As a paediatric doctor I am often in Paediatric A&E facing various first aid crises.  It’s a traumatic time for both the parents and children, and I wanted to give you a few top tips to increase your confidence when dealing with these situations. Forewarned is forearmed, and some of these suggestions may allow you to stay away from the hospital.

1. Safety in the home

Accidental injury is one of the biggest single causes of death in the UK in children over the age of one – more children die from accidents than from cancer or meningitis. Many of these accidents are preventable with some basic steps.

The first thing is making your home safe. A simple check list includes:

  • Fit smoke detectors
  • Ensure you have fire guards
  • Turn electrical switches off
  • Keep flex cords out of reach
  • When cooking keep pan handles pointing away from the edge and out of reach
  • Keep hot drinks in the middle of the table, or up high, out of reach
  • Child resistant bottles for medicines
  • Keep medicines in a cupboard out of reach, even by chair, or have them in a locked cupboard
  • Don’t hang up bags by their cord – children regular get caught up in the cords
  • Never leave your child in the bath unobserved, even for a second.

2. Essential first aid kit

It is always better to be prepared.  You can often buy a ready made kit from your local pharmacy, or you can make you own up. Make sure you know the basics of first aid – if you don’t, you should try to attend a course. Here is a list of essentials I would recommend having in any house;

  • Non-waterproof plasters in varying sizes
  • x2 sterile eye pads
  • x1 crepe bandage
  • x1 triangular bandage
  • x6 medium sterile dressings pads
  • x2 large sterile dressing pads
  • x1 scissors
  • x6 alcohol wipes
  • x6 safety pins
  • Antiseptic cream
  • Antihistamine cream
  • Paracetamol/ Ibuprofen
  • Tape
  • Thermometer

3. Nose bleed

The most common cause of a nose bleed is from a picked nose.  There is a delicate area of skin in the nasal septum (in between of the nostrils) which is very vascular and will bleed when scratched.  To stop this area of the nose from bleeding you pinch the soft tissue around the nostrils and sit the child down with their head tipped forward.  Ask them to breath through their mouth.  You will need to apply pressure for about 3-10 minutes.  If the bleeding does not stop then you will need to go to A&E.

4. Objects stuck in the ear

Straight to A&E I am afraid.  You risk pushing the object further into the ear canal if you have ago yourself. This may mean the A&E team can’t retrieve it and your child needs to have an operation to have it removed.

5. Objects stuck in the nose

This you can often deal with at home. You need to put your mouth over your child’s mouth and blow a short, sharp breath into their mouth.  The aim of this is to force some air up their nose and to push the object out.  Beware you might get covered with mucus!   Having an object in the nose is deemed as a medical emergency because it might dislodge and move to block your child’s airway.  If you can’t remove it yourself you need to seek medical help.

6. Swallowing poisons or tablets

Straight to A&E as quickly as possible.  Remember to take the box of tablets or the bottle of solution with you.  Once at the A&E they will investigate what is in the tablet/liquid and make a plan.  Getting your child to A&E quickly is key to allow action to be taken before the poison is absorbed.

7. Burns

The injured area needs to be put under cold running water immediately.  This will reduce the heat of the skin.  Do this for 10 minutes.  Allow the area to warm up again and, if needed, put it under the tap for a second time for not longer than 10 minutes. More than 10 minutes could lead to the child getting cold.  If you do not have any running water to hand then immerse the wound in any cold liquid you have. You can use a shower head to apply the water to the affected are if one is to hand.  Submerging your child in a cold bath is not ideal as it can make them extremely cold.

Do not remove your child’s clothes if they are stuck to their skin.  Use cling-film, to cover the burn or scald.  Please don’t put butter, toothpaste, oil or ointment on a burn or scald as it will have to be cleaned off before treatment.

Blisters will burst naturally. The raw area underneath them will need a protective dressing.

8. A fit and convulsions

If your child has a fit they may suddenly turn blue and become rigid, with staring eyes. Or their eyes may roll and their limbs may twitch and jerk. Or they may suddenly go floppy. The following will help to deal with the situation:

  • Keep calm, try to remember to note the time.
  • Loosen anything tight around their neck.
  • Make sure that they are not in a place that could cause them harm if they hit anything when twitching/jerking.
  • Don’t put anything in their mouth. If you think they’re choking on food or an object, try to remove it.
  • Most fits will stop within three minutes. When it’s over, reassure your child and make them comfortable. Ideally put them in the recovery position (on their side with their chin raised up)
  • If the fit hasn’t stopped within three minutes or it is their first fit, go to hospital.
  • Don’t panic. Fits need to last longer than 30 minutes for there to be any risk of damage.

Although fits may look alarming, they’re common in children under the age of three. The most common reason for having a fit in this age group is having a temperature.  These fits are known as febrile convulsions. Febrile convulsions are not usually connected with epilepsy.

9. Diarrhoea and vomiting

The risk is from dehydration.  If the child is under 3 months you should seek medical advice early as their risk of dehydration is greater.  Give your child sips of cooled boiled water, or dioralyte.  The aim is small amounts of fluid, often. In A&E we give 5-10ml every 5-10 minutes.  If they only want milk or juice give it to them. If they vomit it up they are unlikely to ask for it again!

10. The British Red Cross First Aid App for Babies and Children

It is free and fabulous.  It is very easy to use and full of practical advice.  I have it on my phone too!

DR ANASTASIA ALCOCK
MRCPCH MBBS BSc(Hons) DTM&H DPID DRCOG 

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