Q&A FIRST AID: The Parent Company My Baba 21 December, 2012 Baby, Parenting How do you treat a child with a nose bleed? The trick is to stem the blood flow by pinching the soft part of the nose by the nostrils and sitting quietly. A slight lean forward will mean that the blood will not trickle down their airway or make them sick from being swallowed. It might take quite a while for the bleeding to stop and you should expect to sit quietly and comfortably for 15 minutes whilst holding the nose. If they are upset this can prolong the bleeding so trying to calm them down will make a big difference. If it seems to be taking longer than 15 minutes you can try asking them to sip an iced drink. If after 30 minutes of pinching continuously it still hasn’t stopped it is then time to pop up to the hospital. If it has stopped resist the temptation to blow their nose and discourage them from picking. If my child bumps their head, how do I know how serious it is? Is there anything I should look out for? Typically my children only bump their head before bed, which is always a worry. Children notoriously bump their heads before bed time! This is because they are tired and therefore more clumsy than usual. Initially as long as they did not lose consciousness your job is to comfort them, watch how they react and look out for any unusual or unexpected behaviour. It is quite normal after all the drama, upset and probably tears for the child to be sick and this is ok if it is once. If they are sick on two or more separate episodes over the next few hours this means you should get them looked at. It is also quite normal after they have calmed down, and particularly after they have cried for a while, to feel tired, especially if it’s bed time. It is ok to let them sleep, as long as you check on them every couple of hours. If they respond to you when you talk to them or tickle their toes then this is normal. If you can’t get a response to a firm or loud stimulus then this needs checking out. We mentioned looking out for unusual or unexpected behaviour. If there has been an episode of unconsciousness, keep them lying down, preferably on their side, re-assure and call an ambulance. If they appear confused or drowsy such that they are struggling to stay awake you will need medical advice. You know your child better than anyone and are the best judge of behaviour that is not normal for him or her. If you see these symptoms or just feel they are not themselves after they have settled down please seek medical help. Bumps on the head can also lead to cuts and heads tend to bleed a lot. Even small cuts can make quite a mess. It will need to be seen to if you can’t stop the bleeding, if it appears deep or if it is wider across than your thumb nail. What should I do if my child burns or scalds himself? How can I tell how serious the burn is and what should my immediate action be? For burns your mantra should be ‘cool the area and keep it clean’. The first thing you need to do is remove any clothing that immediately surrounds the area of the burn unless the clothes are already stuck to the skin in which case leave them, as you will damage the skin. Don’t forget nappies as they can soak up the hot fluid. Then run cool water over the area for 15 minutes. This can be torture for a little one, however it doesn’t have to be ice cold and it doesn’t have to be running; cold water run into a bowl with some ducks and boats might make the idea a whole lot more appealing, and you’d be surprised we have seen even toddlers work out pretty quickly that keeping their hand under the water hurts a lot less than taking it out. Bear in mind that little people lose body heat a lot quicker than us so running a cool shower over their body may seem to be a good idea if they have spilt tea over their front but they’ll soon get cold and shivery and we don’t want that either. A cool compress on the area whilst the rest is dry and warm might be a better alternative. After the cooling period if; – there is an area of redness, or blistering, – it crosses over an area of skin where a joint is (for example the tips of fingers over the knuckle) , or – the burn is bigger than the size of their palm cover the burn with cling film as this does not stick (being careful not to wrap them as this could cause swelling), keep a cool compress over the cling film, give them some pain medicine and take them to hospital. DO NOT PUT ANY OINTMENTS, CREAMS OR ANYTHING ELSE ON THE BURN. There are areas where any burn should be checked out by a medical professional. These are – the face, especially around the nose, mouth and eyes – palms of the hands/feet – genital areas I’m told that your mind often goes blank in an emergency, what’s the most important thing to remember? We have to say that the majority of parents that our nurses meet in the emergency room do amazingly well in the face of adversity. Fear releases adrenalin with gives us almost super human capabilities! Take a deep breath, this will give your brain fuel to think with then things may become clearer! To a degree the most important thing might change according to what the situation is. Although hard, your own safety is the most important thing – if you are also endangered by the same issue as your child you may not be in a position to help them if you try to rescue them, especially if you are alone. In serious incidents airway and breathing always take precedence over other injuries and therefore should be dealt with first. If you are on your own you can start to assess this and take action before you go for help but if there is someone else they should get help as soon as you know something is wrong. In less serious events people struggle to remember the most basic of details like phone numbers and postcodes, even emergency numbers. At the parent company we recommend keeping these details in a prominent place next to the land line, that way even if someone else is ringing for help they’ll know the correct details. You can download our ‘MY FAMILY MEDICAL CHART” by clicking on the link at the bottom of this article. This useful chart asks you to list all the important medical numbers for your family and then take a photo of it to keep on your phone as well. By the way, I recommend that you should always have a static land line, a walkabout isn’t always where you expect it to be and your mobile may not always have signal. How should I deal with a choking baby? It is useful to know a little bit about the baby’s anatomy so that we can think about preventing the choking as well as dealing with it. Children’s airways are round and cylindrical; they are wider at the top than further down, just like a funnel. For this reason you should never blindly search with your finger for something that might be causing an issue as you could make it worse. Because of the shape they may choke more on rounder things like banana, carrot, sausage slices, mini tomatoes or grapes. By changing the shape it might improve their efficiency in dealing with it or prevent it going the wrong way quite so easily – baton the carrots or sausages into strips or cut the round sections into halves again, quarter grapes or cut them length wise rather than across the short middle section. Always supervise children eating and where possible encourage them to sit down and eat, even if it’s only a packet of crisps. Avoid eating if they are crying or upset. Concentration on eating might make the difference. If they do get into trouble the most effective thing initially is often to support them to cough more effectively, sit them forward if they are lying down, maybe stand them up if they are old enough to do so unaided as this makes their coughing more effective. If they are becoming tired or they cannot cough or make noise then you need to help and you will also need to think about further help, especially if you are on your own. These are the steps for a baby up to the age of 1 year: Step 1: Back Slaps Start with 5 slow, firm, sharp slaps with the heel of your hand between their shoulder blades to dislodge the object. It may help if you can manoeuvre them into a position where gravity will help it to fall out. Step 2: Chest Thrusts After 5 back slaps check to see whether the obstruction has dislodged. If it has not been dislodged turn them over to do five chest thrusts. Place two fingers in the middle of their chest just below the nipples, and push inwards and upwards up to five times. If chest thrusts do not dislodge the object, repeat steps one and two. Keep alternating between step 1 and step 2 until either the obstruction clears or you need to implement rescue breathing. NOTE: The process for dealing with choking is simple and only two steps but a first aid class where you can learn on a special training doll and practice so that you know how hard the back slaps and chest thrusts should be, help to cement the knowledge and crucially give you the confidence to take action. What is an anaphylactic shock and what do I do if my child has one? Allergic reaction ranges from itching blotchy skin to full anaphylaxis which is a severe allergic reaction usually requiring the medication adrenalin to be given, often in the form of an Epipen. It can in its worse form cause difficulty in breathing due to swelling in the area of the windpipe. It can also cause diarrhoea and vomiting in large amounts, especially if it’s a food stuff that has caused it. It is not usually the first time that you meet something that you have a severe reaction to it, it’s sometimes the second or third exposure, and there is no rhyme or reason as to why we sometimes develop these reactions. It is to do with the developing immune system which is why sometimes children will have an issue with tomatoes or kiwis and pineapple or peanuts if they are introduced before their body is ready. If your child develops symptoms of an allergic reaction such as swelling, blotchy rash, or hives then you could give them a dose of children’s antihistamine such as Piriton and observe the results. If things improve then keep an eye on them and reassess after the medication wears off. If things do not improve take them to hospital where they can give them more medication that will help. If they show more serious signs like swelling to the lips and tongue, breathing difficulties, wheezing or diarrhoea or vomiting then you should assess whether they should go to hospital and also whether you are the best mode of transport – difficulties in breathing especially in this instance are very often safer in an ambulance. In the mean time keeping an eye or their breathing, supporting them sitting up right and trying to keep them calm may help until the ambulance arrives. I hear that if a child overheats they can fit, what should I do if that happens? Some children suffer with febrile convulsions, which are fits that occur usually in relation to a rise in temperature. This is not necessarily related to epilepsy and doesn’t mean that the child will always fit. It tends to be a phenomenon that affects children between the ages of 1 and 6 at which stage they usually grow out of it. All seizures are frightening, especially the first time. Your baby or child might look hot and red faced, their eyes may roll in the back of their head, their bodies can go stiff or twitch, they clench their fists and they may hold their breath. Whilst we don’t know everything about these fits, like why some people get them and others don’t, we know that there is not one temperature that causes it to happen. We have known children to have temperatures in excess of 40’C and not fit but other children fit with a much lower temperature. One school of thought is that febrile fits are related to the rate of rise of fever. It is usually because of an illness and once the illness, or bug, has gone or the temperature is subdued through medication, the fits stop. If your child has a fit your job is to – Keep them safe. Keep their head safe from injury by putting something soft under it and remove any objects that they could hurt themselves on. – Cool them down by removing clothing or blankets and if the room is hot ensure there is a flow of fresh air, perhaps opening a window. A paracetomol based medicine will also help to bring a temperature down but do not administer this whilst they are having a fit. – Once the seizure is over rest your baby or child on their side with their head tilted back. This will help them to breathe easily. If a child has not had a seizure before you should call an ambulance straight away. The ambulance control can then give medical advice whilst sending help. You may be tempted to drive to Accident and Emergency but although the child might be safe in the back of your car there is no guarantee you’ll be in a suitable frame of mind to drive safely. If this is NOT a first seizure you should have already been advised about what to do if it happens again and can give medication if it has been prescribed or seek medical advice. However if the seizures continue after the treatment above you should call an ambulance. Are their differences in resuscitating an infant and a child? There are some differences like position of the head to open the airway, the size of the breath and the positioning of your mouth for the artificial breathing. For the compressions the strength that you apply is also different for the different age groups, although the position is very similar. That said the guidelines are still 5 rescue breaths followed by 15 compressions before alternating between sets of 15 compressions and 2 breaths. NOTE: If you have not been taught resuscitation skills please do attend a first aid class where you can learn on a special training doll that allows you to practice so that you know how to open the airway and learn how to do rescue breaths and compressions. It is not hard to learn and it will give you the confidence to deal with an emergency. How important is it to participate in a first aid course, and for those that cannot afford to have a class at home, what are the other options? First aid courses give you knowledge and confidence in your ability to provide care if your little one gets into trouble and will certainly help with that mind blank that you asked about it question 5! There are lots of different courses available. The Parent Company classes allow you to go at your own pace and practice as much as you want. In addition we are all trained children’s nurses with an advanced life support qualification and experience in these circumstances. Click here to read what people say about our classes. There are other alternatives though. The Red Cross and St Johns Ambulance run paediatric first aid classes from time to time and some local authorities provide classes through Children’s Centres. The NHS Choices website has excellent advice on first aid. What’s the most commonly asked question? I think we have covered most of the common questions but people ask all sorts of different things which are particular to their worries. Lots of people like to know about meningitis or poisoning. Some people ask more gory questions like how to deal with bleeding or knocked out teeth. The truth is that our first aid courses are so comprehensive that we very rarely get asked any questions at the end of it because we’ve usually discussed everything. This article is provided by The Parent Company for general information only and should not be treated as a substitute for medical advice from your doctor or any other health care professional. The Parent Company is not responsible or liable for any diagnosis made or actions taken by a user based on the information it contains. These questions have been answered by The Parent Company. We provide private first aid classes in your own home for small groups. Our trainers are all paediatric nurses working in Accident and Emergency, paediatric wards or in the community. Call 020 7935 9635 or visit The Parent Company for more information.