First Aid Fast for Babies and Children

49WOUNDS AND BLEEDING Internal bleeding IMPORTANT Suspect this when signs of shock develop without obvious blood loss. ● If the child is There may also be “pattern bruising” around the injury with marks from unresponsive, open clothes or crushing objects because bleeding may be occurring in the her airway and check lungs or abdomen. breathing. If breathing, place in the recovery Raise and Cover her ☎ CALL 911 OR YOUR position; if she is not support with a blanket LOCAL EMS breathing, begin CPR her legs immediately with 30 Keep her 1 Help her lie down; chest compressions head low raise her legs. as elsewhere. 2 Monitor breathing, ❯❯ see also pulse, and level of response while waiting ● Shock, p.36 for help, p.14. ● Unresponsive baby, pp.19–21 ● Unresponsive child, pp.22–27 Crush injury IMPORTANT A crush injury can be serious because it may cause internal bleeding and ● If your child has been broken bones as well as open wounds. crushed for over 30 minutes, do not remove Remove the ☎ CALL 911 OR YOUR the object—it may object quickly LOCAL EMS cause toxic fluids from the damaged muscles 1 If the incident has to be released into the only just happened, body. This increases remove the heavy object the risk of death. from the child quickly. ● If you suspect broken Press on 2 Control any bones, support the wound to bleeding by injury, but do not move control pressing firmly on the your child unless he is bleeding wound, with your hand in immediate danger or a clean pad. Support and it is safe to do so. the injured part, but do Watch for signs of shock not move it. while waiting for help. ❯❯ see also ● Severe bleeding, p.38 ● Shock, p.36 ● Leg injury, p.64

50 WOUNDS AND BLEEDING IMPORTANT Chest wound ● Monitor your child A wound to the chest can cause serious internal injuries. The lungs are for signs of shock. particularly vulnerable, and breathing problems, shock, and collapsed lungs may follow an injury. If the wound is not obviously bleeding, ● If your child becomes leave it exposed—don’t cover it with a dresssing. unresponsive and is not breathing normally, ☎ CALL 911 OR YOUR 1 Help your child begin CPR with LOCAL EMS to sit down in a 30 compressions semi-upright position. immediately. CALL 911 OR YOUR LOCAL EMS. ● If you need to place him in the recovery position, place him so that he is lying on his injured side to support his chest and help the good lung function. Support him in semi-upright position ❯❯ see also Apply direct 3 Monitor his pressure only breathing, pulse, ● Checking vital signs, if wound is and level of response p.14 bleeding while you wait for help to arrive. If he becomes short ● Severe bleeding, p.38 2 If the wound is obviously of breath, release pressure bleeding, apply direct pressure and remove dressing. ● Shock, p.36 with your hand—over a dressing if there’s one available. Support ● Unresponsive child, the child in the same position pp.22–27 until help arrives.

51WOUNDS AND BLEEDING Abdominal wound IMPORTANT A child with an abdominal wound is likely to develop the signs of shock. ● Monitor your child There is high risk of internal as well as external bleeding because internal for signs of shock. organs may be damaged, so this is an emergency. ● If your child becomes Cover wound 1 Help your child lie unresponsive and is with dressing down and loosen not breathing normally, any tight clothing around begin CPR with her waist. Cover the 30 compressions injury with a large sterile immediately. CALL 911 dressing and, if needed OR YOUR LOCAL EMS. to stop bleeding, apply pressure over the pad. ● If intestines are protruding from wound, do not apply pressure. Follow steps 2–4. ☎ CALL 911 OR YOUR LOCAL EMS Tape dressing 2 If your child has a in place major abdominal wound, just cover the wound with a sterile dressing. Raise and support her knees by placing a pillow under them—this eases the strain on the abdomen. 3 Secure the dressing lightly 4 Monitor her breathing, pulse, ❯❯ see also in place with tape; use and level of response while you hypoallergenic tape if possible. wait for help to arrive.Treat for shock if ● Checking vital signs, necessary. Continue to reassure her and p.14 watch for any change in her condition while waiting for help. ● Severe bleeding, p.38 ● Shock, p.36 ● Unresponsive child, pp.22–27

52 BURNS AND SC ALDS IMPORTANT Burns and scalds ● If cooling with a It is very important to cool the burn as quickly as possible to stop the shower, make sure burning, minimize damage, and reduce pain. You must always seek it is cool or cold and medical advice or take a child to the hospital following any burn— that the pressure is however small—because there is high risk of infection. set to low. Flood burn with 1 Start cooling the ● Do not immerse cold running burn as quickly as young children in cold water possible to stop burning water because this can and minimize swelling. overcool the child and Flood the affected area result in hypothermia. with cool or cold water. Help the child to sit or lie ● If no cold water is down on a rug to make available, use another sure the burned area does cool liquid such as milk. not come into contact with the ground. ● Never put lotions, lard, butter, or oil on Sit child on a rug a burn or scald. to keep burn as clean as possible Thermal burns to the mouth 2 While you cool and throat the burn, Burns in this area are ✆ SEEK MEDICAL very serious as they ADVICE cause swelling and inflammation of the 3 Continue cooling air passages, giving the burn for at a serious risk of least 10 minutes or until suffocation. Act the pain stops. quickly. If necessary, loosen clothing from around her neck. ● If your child becomes unresponsive and is not breathing normally, begin CPR with 30 compressions immediately. CALL 911 ORYOUR LOCAL EMS.

BURNS AND SC ALDS 53 Continue cooling 4 Don’t interfere IMPORTANT for 10 minutes with the burn but while cooling it, remove ● Do not remove any Remove constricting any constricting clothing, clothing or material clothing; lift it as shoes, or watches from that is sticking to the you cut it to keep the area before it starts to burned area because away from burn swell. Cut away clothing this may cause further from around the burn, but injury. Cover burn with plastic don’t touch anything that wrap to protect from is sticking to it. ● If you have no plastic infection wrap, use a sterile 5 Once the burn is dressing or any clean, cooled, cover it nonfluffy material. with plastic wrap. Lay it lengthwise along the limb; ● Do not give your don’t wrap it around a child anything to limb, which will swell. eat or drink because Monitor breathing, pulse, an anesthetic may and level of response be needed. while you are waiting for help to arrive. ● If your child becomes unresponsive and is ❯❯ see also not breathing normally, begin CPR with ● Checking vital signs, 30 compressions p.14 immediately. CALL 911 ● Fire, p.11 OR YOUR LOCAL EMS. ● Shock, p.36 ● Unresponsive baby, Using a plastic pp.19–21 bag ● Unresponsive child, pp.22–27 You can use a clean plastic bag to protect an injured hand or foot. Secure it loosely with a piece of tape that is applied to the bag; don’t put tape on the child’s skin.

54 BURNS AND SC ALDS IMPORTANT Electrical burn ● Do not touch your An electric shock from a low-voltage source can result in burns. These child until you are sure may occur at both the point of entry and the point of exit of the current. the electrical current has been turned off. 1 Hold the injured area under cool ● Seek medical advice running water for at least for all burns to children. 10 minutes to cool the burn thoroughly. ● Do not use cold water; a small child could Cool burns with become hypothermic. cool water for at least 10 minutes ● If child becomes unresponsive and is not breathing normally, begin CPR immediately with 30 chest compressions; if breathing, place in the recovery position. CALL 911 OR YOUR LOCAL EMS. Cover burns on a 2 If the burn is on▲ hand with a clean a hand or foot, a plastic bag clean plastic bag can be used, bandaged below the ❯❯ see also burn, or clean material such as a pillowcase. ● Electrical injury, p.12 ● Unresponsive baby, TAKE YOUR CHILD pp.19–21 TO THE HOSPITAL ● Unresponsive child, p.22–29

BURNS AND SC ALDS 55 Chemical burn to skin IMPORTANT Chemical burns can be caused by household agents such as oven ● Call Poison Control cleaner or paint stripper. These burns can be serious and there will Center (800-222-1222) be fierce, stinging pain, redness or staining, followed by blistering for guidance. and peeling of skin. ● Note the name of the Protect 1 Wash away all substance that caused yourself traces of the the burn and give the with chemical by holding the information to the gloves affected area under cool hospital staff. running water for at least 20 minutes to remove ● Always wear protective the chemicals and stop gloves when treating the burning. Make sure your child, and beware contaminated water of chemical fumes. drains away from ● If plastic wrap is the injury. not available, a clean, nonfluffy material can be laid over the burn to protect from infection. Wash chemical off under cold running water for at least 20 minutes If burning sensation 2 Once the burn is increases, flush cooled, it can be again before covered very lightly with recovering plastic wrap, which will with wrap protect from infection and prevent it from drying out. ▲ ❯❯ see also TAKE YOUR CHILD TO THE HOSPITAL ● Chemical burn to eye, p.56 OR ● Fume inhalation, p.33 ☎ CALL 911 OR YOUR LOCAL EMS ● Swallowed chemicals, p.57

56 BURNS AND SC ALDS IMPORTANT Chemical burn to eye ● Do not let your child Splashes of chemicals in the eye can cause scarring or even blindness. touch his eye. The eye Your child may have a chemical burn if he complains of fierce pain in will be shut in spasm the eye; he has difficulty opening the affected eye; the surface of the and pain, so gently pull eye is watery; or there is redness and swelling in and around the eye. the eyelids open. Using pitcher Wear 1 Protect yourself of water protective from the chemical gloves with rubber gloves. Hold If you can’t hold your your child’s head over a child under a faucet, sink, with the unaffected you may find it easier eye uppermost. Gently to use a pitcher to run cool or tepid water pour water over the over the contaminated affected eye. Get a eye for at least 10 minutes. helper to support your Make sure that both child with her head sides of the eyelid are tilted down and to thoroughly washed and one side. Do not splash the unaffected eye that the contaminated with the contaminated water drains away from water. your child’s face. Rinse eye with 2 Once the injured cold water for eye is thoroughly 10 minutes washed, cover it with a large sterile dressing. Hold Cover eye with the dressing in place until clean pad you get medical aid. TAKE YOUR CHILD▲ TO THE HOSPITAL OR ☎ CALL 911 OR YOUR LOCAL EMS

Swallowed chemicals POISONING 57 If you think your child has swallowed a poison, try to find out what, IMPORTANT when, and how much she has taken. Be aware too that some chemicals also give off dangerous fumes. ● Do not try to make your child vomit Wash your 1 Wipe away any because this can child’s lips and residual chemical cause further harm. mouth gently from around your child’s mouth and face. ● If your child becomes unresponsive, open her airway and check for breathing. If breathing, put her in the recovery position. If not breathing, begin CPR immediately. CALL 911. ● If you need to give rescue breaths and there are chemicals on the child’s mouth, protect yourself by using a face shield or pocket mask. Help her take 2 Her lips may sips of cold be burned by a water corrosive substance or discolored, so give her frequent sips of cold water or milk to cool them. ☎ CALL THE POISON CONTROL CENTER Keep container 3 Find out what ❯❯ see also to show EMS chemical your child swallowed, when, and if ● Chemical burn to possible how much, then eye, opposite call the Poison Control Center (800-222-1222) ● Fume inhalation, for guidance on p.33 appropriate treatment. ● Unresponsive baby, pp.19–21 ● Unresponsive child, pp.22–27

58 POISONING Drug or alcohol poisoning IMPORTANT If your child has taken medication, the container may be nearby. If he drank alcohol, there may be a smell of alcohol and he may be ● Do not make your staggering and throw up. He may also have a flushed and moist child throw up because face; slurred speech; deep, noisy breathing; and a pounding pulse. it can cause more harm. Keep container 1 Try to find out what he has ● Even a small amount taken, when, and how much. of alcohol may harm a Count how Check the label on the medicine young child. many pills bottle. are left ● If your child becomes ✆ IF UNRESPONSIVE, unresponsive and is not CALL 911 breathing normally, begin CPR immediately with 30 chest compressions. CALL 911 OR YOUR LOCAL EMS. ❯❯ see also 2 If he drank alcohol, let your child rest where ● Unresponsive baby, you can watch him while pp.19–21 waiting for help to arrive. Give him a bowl in case he ● Unresponsive child, throws up. If he falls asleep, pp.22–27 try to wake him to make sure he can be easily roused. IMPORTANT Plant poisoning ● Do not make your Many plants are poisonous in large quantities. Small pieces or one or child vomit. This can two berries are unlikely to be fatal but can cause stomach upset. cause further harm. Check his mouth 1 Try to find out what your and tell him to spit child ate, when, and how out any pieces much—keep a sample of the plant. ✆ CALL POISON CONTROL CENTER (800-222-1222) 2 Look inside your child’s mouth. Pick out any remaining pieces of plant or berries.

59HEAD, FACE, AND SPINE INJURIES Scalp wound IMPORTANT This type of wound can bleed profusely. If the wound was caused ● If blood continues to by a blow to the child’s head, watch for any change in her condition, seep through the first especially her level of response, while waiting for emergency help. and second dressings, add another and apply Apply firm, Place a pad 1 Cover the injury more pressure to stop steady pressure on the with a clean pad the bleeding. wound or sterile dressing that is larger than the wound. ● If the bleeding is Secure bandage Press firmly on the pad massive, uncontrollable, firmly but not and the wound to control or there is a chance of too tightly the bleeding. Place brain injury, call 911 another pad on top, if or your local EMS. necessary, and keep pressing on the wound. ● If your child becomes unresponsive and is 2 Bandage the not breathing normally, dressing firmly begin CPR immediately in place. If the bleeding with 30 chest continues, apply pressure compressions. again with your hand. CALL 911 OR YOUR LOCAL EMS. 3 Help your child lie down with her head and shoulders slightly raised. Keep her head 4 If you think and shoulders the wound may slightly raised need stitches, take your child to the doctor or emergency room. ❯❯ see also ● Head injury, p.60 ● Severe bleeding, p.38 ● Shock, p.36 ● Unresponsive baby, pp.19–21 ● Unresponsive child, pp.22–27

60 HEAD, FACE, AND SPINE INJURIES IMPORTANT Head injury ● Never shake a baby If your child has a minor bump to the head, she may simply have a or child to assess her bruise with no other sign of injury. If, however, the child has suffered reactions. a more serious blow, the brain can be shaken inside the skull and she may be dazed or temporarily unresponsive—this is concussion. Your ● If a head injury occurs child may have a headache, feel dizzy, complain of nausea, and may during an athletic not remember what happened. activity, do not allow your child to continue If there has been a severe blow to the head, there may be bleeding to play until she has or swelling within the skull that can press on the brain, which is a serious been assessed by a condition. A child may seem unaffected at first, but as time goes by healthcare professional. (minutes, hours, or even days) her condition can worsen, and so it is very important to watch her and monitor her condition looking for Signs of signs of a worsening head injury (see box, left). worsening head injury 1 If the child is dazed, help 3 Make her rest and watch her lie down on the floor her closely. Check her for Seek urgent medical (protect her from the cold). Don’t sit signs of a worsening head injury, advice if after a head her on a chair because she may fall left, reassure her, and stay with her. injury you notice any off and hurt herself. If she does not recover completely of the following in or shows any sign of deterioration, your child: 2 If your child was “knocked out,” even briefly, ☎ CALL 911 OR YOUR ● She becomes LOCAL EMS disoriented and/or ✆ SEEK MEDICAL increasingly drowsy; ADVICE Remain with her and monitor ● She complains of her condition double vision; Help her to sit ● She is vomiting; on the floor, not on a chair ● She complains of a persistent headache; ● She is confused, with loss of memory, dizziness; ● She has difficulty speaking and/or walking and problems with balance; ● She suffers a seizure.

61HEAD, FACE, AND SPINE INJURIES Checking a child’s level of response IMPORTANT Your child could be awake following ● Does she only respond to voice ● Suspect skull fracture an injury, completely unresponsive, by answering simple questions if the level of response or somewhere between the two. She or obeying instructions? Does is impaired, there is may deteriorate over minutes, hours, she open her eyes? blood or blood-stained or even days. It is important to assess watery fluid coming her condition and monitor any ● Does she respond only to pain, for from the nose or ear; changes so that you can tell the example, by opening her eyes if you there is a soft area on emergency personnel or hospital staff. flick her foot or tap her shoulder? the scalp; blood showing on the white ● Is she alert? Are her eyes open and ● Is she completely unresponsive? of the eye; and/or does she respond normally when distortion of the face you talk to her? Note any response or change of or head. response, and the time. ● Remember, there’s a possibility of a If your child becomes unresponsive spinal injury with any head injury. Do not move your child because there could be an associated back or neck injury, and moving her could result in damage to the brain or spinal cord. ❯❯ see also Lift jaw up to 1 Kneel behind her ● Checking vital signs, open airway head and rest your p.14 elbows on the ground or ● Cold packs, p.108 Check your knees. Open her ● Scalp wound, p.59 breathing airway using the jaw ● Spine injury, p.63 thrust: place one hand ● Unresponsive baby, on either side of her face, pp.19–21 with your fingertips on ● Unresponsive child, the angles of her jaw. pp.22–27 Gently lift the jaw up to open the airway (don’t tilt her head back). 2 Check her breathing. If she is breathing, continue to support her jaw to keep the airway open. If she is not breathing, begin CPR immediately. Ask someone else to call 911. ☎ CALL 911 OR YOUR LOCAL EMS

62 HEAD, FACE, AND SPINE INJURIES IMPORTANT Nose or cheekbone injury ● If pinching her nose The main risk with fractures to the nose or cheekbones is that the hurts too much, simply swelling can affect the air passages, causing breathing problems. ask her to sit forward There may also be bleeding from the child’s nose or mouth. over the bowl and give her a soft pad or towel to soak up the blood. Apply cold 1 Help your child compress sit down and apply to injury a cold pack (see p.108) to the injured area to help minimize the swelling. Hold the cold pack in place for about 20 minutes. ❯❯ see also Pinch nostrils 2 If your child’s nose together to is bleeding, ask her ● Nosebleed, p.45 stop bleeding to sit with her head well forward and to pinch the ● Unresponsive baby, fleshy part of her nose to pp.19–21 help control bleeding. If any bones are broken, ● Unresponsive child, pp.22–27 TAKE YOUR CHILD TO THE HOSPITAL ▲ IMPORTANT Jaw injury ▲ ● If your child becomes A broken jaw will be tender and swollen, with loss unresponsive and is of normal mobility. Her teeth may be out of line. not breathing normally, begin CPR immediately 1Hold ice Help your child to sit with head well with 30 chest forward.Tell her to spit out any loose compressions. pack in cloth CALL 911 OR YOUR against jaw; LOCAL EMS. support jaw teeth and not to swallow any blood or saliva. ❯❯ see also with hand 2 Hold an icepack gently under her injured jaw, and support it in this ● Unresponsive baby, pp.19–21 position until you get to the hospital. Do not ● Unresponsive child, bandage the pad in place in case she vomits. p.22–27 TAKE YOUR CHILD TO THE HOSPITAL

63HEAD, FACE, AND SPINE INJURIES Spine injury IMPORTANT If a child lands on his neck or back in a fall or falls awkwardly and ● Do not move the complains of back pain or tingling in any part of his body, suspect spine injured child from the injury. Support him in the position found to prevent further damage. position in which you find him unless his life Lie behind child’s 1 Reassure your child and tell is in danger. head and rest him not to move. Lie behind elbows on the his head, rest your elbows on the ● If you do have to ground ground, and place your hands on move him, take care either side of his head; don’t cover his not to twist or bend ears. Keep his head in line with his the neck or spine. spine, but don’t pull on his neck. ● If your child becomes Support his head unresponsive, open in your hands airway using the jaw thrust technique (p.61) and check breathing. If breathing, maintain jaw thrust and keep the head, neck, and spine aligned; if not, begin CPR immediately, with 30 compressions. CALL 911 OR YOUR LOCAL EMS. Spread your fingers Keep his back so that you don’t and neck aligned cover child’s ears ☎ CALL 911 OR YOUR Maintain head LOCAL EMS support 2 Keep his head and neck ❯❯ see also supported in the same position until help arrives.Ask ● Checking vital signs, someone to put rolled blankets or p.14 towels around his neck and shoulders for extra support. ● Head injury, p.60 3 Continue to keep his head ● Unresponsive baby, steady. Monitor breathing, pp.19–21 pulse, and level of response while waiting for help to arrive, and ● Unresponsive child, perform CPR if needed. pp.22–27

64 BONE, JOINT, AND MUSCLE INJURIES IMPORTANT Pelvic injury ● Do not move your If your child has a broken pelvis, she will be unable to stand, with pain child—treat her in the around the hip and groin, and possible bleeding from the urinary orifice. position you found her. Immobilize legs ☎ CALL 911 OR YOUR ● Do not bandage if with bandages LOCAL EMS it causes pain. to prevent movement Pad between child’s legs ● If you see signs of and immobilize them with shock or bleeding but a figure-eight bandage no obvious wound, around feet and ankles treat for shock but and a broad-fold bandage do not raise her legs. around both knees. ❯❯ see also Monitor her while you wait, see p.14. ● Shock, p.36 IMPORTANT Leg injury ● If there is a wound, Suspect a break if your child is in severe pain. He needs an X-ray or scan treat bleeding and to confirm whether or not a bone is broken. Treat the leg in the position cover with a sterile found to prevent broken bone ends causing further internal injury. dressing. ● Do not attempt Support injured 1 Make your child to straighten the leg by holding comfortable and injured leg. joints above and keep him still. Keep his below injury leg in the position you ❯❯ see also found it by supporting the ankle and knee joints. ● Severe bleeding, p.38 ● Shock, p.36 Place rolled blankets or 2 Support the joints towels around injured leg until help arrives. Ask a helper to place ☎ CALL 911 OR YOUR padding along the outer LOCAL EMS side of the limb and between the legs. Cover your child with another blanket to keep him warm. If you suspect shock, raise only the uninjured leg.

65BONE, JOINT, AND MUSCLE INJURIES How to splint an injured leg Support joints above and If you are going to have to wait for help, for below injury example if you are in a remote area, you can splint the injured leg for extra support. 1 Maintain support at the Place soft Slide bandages joints.Ask a helper to place padding under natural padding such as a rolled-up towel between legs hollows or small blanket between the thighs, knees, and ankles. Bring Maintain support Fracture site the uninjured leg to the broken one. Tie narrow-fold 2 Slide bandages through bandage in the hollows under the legs. figure-eight at Place a narrow-fold bandage at ankles and feet the ankle and broad-fold bandages under the knees and below the Keep bandages clear fracture. Secure the bandage at of the site of injury the ankles first. Tie square knots 3 Secure the broad-fold on uninjured side bandages at the knee then below the injury site—and above if there is room.Tie all knots against the uninjured leg. Making broad-fold and narrow-fold bandages Fold bandage in half to make a broad-fold bandage 1 3Take a triangular bandage Broad-fold bandage 2 4Fold top point over Fold bandage in half again to to touch the base make a narrow-fold bandage Narrow-fold bandage

66 BONE, JOINT, AND MUSCLE INJURIES IMPORTANT Knee injury ● Follow the RICE This type of injury can be very painful, and your child may not be able procedure: to move it. The area around the knee joint can swell very quickly. R Rest injured part. I Place ice on the Support his 1 Reassure your injury. knee with child and help C Provide compression a pillow him lie down. Place a by bandaging the area pillow under his legs to lightly. Wrap padding support them in the most E Elevate injured part. around joint comfortable position. Place a cold pack on the ● If you suspect a Secure padding knee.Then wrap a layer major injury, take your with bandage of soft padding around it. child to the hospital in the treatment position. Keep him 2 Secure the padding CALL 911. comfortable with a bandage. ❯❯ see also ✆ SEEK MEDICAL ADVICE ● Cold packs, p.108 ● Leg injury, p.64 IMPORTANT Foot injury ● Follow the RICE Your child’s foot may be bruised, swollen, and stiff and she may not be procedure: able to stand. If caused by crushing, one or more bones may be broken. R Rest injured part. I Place ice on the injury. Reduce swelling 1 Sit the child down C Provide compression with an ice pack to rest the injury. by bandaging the area lightly. 2 Place a cold pack E Elevate injured part. on the injury, then provide compression ❯❯ see also by bandaging it lightly. ● Cold packs, p.108 3 Elevate the injury ● Leg injury, p.64 to reduce bruising, pain, and swelling. Keep leg ✆ SEEK MEDICAL elevated ADVICE

67BONE, JOINT, AND MUSCLE INJURIES Ankle injury IMPORTANT The most common injury is a sprain. Suspect a sprain if your child ● If the pain is very can’t take her full weight on her foot after a fall, or she has twisted, severe or you think a or wrenched, her ankle. She may need an X-ray or scan. bone could be broken, wrap the ankle as Rest foot and 1 Help your child shown below and TAKE remove shoe sit down to rest YOUR CHILD TO THE and sock her foot. Gently remove HOSPITAL or CALL 911. her shoe and sock before the injured area swells. ● Follow the RICE procedure: R Rest injured part. I Place ice on the injury. C Apply compression by loosely bandaging the injured part. E Elevate injured part. Apply a cold 2 Place a cold pack pack on the injury (see p.108) to minimize swelling. Secure padding 3 Provide 4 Elevate the with a bandage compression: injury to help wrap a thick layer of reduce bruising, pain, Keep ankle raised soft padding such as and swelling. and supported cotton around the ankle and secure it with ❯❯ see also a bandage. Make sure that the bandage is not ● Check circulation, too tight. p.105 ● Cold packs, p.108 ✆ SEEK MEDICAL ● Leg injury, p.64 ADVICE

68 BONE, JOINT, AND MUSCLE INJURIES IMPORTANT Collarbone injury ● If putting a sling on A collarbone may be broken by indirect force, for example, if a child falls the child causes further onto her outstretched hand, or by a blow to her shoulder. There will be pain, stop and support tenderness in your child’s shoulder and arm—increased by attempts to the affected arm by move it—and her head may be turned and inclined to the injured side. hand instead. Sit child 1 Help your child sit down down and gently bring the arm on the Place arm on injured side across her injured side chest.Ask her to support across her chest her arm with her hand. Slide a triangular bandage between the child’s arm and her chest. Ask child to Tie knot away 2 Support your support arm from injury child’s arm in an on injured side arm sling to minimize swelling and discomfort. Support arm on Make sure the knot is not injured side with over the site of injury. an arm sling 3 For additional ❯❯ see also immobilization and comfort you can place soft ● Triangular bandages, padding between the arm p.106 and the sling, then tie a broad-fold bandage around the arm and body. ▲ TAKE YOUR CHILD TO THE HOSPITAL

69BONE, JOINT, AND MUSCLE INJURIES Rib injury IMPORTANT A child may have a broken rib following a blow to her chest, a heavy ● Do not give the child fall, or having been crushed. Symptoms include sharp pain at the anything to eat or drink fracture site, bruising, swelling, or possible wound on the injured because an anesthetic side, and pain when breathing. may be needed. 1 Help your child ● If your child develops sit down and breathing difficulties, gently bring the arm on signs of internal the injured side across her bleeding, or shock, chest.Ask her to support CALL 911 OR YOUR her arm with her hand; LOCAL EMS. you may need to help her. ● If your child becomes unresponsive and has abnormal breathing, begin CPR immediately with 30 compressions. CALL 911 OR YOUR LOCAL EMS. Ask child to support arm on injured side ▲2 Support the arm ❯❯ see also on the injured side in an arm sling to ● Chest wound, p.50 minimize discomfort. ● Internal bleeding, TAKE YOUR CHILD p.49 TO THE HOSPITAL ● Shock, p.36 Support arm on injured side with a sling ● Triangular bandages, p.106 ● Unresponsive child, pp.22–27

70 BONE, JOINT, AND MUSCLE INJURIES IMPORTANT Arm injury ● Do not give the child The treatment here is for injuries to the upper arm, forearm, and wrist. anything to eat or drink Move the arm as little as possible to minimize pain. because he may need an anesthetic. 1 Help your child sit down. Support ● If the child cannot the arm and encourage bend his arm treat as him to help. Place a soft for elbow injury below. pad around the injury and between his arm and his chest. Place padding 2 For extra support around injury place the arm to protect it in a sling and knot it on the uninjured side. ❯❯ see also Support injured ✆ SEEK MEDICAL arm by hand ADVICE ● Collarbone injury, p.68 IMPORTANT Elbow injury ● Do not give the child Suspect an elbow injury if your child is unable to bend her arm, pain is anything to eat or drink increased by any attempts at movement, or there is swelling around the because she may need elbow. Keep the injury still because bone ends can damage blood vessels. an anesthetic. Place injured Put soft padding 1 Help the child sit ● Do not straighten or arm across around the joint down, holding her bend the child’s elbow. body arm across her body. Pad Tie broad-fold around the injury. ● If bandaging causes bandages around pain, help the child lie arm and body 2 Apply broad-fold down with her arm in above and below bandages around a comfortable position injured elbow the body and arm above across her body. CALL and below the elbow. 911 OR YOUR LOCAL Check circulation at EMS. the wrist regularly. ❯❯ see also ✆ SEEK MEDICAL ADVICE ● Check circulation, p.105 ● Triangular bandages, p.106

71BONE, JOINT, AND MUSCLE INJURIES Hand injury IMPORTANT This type of injury can be very painful. There may be several broken ● If there is a wound, bones, and often a joint is dislocated. If your child’s hand was crushed control the bleeding there may also be an open wound. by pressing a clean dressing or pad over the site of the wound. Wrap hand in 1 If there is no Jammed soft padding wound, wrap fingers the injured hand in soft padding. Raise your Hold the fingers under child’s hand into a cold running water comfortable position. for a few minutes to relieve the pain and 2 Place your child’s minimize swelling. If arm in an elevation the fingers still hurt, sling to reduce swelling apply a cold pack for and provide extra comfort 10 minutes (see p.108). on the trip to the hospital. Support hand and arm in elevation sling Tie broad-fold 3 For extra support, ❯❯ see also bandage around tie a broad-fold arm and body bandage (see p.73) around ● Crush injury, p.49 the arm and body; secure it with a knot on the ● Finger injury, p.72 uninjured side. ● Severe bleeding, p.38 ✆ SEEK MEDICAL ADVICE ● Triangular bandages, p.106

72 BONE, JOINT, AND MUSCLE INJURIES IMPORTANT Finger injury ● If pain or bleeding is Injury to a finger is common in children and can vary from simple cuts severe, there is missing or abrasions to broken bones or tendon damage if, for example, the tissue, or a fingernail finger is shut in a door. It is important to get the injury checked because is damaged, TAKE there are several blood vessels, tendons, and nerves in the finger that YOUR CHILD TO can be damaged, leading to deformity, bruising, and loss of sensation. THE HOSPITAL. Control bleeding with 1 Apply direct 2 Raise and support direct pressure pressure over a the finger, or ask sterile or clean pad to your child to hold it up, to control any bleeding; do help relieve the pain and not press hard. Stop if control the bleeding. this causes pain because there may be an underlying fracture. 3 Secure the dressing▲ with a bandage—a ❯❯ see also tube gauze bandage is ideal. For extra comfort, ● Amputation, p.48 splint the finger to the next uninjured one. ● Crush injury, p.49 ✆ SEEK MEDICAL ● Severe bleeding, p.38 ADVICE ● Triangular bandages, OR p.106 TAKE YOUR CHILD TO THE HOSPITAL 4 Support the arm in a raised position in an elevation sling if it makes your child more comfortable. Apply elevation sling to help relieve pain

73BONE, JOINT, AND MUSCLE INJURIES Cramp IMPORTANT This is a painful muscle spasm that often affects the muscles in the foot, ● If symptoms don’t calf, or thigh. A cramp can occur after strenuous exercise or as a result ease, SEEK MEDICAL of dehydration through excessive sweating. You can relieve the pain ADVICE. by stretching the affected muscles, then massage them to “relax” the spasm. Give your child water to drink to ease dehyration. Extend Extend toes toes to to stretch ease toward shin pain For a cramp in the foot, encourage For a cramp in the calf muscles, sit or your child to stand while you support lay the child down and help her straighten the affected foot. Extend the toes her leg while you support her foot. Extend upward to stretch the muscles. Once the her foot toward her knee to stretch the calf spasm has passed, massage the underside muscles. Once the spasm has passed, massage of the foot with your fingers. the back of her leg to relax the muscles. Massage Straighten affected leg to stretch muscles once affected spasm eases muscles For a cramp in the front of the thigh, For a cramp in the back of the thigh, ❯❯ see also help your child lie down, then raise and raise and support her leg, and straighten support her leg. Bend her knee to stretch her leg to stretch the muscles. Once ● Heat exhaustion, p.88 the muscles.Then, once the spasm has the spasm has passed, massage the passed, massage the affected muscles. affected muscles.

74 BONE, JOINT, AND MUSCLE INJURIES IMPORTANT Bruises and swelling ● If you think your child After a fall or bump, bruising and swelling may has a fractured arm, develop rapidly. Resting, cooling, and raising support it in a sling and the injury will minimize discomfort. take her to a doctor. Raise and 1 Make your child ● If bruising is severe support injured comfortable. Raise or extensive, SEEK part on a pillow and support the injury MEDICAL ADVICE. to rest it and minimize swelling and discomfort. Cold packs Applying a cold pack to an injury helps minimize swelling and discomfort by reducing blood flow to the area. Make one by filling a plastic bag two-thirds full of ice and a small amount of water, or use a bag of frozen fruit or vegetables; wrap the bag in a cloth so that the ice does not make direct contact with the skin. You can also use cloth wrung out in cold water. (see p.108). Apply a cold compress 2 To reduce swelling, to reduce swelling hold a cold pack against the injury for no Leave a cold pack in more than 20 minutes place on an injury (see left). for 20 minutes, ideally uncovered.

Splinter FOREIGN OBJECT S 75 There is always a risk of infection with splinters. They IMPORTANT are often dirty and the bacteria can be carried deep into the skin. Children are most likely to get splinters in ● If your child is not their hands and knees because they crawl on the floor. immunized against tetanus infection, SEEK MEDICAL ADVICE. ● Do not poke at the area with a needle to remove the splinter. ● If you cannot remove the splinter, or if it breaks off, SEEK MEDICAL ADVICE. Wash around splinter 1 Clean the area around the splinter thoroughly with soap and warm water. Grasp splinter and 2 Grasp the splinter pull straight out as close to the skin as possible, and carefully Support draw it back out at the child’s hand same angle it went in. 3 Clean the area again, washing well with soap and water. ❯❯ see also ● Infected wound, p.42 ● Tetanus, p.42

76 FOREIGN OBJECT S IMPORTANT Object in eye ● Do not touch, or Tiny hairs or specks of dust on the surface of the eye can be very attempt to remove, uncomfortable for a child. Anything on the surface can generally any foreign object be washed off easily; try to keep your child from rubbing her eye. that is sticking to, or embedded in, the eye. Examine 1 Help your child sit the eye down, facing the ● Tell your child to keep light. Separate the eyelids his eyes still, and cover Separate of the affected eye.Ask the affected eye with a eyelids gently her to look right, left, up, sterile dressing. TAKE and down. Examine her YOUR CHILD TO AN Ask her to look eye thoroughly. OPHTHALMOLOGIST right, left, up OR THE HOSPITAL. and down If an object Try to wash 2 If you can see the has been out foreign foreign object on removed object the surface of the eye, try to rinse it off using a ● If a hankerchief is Use a bowl to pitcher of clean water.Tilt used, be very careful catch water her head and aim for the not to scratch the inner corner so that water surface of the eye. will wash over her eye. Or, try lifting it off with a ● If eye is still red or damp swab or the corner sore TAKE HIM TO THE of a handkerchief. OPHTHALMOLOGIST OR HOSPITAL. Lift upper eyelid 3 If an object is over lower lid under the eyelid, you can ask an older child ❯❯ see also to clear it by lifting the upper eyelid over the ● Eyebrow or eyelid lower one.You will need wounds, p.44 to do this for a toddler or young child; if necessary, wrap her in a towel first to stop her from grabbing your arms.

FOREIGN OBJECT S 77 Object in ear IMPORTANT Children often push things into their ears. A hard object may become ● Do not attempt to stuck, which can cause pain and mechanical hearing loss, which will be remove the object. resolved when it is removed; it may even damage the child’s eardrum. Find out what is in Reassure your child and the ear but don’t ask her what she put try to remove it into her ear. Don’t try to remove the object, even if you can see it.▲ TAKE YOUR CHILD TO A DOCTOR, AN EAR DOCTOR,OR THE HOSPITAL If there is an insect in the ear If an insect flies or crawls into your child’s ear she may be very alarmed. 1 Help her sit down. Support her head with the affected ear uppermost. 2 Gently flood the ear with tepid water so that the insect floats out.

78 FOREIGN OBJECT S IMPORTANT Object in nose ● Do not attempt to If your child has something stuck in his nose, his breathing may be remove the object, difficult or noisy and his nose may be swollen. Smelly or blood-stained even if you can see it. discharge from the nose indicates an object has been present for a while. Keep him Tell him to 1 Reassure your calm breathe through child and try to his mouth find out what he put in his nose.Tell him not to touch it.▲ 2 Tell your child to breathe through his mouth until the object is removed. TAKE YOUR CHILD TO THE DOCTOR IMPORTANT Swallowed object ● If the object is sharp Young children often put small objects in their mouths and may swallow or large, don’t give your them. Most objects will pass straight through the digestive system. Small child anything to eat or button batteries are dangerous because they contain corrosive chemicals. drink. TAKE YOUR CHILD If you have any doubt about what your child swallowed and how to treat TO THE HOSPITAL it, call the Poison Control Center (800-222-1222). ● If he has swallowed Ask him 1 Reassure your a battery, CALL THE what he has child.Try to find POISON CONTROL swallowed out what the child has CENTER AND TAKE swallowed. YOUR CHILD TO THE HOSPITAL 2 If the object is small and smooth like a pebble or a coin, there is little danger. ✆ SEEK MEDICAL ADVICE

BITES AND S TINGS 79 Animal and human bites IMPORTANT The main risk with any bite is infection; sharp pointed teeth can carry ● If the bleeding is germs through the skin and into the tissues. Severe wounds with torn severe, treat it; then, edges may need advanced medical care. Rabies is rare but possible; teach if there are signs of your child to watch out for wild animals and pets behaving strangely. shock, CALL 911 OR YOUR LOCAL EMS. Wash wound 1 Wash the wound with soap and thoroughly, using ● If you think your warm, running water soap and warm water. child may have been Rinse the wound under bitten by a rabid running water for at least animal, take him to the five minutes to wash away hospital immediately. any dirt. ● Make sure child’s tetanus immunization is up to date. Dry wound 2 Gently but ❯❯ see also and cover with thoroughly, pat the an adhesive wound dry with a clean ● Severe bleeding, p.38 bandage pad or tissue. Cover it ● Infected wound, p.42 with an adhesive bandage ● Shock, p.36 For a serious animal bite or a small sterile dressing. Control bleeding ✆ SEEK MEDICAL by pressing ADVICE on wound 1 If bleeding is severe, apply direct pressure over the wound, preferably over a sterile dressing or clean, nonfluffy pad. ☎ CALL 911 OR YOUR LOCAL EMS 2 Cover the wound with a sterile dressing or pad and bandage firmly in place to help maintain direct pressure; make sure the bandage is not too tight (see p.105).Treat child for shock if necessary. Monitor the child’s breathing, pulse, and level of reponse while waiting for help to arrive.

80 BITES AND S TINGS IMPORTANT Insect sting ● If severe rash, face Bee, wasp, or hornet stings can be very alarming for a child, but they and neck swelling, and/ are rarely dangerous. Your child will experience a sharp pain followed or breathing difficulties by soreness, red skin, and slight swelling around the site of the sting. develop, treat for anaphylactic shock. Scrape off a 1 If the stinger is still CALL 911 OR YOUR protruding stinger in the skin, brush or LOCAL EMS. scrape it off sideways with your fingernail or a plastic If sting is in card. Don’t try to remove it mouth with tweezers because you may inject more venom Give your child an ice into your child. cube to suck or cold water to sip and SEEK Place a cold pack 2 Place a cold pack MEDICAL ADVICE. over area (p.108) on the If swelling develops, site for about 20 minutes CALL 911 OR YOUR to minimize the pain LOCAL EMS. and swelling. Rest the injured part. If pain and ❯❯ see also swelling persist, ● Anaphylactic shock, ✆ SEEK MEDICAL p.91 ADVICE IMPORTANT Poison ivy rash ● If the rash is extensive, If your child brushes against poison ivy, he may develop a blotchy, red, SEEK MEDICAL ADVICE. itchy rash that may frighten him. Reassure him and soothe the rash. Soothe rash by 1 To relieve the dabbing with itching, dab the calamine lotion rash with cotton soaked in calamine lotion. ❯❯ see also 2 Alternatively, place ● Allergy, p.90 a cold pack over ● Cold pack, p.108 the rash until the pain is relieved, about 20 minutes.

BITES AND S TINGS 81 Tick bite IMPORTANT Found in woodlands and long grass, ticks are minute, spiderlike creatures ● Do not attempt to that carry viruses and bacteria, including Borrelia, which causes Lyme burn the tick or cover it disease. They attach themselves to people and animals to suck blood and with petroleum jelly in can swell up to the size of a watermelon seed. Always check yourself and your attempt to remove your child after walking in areas where ticks are likely to be found. it. You could injure the child and it may cause 1 Using fine-toothed tweezers, the tick to regurgitate grasp the tick as close to the infective fluid into her. child’s skin as possible. Pull the tick’s “head” upward using steady pressure. ● If you can’t remove Don’t twist or crush the tick because the tick or you think this can leave mouth parts (and saliva) mouth parts remain, embedded in the child. SEEK URGENT MEDICAL ADVICE. Grasp head as close to skin as possible Lyme disease Wash the bite The first sign of this site thoroughly may be a circular rash at the site of the bite that can develop up to 30 days later.The rash is described as looking like a bull’s-eye. In many cases, however, this rash never appears, so if there are any other symptoms, such as fever or joint aches, SEEK URGENT MEDICAL ADVICE. 2 Wash the area 3 Put the tick into a 4 If your child ❯❯ see also around the bite sealed plastic bag develops a rash with soap and water. and take it to your doctor, around the bite site or ● Fever p.94 who may want to check they start to display ✆ SEEK MEDICAL that it is complete as well as any flulike symptoms, ADVICE test it for the bacteria that see box right, seek urgent cause Lyme disease. medical advice.

82 BITES AND S TINGS IMPORTANT Jellyfish sting ● If the sting is caused Jellyfish and sea anemone venom is contained in stinging cells that by Portuguese man stick to a child’s skin. Stings from marine creatures in temperate waters o’war, immerse the may not be dangerous, but those in tropical waters can cause severe area in hot water poisoning. Vinegar or seawater should be used to flush the stung area. (104ºF/40ºC) for 10 minutes and SEEK 1 Pour vinegar if MEDICAL ADVICE. available or seawater over the affected ● If the skin is very red area to incapacitate the and painful, TAKE HER stinging cells. TO THE HOSPITAL. Flood the affected 2 Help the child ● If the injury is area with vinegar or sit down and extensive or your child seawater immobilize the area as develops anaphylactic for snakebite, see opposite. shock, CALL 911 OR YOUR LOCAL EMS. ❯❯ see also ☎ CALL 911 OR YOUR LOCAL EMS ● Anaphylactic shock, p.91 3 Monitor breathing, pulse, and level of ● Checking vital signs, response while you wait. p.14 IMPORTANT Marine puncture wound ● Make sure the water When stepped on, the spines from a marine creatures such as catfish, is not too hot. lionfish, stonefish, and stingrays can puncture the skin, causing painful swelling and soreness. The spines can also break off and become ● If any spines remain embedded in a child’s foot. embedded in the skin, or the foot starts to Immerse the injury in swell, elevate the limb water as hot as your child and TAKE YOUR CHILD can bear for about 30 TO THE HOSPITAL minutes.Add more hot water as it cools, but be Immerse her foot careful not to scald her. in hot water ▲ TAKE YOUR CHILD TO THE HOSPITAL

BITES AND S TINGS 83 Snakebite IMPORTANT The toxin in a snake’s venom can be either hemotoxic and neurotoxic. ● Do not let your child Hemotoxic venoms cause bruising, swelling, and bleeding, while walk around; keeping neurotoxins can cause tingling, numbness, oral swelling, and also him still prevents the difficulty breathing. venom from spreading. ☎ CALL 911 OR YOUR 1 Remain calm. Help ● Do not apply a LOCAL EMS the child lie down tourniquet, cut out the and stay still. wound, or try to suck out the venom. Cover a painless bite 2 Place a pad over with clean pad, then the site and put a ● If possible, give an apply a small roller pressure bandage on top. accurate description bandage on top Immobilize the bitten part of the snake to the with broad-fold bandages. emergency services Raise the heart above personnel, but never the level of the bite try to capture it. ● If your child develops a severe allergic reaction, treat as for anaphylactic shock. ● If your child becomes unresponsive and is not breathing normally, begin CPR immediately, with 30 compressions. CALL 911 OR YOUR LOCAL EMS. Apply second roller bandage from 3 If emergency help ❯❯ see also bite as far up leg as possible will be delayed, Place padding apply a second pressure ● Anaphylactic shock, between legs bandage that extends from p.91 the bite as far up the limb Immobilize the as possible.You should be ● Checking vital signs, affected limb able to slip your finger p.14 under the bandage; loosen if necessary. ● Triangular bandages, p.65 and p.106 4 Immobilize a leg with folded ● Unresponsive baby, triangular bandages and pp.19–21 padding; use a sling if the arm is affected. ● Unresponsive child, p.22–27

84 EFFECTS OF HEAT AND COLD IMPORTANT Hypothermia ● Do not put a source This develops if the body temperature falls below 95ºF (35ºC), and if it of direct heat, such as falls further it is very serious. An older child is most likely to develop it a hot water bottle, outside in poor weather conditions, especially if there is a high wind-chill next to the child’s skin factor, or if a child falls into cold water. For babies, see opposite. If your because it may cause child has had cold exposure and is shivering, she may have mild a burn. hypothermia. As she gets colder and the shivering stops, her condition is more serious. She may become listless, confused, or unresponsive. ● If your child becomes unresponsive and isn’t For a child outside Your body Take your child to a breathing normally, warmth will shelter. If there isn’t one begin CPR with Protect her help child nearby lay her on a layer 30 compressions from contact of dry insulating material immediately. CALL 911 with the such as soft brush or moss OR YOUR LOCAL EMS. ground and protect her from the wind.Wrap her in a dry sleeping bag and a foil blanket if available. Use your body to keep her warm, too. ☎ CALL 911 OR YOUR LOCAL EMS For a child indoors 1 If you can get to a shelter or your Cover her child is indoors, remove head with any wet clothes and a hat replace them with dry ones. Cover her with Warm her plenty of blankets—you hands with can put her in bed. Cover gloves her head with a hat and make sure that the room is warm. Stay with her. ✆ SEEK MEDICAL ADVICE

85EFFECT S OF HEAT AND COLD Help her sip a 2 Give your child a warm drink warm drink and some high-energy foods, such as chocolate. ❯❯ see also Monitor her breathing, pulse, temperature, and ● Checking vital signs, level of response. Do p.14 not leave her alone until you are sure that her ● Unresponsive baby, temperature has returned pp.19–21 to normal. ● Unresponsive child, Stay with her until p.22–27 her temperature has returned to normal Hypothermia in babies Cuddle him against your body A baby’s temperature regulation is not fully developed. He can lose body heat rapidly and develop hypothermia in a cold room. Suspect hypothermia if you are in a cool or cold environment and your baby’s skin feels cold; he is limp and unusually quiet; and he refuses to feed. ☎ CALL 911 OR YOUR Put a hat on LOCAL EMS his head 1 Rewarm a baby by Wrap him warming the room or up well taking him to a warm room. Wrap him in blankets. 2 Put a hat on his head and cuddle him against your body so that he is warmed by your body heat.

86 EFFECT S OF HEAT AND COLD IMPORTANT Frostbite ● Do not warm by If children are exposed to extreme weather conditions, the tissues of rubbing because it can the fingers, toes, and other extremeties may freeze. Your child may have damage the skin and frostbite if she has pins and needles, with numbness and hard, stiff skin surrounding tissues that is turning white and waxy. Shelter your child before treating her. ● Do not use direct Gently remove 1 While you are heat, such as hot water clothing from still outside, advise bottles or an open affected area your child to put her flame, to rewarm skin. hands under her armpits to use her body warmth ● Never burst blisters. to prevent her condition from worsening. If the skin is broken 2 Once in a warm shelter, help her If there are any open sit down, then start wounds or the frozen treatment. Gently remove skin is broken, cover constrictions from the the area with a soft affected area such as shoes, gauze dressing and socks, and/or gloves and bandage it lightly rings. Undo her coat. Start in place.TAKE warming the affected area YOUR CHILD with your hands, in your TO THE HOSPITAL. lap, and/or in the child’s armpits; don’t rub them. Take her gloves off very carefully 3 Place the affected 4 Raise the affected ▲ TAKE YOUR CHILD part(s) in warm area to reduce TO THE HOSPITAL water—it should be swelling. Give your child around 104ºF (40ºC). the recommended dose Pat dry and cover with of acetaminophen (not a light gauze bandage. aspirin) to ease the pain.

87EFFECT S OF HEAT AND COLD Sunburn IMPORTANT Sunburn is red, and may be itchy or tender. Babies and young children ● If there is blistering are very vulnerable: keep them in the shade; apply sunscreen; put on a or other skin damage, SEEK MEDICAL ADVICE. hat, and cover with protective clothing in hot weather. ● If your child is Give him cold 1 Move your child restless, flushed, dizzy, water to sip into the shade or or has a temperature or into a cool room and give headache, he may have him a cold drink. Cool heatstroke—CALL 911 the skin with cold water OR YOUR LOCAL EMS. compresses. 2 Apply an aloe vera cream or gel to soothe the skin. Make sure you know your child is not allergic to it. Apply cooling ❯❯ see also cream to reduce discomfort ● Heat exhaustion, p.88 ● Heatstroke, p.89 Heat rash IMPORTANT This is a prickly, red rash that develops particularly around the sweat ● If your baby develops glands on the chest and back and under the arms. heat rash, remove some of her clothes to cool 1 Help your child sit Sponge her Leave her her, or bathe her in down in a cool down skin to tepid water. Dry her room and undress her. dry off in gently, leaving her skin Sponge the affected area the air slightly damp. with cool water. ● If the rash has not 2 Pat her almost dry faded after 12 hours, or with a soft towel, if she develops a raised leaving the skin slightly temperature, SEEK damp.Apply calamine MEDICAL ADVICE. lotion if the rash itches. ❯❯ see also ● Heat exhaustion, p.88

88 EFFECT S OF HEAT AND COLD IMPORTANT Heat exhaustion ● If a baby or very Caused by excessive heat, whether the result of too many clothes or young child develops being left in a hot car, heat exhaustion can lead to dehydration—a loss heatstroke, undress him completely in of water and salts from the body because of excessive a cool room. sweating without taking in fluids to replace what has been lost. A full, bounding pulse is a symptom. ● If your child becomes unresponsive Lay child down 1 Take your child and is not breathing in cool place into the shade or normally, begin CPR into a cool room. Help with 30 chest Put folded towel or him to lie down. compressions cushion under head immediately. CALL 911 2 Raise and support OR YOUR LOCAL EMS. Raise his legs your child’s legs on some pillows.This improves blood supply to the brain. Encourage him to rest quietly. Give him as much 3 Help your child sip cool water as he as much cool water can manage as he can manage. Later give oral rehydration salts ❯❯ see also or an isotonic sports drink to replace salt lost from ● Checking vital signs, the body. p.14 ✆ SEEK MEDICAL ● Heatstroke, opposite ADVICE ● Unresponsive baby, 4 Monitor breathing, pp.19–21 pulse, level of response, and temperature. ● Unresponsive child, If his condition worsens, p.22–27 ☎ CALL 911 OR YOUR LOCAL EMS

89EFFECT S OF HEAT AND COLD Heatstroke IMPORTANT This is a life-threatening condition that develops if the body becomes ● If a baby or very overheated in hot surroundings. Treat your child for heatstroke if she young child develops develops a sudden headache; is confused; has hot, flushed, dry skin; is heatstroke, undress becoming unresponsive; and has a temperature of over 104°F (40°C). him completely in a A rapidly weakening pulse is very serious. cool room. Pour water on 1 Quickly move ● If your child becomes sheet to keep it cool child into a cool unresponsive and is not place. Remove as much breathing normally, outer clothing as you can. begin CPR with 30 chest compressions immediately. CALL 911 OR YOUR LOCAL EMS. Cover child with ☎ CALL 911 OR YOUR cold wet sheet LOCAL EMS Remove outer 2 Help the child sit clothing down on ground. Support her with pillows and/or against a wall and wrap her in a cold, wet sheet. Gently pour more water over the sheet to keep it cool. Monitor 3 A fan, and icepacks temperature applied to the groin and armpits, will also help cool the child, but make sure she doesn’t shiver, which will actually raise her core temperature. Cover with 4 Replace wet sheet ❯❯ see also light covering with dry, light once cooled cover. Reassure your child ● Checking vital signs, and monitor breathing, p.14 pulse, level of response, and temperature while ● Unresponsive baby, waiting for help to arrive. pp.19–21 Repeat the cooling if her temperature starts ● Unresponsive child, to rise again. p.22–27

90 MEDIC AL DISORDERS IMPORTANT Allergy ● If the child’s This is an abnormal reaction in the body’s defenses that occurs in response condition does not to exposure to an allergen, and symptoms vary depending on the cause. improve, the rash Common allergens include pollen; dust; some foods such as nuts, worsens or he develops shellfish, and eggs; as well as insect stings or bites. Mild allergy normally breathing difficulties develops slowly, and a child may have an itchy rash or raised blotchy areas and/or swelling of on his skin, sneezing, and red itchy eyes. Any swelling of the feet, hands, the face or neck or is and/or face; wheezing; and even stomach pain, vomiting, and diarrhea becoming distressed, can be signs of a serious anaphylactic reaction. treat for anaphylactic shock, opposite. CALL 911 OR YOUR LOCAL EMS. 1 Try to identify Dab calamine the cause and try on itchy skin to remove the allergen ❯❯ see also from the child or the child from the allergen. ● Asthma, p.35 If pollen is the allergen, move him indoors. If he ● Anaphylactic shock, has a reaction to laundry opposite detergent, remove the affected clothing. 2 Treat any symptoms. For example, soothe an itchy rash with calamine lotion. Suggest he use his asthma medication if necessary. 3 Talk to your pharmacist because some mild allergies can be controlled with over-the- counter medication formulated for children. If the symptoms persist, ✆ SEEK MEDICAL ADVICE Offer recommended dose of antihistamine medication

MEDIC AL DISORDERS 91 Anaphylactic shock IMPORTANT This is a severe allergic reaction affecting the whole body that may ● If child has a known develop within a few minutes of, for example, the injection of a drug, allergy and has her an insect sting, or ingestion of a food. It causes constriction of the air own medication, help passages and swelling of the face and neck that can result in suffocation. her use it or give it to Suspect anaphylactic shock if your child has increased difficulty her yourself, see below. breathing. Skin may be blotchy or flushed. ● If your child becomes ☎ CALL 911 OR YOUR unresponsive and is not LOCAL EMS. breathing normally, begin CPR with 30 Support her in a chest compressions immediately. CALL 911 position that helps 1 Help your child OR YOUR LOCAL EMS into a position her breathing; that helps breathing. ❯❯ see also sitting upright is often best ● Checking vital signs, p.14 Help with medication. ● Shock, p.36 2 Monitor breathing, pulse, and level of ● Unresponsive baby, response as you wait for pp.19–21 emergency help. If pulse weakens and she becomes ● Unresponsive child, pale, treat for shock. pp.22–27 Administering an auto-injector A child with a known allergy is often prescribed medication—usually an auto-injector of epinephrine— to use in the event of a reaction. 1 Hold the injector with your fist Push injector into and remove the safety cap; don’t thigh muscle put your thumb over the end. (through clothing) until it clicks Safety cap Tip 2 Place the tip firmly against the child’s thigh to release the medication. Hold it in place for 10 seconds, remove it, and rub the injection site for 10 seconds; repeat at 5-minute intervals if there’s no improvement.

92 MEDIC AL DISORDERS IMPORTANT Diabetic emergency ● Do not give an If a child with Type 1 diabetes has low blood sugar he may be weak or unresponsive child hungry; confused or behaving aggressively; sweating; and very pale. He anything to eat or drink. may also have a strong, pounding pulse and breathing may be shallow. ● If your child does not Give him a sugary Help your child to sit improve after food or drink or sweet food down and give him a drink, or deteriorates, 0.5–0.7oz of glucose CALL 911 OR YOUR Sit child (5fl.oz orange juice, or LOCAL EMS. down 3tsp sugar) to raise his blood sugar levels. If he ● Do not give your recovers, give him more. child a diet or low- Check his glucose levels calorie drink. and monitor him until he is fully recovered. ● Make sure the child’s doctor checks insulin dosage even if he seems to have recovered completely. ✆ SEEK MEDICAL ADVICE If the child becomes unresponsive If she is breathing, place her in the recovery position, p.26.Then, ☎ CALL 911 OR YOUR Place unresponsive breathing child LOCAL EMS in the recovery position 1 If she is not Check for breathing breathing normally, begin CPR immediately (see p. 24) Open with 30 chest airway compressions. 2 Open airway and give 2 rescue breaths

MEDIC AL DISORDERS 93 Fainting IMPORTANT Your child may be about to faint if she complains of feeling weak, sweaty, ● Do not sit your child and nauseous, and is very pale. The period of unresponsiveness is brief on a chair with her and accompanied by a slow pulse; recovery is rapid and complete. head down if she is feeling faint because 1 Help your child lie down and 2 Reassure your child and she may fall off and raise her legs above the level help her sit up gradually. hurt herself. of her heart; this helps improve the If she starts to feel faint again, blood flow to the vital organs. help her to lie back down until ● If your child becomes Support her legs on a pile of pillows she feels better, then try again. If unresponsive and is not or folded blankets. you are concerned about your breathing normally, child after the faint, begin CPR immediately with 30 compressions. CALL 911 OR YOUR LOCAL EMS. ✆ SEEK MEDICAL ADVICE Cool her ❯❯ see also by fanning her face ● Unresponsive child, pp.22–27 Raise her legs above the level of her heart

94 MEDIC AL DISORDERS IMPORTANT Fever ● If your baby is under A body temperature that is above 100.4°F (38°C) indicates fever. An three months old, you infection is the usual cause. A moderate fever is not harmful, but a should not give her temperature above 102.2°F (39°C) can be dangerous and may trigger acetaminophen syrup seizures, particularly in very young children. As the fever advances unless you are advised she will have hot, flushed skin, be sweating, and have a headache. to do so by your doctor. Take her 1 Take your child’s ● If your child is very temperature temperature. If hot, take off as many you are using a digital clothes as possible; but Tuck the thermometer, on a young do not sponge with thermometer child lift your child’s arm water to cool her. under her arm and tuck the pointed end into her armpit. Fold her ● If your child arm over her chest and complains of a severe leave the thermometer headache, suspect in place until it beeps; meningitis. TAKE an armpit reading will YOUR CHILD TO THE be about 1ºF (0.5ºC) lower HOSPITAL or CALL 911. than under the tongue. ● Raised body temperature can be caused by overheating, see Heatstroke p.89. Leave a drink 2 Make your child beside her comfortable on a bed or sofa, but do not ❯❯ see also Give her the cover her.To help bring recommended down her temperature, ● Febrile seizures, p.96 dose of make sure she has plenty ● Heatstroke, p.89 acetaminophen of water or diluted fruit ● Meningitis, opposite syrup juice to drink. 3 You can give her the recommended dose of acetaminophen syrup (not aspirin) to help reduce her temperature; never give aspirin to anyone under the age of 16 years.

MEDIC AL DISORDERS 95 Meningitis IMPORTANT This is a life-threatening infection affecting the tissues that surround the ● If there is any delay brain. In the early stages your child will have a flulike illness with a high contacting medical temperature. If his neck is stiff and his eyes are sensitive to light, he advice, or if you are needs immediate medical evaluation. Take him to the hospital or call 911 concerned about or your local EMS. He may complain of cold hands and feet, or joint and your child’s condition, limb pain. As infection develops he is likely to have a headache, begin TAKE YOUR CHILD vomiting, and become increasingly drowsy. Later, a red or purple rash TO THE HOSPITAL may develop that does not disappear if pressed. or CALL 911 even if you have already Child may 1 If your child has seen a doctor. complain that a high fever and light hurts his eyes a flulike illness, monitor ● In some cases, the him carefully. If light hurts rash may not develop, his eyes and he has a stiff or if it does, it will neck, he needs immediate be one of the last medical attention. symptoms to appear. ☎ CALL 911 OR YOUR LOCAL EMS Meningitis rash will 2 Treat fever. Give remain visible if you him plenty of press a glass against it fluids to drink and the recommended dose of acetaminophen syrup (not aspirin). Check your child’s body for signs of a rash. If you see any spots, press a glass gently against them. If you can still see the spots through the glass, ✆ SEEK MEDICAL ADVICE Press side of a glass ❯❯ see also against the rash ● Febrile seizures, p.96 ● Fever, opposite

96 MEDIC AL DISORDERS IMPORTANT Febrile seizures ● Do not sponge a Young children may develop these seizures when they have a high child with lukewarm temperature. Suspect a febrile seizure if your child has a fever and is water to cool her having a seizure: she is shaking vigorously; flushed and sweating with because there is a risk a very hot forehead; eyes are rolled upward, fixed, or squinting; she is of overcooling her. holding her breath and her face looks blue; she is clenching her fists. ● If a child becomes Protect her 1 Place soft padding, unresponsive, check with padding such as towels or breathing. If breathing, pillows, around your place in the recovery child so that even violent position; if not, begin movement will not lead CPR immediately. to injury. CALL 911 OR YOUR LOCAL EMS. Cool her by 2 Undress your child removing clothing to help cool her down. Make sure there is a good supply of cool fresh air, but be careful not to overcool her. After seizure Place her 3 When the seizure stops, cover in recovery stops, place her her with position in the recovery position. a sheet Cover her with a light blanket or sheet and ❯❯ see also reassure her. If her temperature rises again, ● Fever, p.94 repeat steps 1 and 2. ● Unresponsive baby, pp.19–21 ☎ CALL 911 OR YOUR ● Unresponsive child, LOCAL EMS pp.22–27

MEDIC AL DISORDERS 97 Epileptic seizures IMPORTANT These are caused by a disturbance in the electrical activity of the brain. ● Do not hold her A seizure may progress through stages: sudden loss of responsiveness, down or try to move sometimes with a cry; rigidity and arching of back; breathing may cease; her during the seizure. jerking or vigorous shaking movements begin; froth or bubbles appear at the mouth, possibly blood stained; loss of bladder or bowel control. ● Do not put anything The child will be responsive again within a few minutes and appear in her mouth or give dazed. Afterward she may fall into a deep sleep. her anything to eat or drink. Clear away 1 If your child starts nearby objects, to fall, help her ● Look for a card or such as chairs to the floor. Prevent bracelet alerting you to injury by clearing away the fact that a child has objects that she may a history of epilepsy. knock against. ● If your child has never had a seizure before, it lasts more than 5 minutes, she has repeated seizures, or if she is unresponsive for more than 10 minutes, CALL 911 OR YOUR LOCAL EMS. Protect her head with soft padding 2 Place padding Absence —make sure it cannot cover airways under or around seizures her head to prevent injury. Place her in the recovery These seizures can position if breathing 3 When her seizure be recognized by a is over, your child momentary “switching may become unresponsive. off,” some facial Remove any padding and twitching, or distracted open her airway and movements such as check breathing. lip-smacking. If this happens, reassure 4 If she is breathing, the child and seek place her in the medical advice. recovery position. Stay with her until she is fully ❯❯ see also recovered. She may feel dazed and behave oddly, ● Unresponsive baby, or sleep deeply. pp.19–21 ● Unresponsive child, ✆ SEEK MEDICAL pp.22–27 ADVICE

98 MEDIC AL DISORDERS IMPORTANT Vomiting and diarrhea ● If vomiting is A baby or child who is suffering repeated vomiting and/or diarrhea can prolonged, your child become dehydrated very quickly. It is important to replace lost fluids by may need to be treated giving your child sips of water. Don’t give a baby or child milk unless with oral rehydration you are breastfeeding. solutions. SEEK MEDICAL ADVICE. 1 If your child is vomiting, hold her ● Do not give your over a bowl. Support her child antidiarrheal upper body with your free medication. hand while she vomits. Reassure her. Support her while she vomits Give her water 2 Give her drinks to drink of water to replace any fluid loss and to remove the unpleasant taste. Encourage her to sip each drink slowly. 3 Let her rest quietly, in bed if she wants to. Make sure the bowl is still at hand in case she vomits again, and give a fresh drink of water. When she is hungry again, offer easily digested foods such as pasta, bread, or potatoes in the first 24 hours.