe), treat ● If the blister is very as here. You can buy special padded blister bandages. large, cover it with a clean, nonfluffy Clean blister 1 Clean the blister dressing, held in place with soap thoroughly with with adhesive tape and water soap and water. Rinse or a bandage. it with clean water. ● Do not deliberately break a blister because this can cause it to become infected. ● Do not use this method for a blister caused by a burn; treat these as described on pages 52–53. Pat dry with a 2 Thoroughly dry clean pad the blister and the surrounding skin. Pat it gently with a clean gauze pad or paper tissues. Cover with 3 Ideally cover it an adhesive with a blister dressing, bandage if you have one; smoothing if not, a normal one will the edges do.The adhesive bandage needs to have a pad large enough to cover the ❯❯ see also entire blister. Make sure the edges are smooth, to ● Burns and scalds, prevent another blister p.52 from developing.

44 WOUNDS AND BLEEDING IMPORTANT Eyebrow or eyelid wounds ● Do not try to remove A wound to the eyebrow or eyelid may be associated with a more serious objects in the eye, eye injury or infection, which can damage the child’s sight. If you do except an eyelash not suspect any other injury, follow the steps below, but if there is any or speck of dirt. chance of eye trauma or objects embedded in the eye, take the child to the hospital immediately. ● If he cannot keep his eyes still, cover 1 Help your child 2 Reassure your 3 Keep him lying on both of them. lie down and child and lay a his back if bleeding. cradle his head in your sterile dressing over the TAKE YOUR CHILD ● Put the dressing over lap to keep it still—make injured eye. Gently hold TO THE HOSPITAL the eyebrow and lid, sure he can hear you. He the dressing in place until not the eyeball. may be in pain; tell him you get medical help. not to rub or move either of his eyes. ▲ Lay a sterile dressing over injured eye ❯❯ see also ● Chemical burn to eye, p.56 ● Object in eye, p.76

45WOUNDS AND BLEEDING Nosebleed IMPORTANT Children get nosebleeds from a blow to the nose, or from picking ● If there is blood or it. Bleeding usually stops quickly, but it can alarm young children. blood-stained watery fluid coming from the Tilt her head 1 Help your child nose following a head forward sit down with her injury, CALL 911 OR head well forward.Ask YOUR LOCAL EMS. Pinch the soft her to breathe through part of the nose her mouth, then pinch the ● If the nosebleed is below the bone fleshy part of her nose for severe or goes on for 10 minutes.Then release more than half an hour, the pressure. TAKE YOUR CHILD TO THE HOSPITAL. Pinch for 10 more Keep her 2 Tell your child to minutes if bleeding head spit out any excess has not stopped forward fluid in her mouth. If the bleeding has not stopped, Let her pinch it again for another dribble or 10 minutes, then release spit into pressure. If the nose is still a bowl bleeding, pinch it again for up to 10 minutes. Tell her not to blow Clean with 3 Once the bleeding her nose warm water has stopped, use some cotton dipped in lukewarm water to clean ❯❯ see also your child’s face.Advise her to rest and not to ● Head injury, p.60 blow her nose. If your child picks at (or blows) her nose within the next few hours, the bleeding may start again.

46 WOUNDS AND BLEEDING IMPORTANT Ear wound ● If the bleeding Outer ear wounds can bleed profusely, which can be alarming. If blood follows a head injury is coming from inside the ear, check that your child has not inserted and there is blood or something into it. If bleeding follows a head injury, CALL 911 OR YOUR watery blood-stained LOCAL EMS. fluid draining from the ear, CALL 911 OR 1 Help your child sit YOUR LOCAL EMS. down and gently pinch the wound with ● If the injury is caused your thumb and forefinger by an earring being over a clean piece of ripped out, your child gauze. Keep pressing for may need stitches. 10 minutes. TAKE YOUR CHILD TO THE HOSPITAL. Press on wound over a clean Bleeding from pad for inside the ear 10 minutes Help your child into Bandage to 2 Cover the injured a semiupright position, keep wound ear with a sterile with his head tilted covered dressing and lightly toward the injured side bandage it in place. to allow blood to drain away. Put an absorbent pad over the ear and bandage it lightly in place. Do not plug the ear. SEEK MEDICAL ADVICE. ✆ SEEK MEDICAL ADVICE ❯❯ see also ● Head injury, p.60 ● Object in ear, p.77

47WOUNDS AND BLEEDING Mouth wound IMPORTANT These wounds can be the result of a child biting the inside of his mouth ● Do not wash out his in a fall, for example, or from the loss of a tooth. Make sure your child mouth—it may disturb does not inhale blood because this can result in breathing problems. a blood clot. Lean child 1 Help your child ● If he loses an “adult” over a bowl sit down with tooth, it may be his head over a bowl. possible for a dentist to Encourage him to spit replant it. Do not clean out any blood. the tooth. Keep it moist by putting the tooth in milk or saliva. Take your child to the dentist. ● Ensure a baby tooth has not been inhaled or swallowed. A dentist should check the gum. Press on wound 2 Place a pad over Bleeding from over a clean pad the wound and tooth socket for 10 minutes pinch it between your thumb and forefinger, Ask your child to sit maintaining the pressure down and support her for 10 minutes.Your jaw. Place a pad over child may be able to the tooth socket, do this for himself. making sure that it is higher than the ✆ SEEK MEDICAL adjacent teeth.Tell ADVICE her to bite hard on the pad.A younger child may need you to hold the pad in place.

48 WOUNDS AND BLEEDING IMPORTANT Amputation ● Get to a hospital Whether a injury causes partial or total amputation, the limb can often quickly. It may be be reattached. Your child will need an anaesthetic so don’t give him possible to reattach an anything to eat or drink because it may delay surgery. amputated part using microsurgery when Press over a clean 1 Control the blood both the child and the pad to control loss by pressing severed part reach bleeding firmly on the injury using the hospital in time. a sterile dressing or clean pad. If necessary, treat for ● Never wash the shock; help your child lie severed part or allow down and raise his legs it to come into direct above his heart. contact with ice. ● Do not apply gauze to open wounds. Care of the Support the 2 Bandage or tape amputated injured part the dressing firmly part in place.You can cover a Bandage finger with a gauze finger Preserve the severed the pad bandage to protect it. part until you get to the hospital.Wrap it in ☎ CALL 911 OR YOUR plastic wrap or a plastic LOCAL EMS bag, then in a soft fabric, such as a cotton 3 Tell the 911 operator handkerchief or piece or EMS dispatcher it of gauze. Place the is an amputation. Monitor wrapped part in a your child for signs of shock plastic bag filled with while waiting. If possible, ice cubes; the part put the severed part in a must not touch the ice. plastic bag and keep it cool, Put the whole package see left. in another bag or container. Mark with ❯❯ see also the time of injury and the child’s name ● Severe bleeding, p.38 then give it to the ● Shock, p.36 emergency personnel.