The latest child care related news, views and reviews August 14, 2013
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Incidents and accidents in the home
It's time we all brushed up on first aid

first aidAll manner of things can happen to children at home, from allergic reactions to asthma attacks, bites, stings, burns and convulsions. Would you know how to deal with them all?

For example when was the last time you did a first aid course? And would you know how to deal with the majority of household injuries, emergencies or accidents at home or at play?

Can you remember what to do and what not to do when dealing with injured or sick kids, such as never slap a choking child on the back if they are able to cough and always put the head forward not back for a nose bleed?

According to Kidsafe, the Australian not-for-profit organisation set up to help prevent injuries and deaths in children, about 350 children are killed each year and more than 60,000 are hospitalised as a direct result of accidents.

And a 2009 report published by the Australian Institute of Health and Welfare suggested that young boys were overall 80 per cent more likely to die from injury than young girls.

Most home and play related accidents are preventable, but if you can't prevent them, could you treat them? Can you correctly answer the following questions relating to common incidents in the home?

  • What's the correct way to treat a burn?
  • Do you know the procedure for a spider or snakebite?
  • How should you deal with an asthma attack?
  • What are the steps to take with anaphylaxis?
  • What is a normal vs a dangerously high temperature?
  • What's a febrile convulsion and what should you do?
  • How do you correctly deal with a choking baby? And how does it differ with an older child or adult?

St John's Ambulance Australia runs a first aid course called Caring For Kids. This course is designed to meet the first aid needs of parents, grandparents, carers in the child care industry and members of the public who may be entrusted with the care of babies and children.

It covers pretty much every situation you're likely to come across from bites and stings, nosebleeds, fits, choking, bleeding, concussion and potential spinal injury.

The principle behind every emergency procedure though is what is known as the DRSABCD or Drs ABCD. DRSABCD (which applies for adults and children alike) stands for:

  • DANGER – always check the danger to you, any bystanders and then the injured or ill person. Make sure you do not put yourself in danger when going to the assistance of another person.
  • RESPONSE – is the person conscious? Do they respond when you talk to them, touch their hands or squeeze their shoulder?
  • SEND for help – call triple zero (000). Don't forget to answer the questions asked by the operator.
  • AIRWAY – Is the person's airway clear? Is the person breathing?
  • If the person is responding, they are conscious and their airway is clear, assess how you can help them with any injury.
  • If the person is not responding and they are unconscious, you need to check their airway by opening their mouth and having a look inside. If their mouth is clear, tilt their head gently back (by lifting their chin) and check for breathing. If the mouth is not clear, place the person on their side, open their mouth and clear the contents, then tilt the head back and check for breathing.
  • BREATHING – check for breathing by looking for chest movements (up and down). Listen by putting your ear near to their mouth and nose. Feel for breathing by putting your hand on the lower part of their chest. If the person is unconscious but breathing, turn them onto their side, carefully ensuring that you keep their head, neck and spine in alignment. Monitor their breathing until you hand over to the ambulance officers.
  • CPR (cardiopulmonary resuscitation) – if an adult is unconscious and not breathing, make sure they are flat on their back and then place the heel of one hand in the centre of their chest and your other hand on top. Press down firmly and smoothly (compressing to one third of their chest depth) 30 times. Give two breaths. To get the breath in, tilt their head back gently by lifting their chin. Pinch their nostrils closed, place your open mouth firmly over their open mouth and blow firmly into their mouth. Keep going with the 30 compressions and two breaths at the speed of approximately five repeats in two minutes until you hand over to the ambulance officers or another trained person, or until the person you are resuscitating responds. The method for CPR for children under eight and babies is very similar and you can learn these skills in a CPR course.
  • DEFIBRILATOR – for unconscious adults who are not breathing, apply an automated external defibrillator (AED) if one is available. They are available in many public places, clubs and organisations. An AED is a machine that delivers an electrical shock to cancel any irregular heart beat (arrhythmia), in an effort get the normal heart beating to re-establish itself. The devices are very simple to operate. Just follow the instructions and pictures on the machine, and on the package of the pads, as well as the voice prompts. If the person responds to defibrillation, turn them onto their side and tilt their head to maintain their airway. Some AEDs may not be suitable for children.


NOSEBLEEDS: Head back or forward?

The answer is never put a child's head back when they have a nosebleed. It can cause them to choke and essentially drown in their own blood.

Bleeding from the nose is usually not severe, but is very messy!

The most effective and best way to treat a nosebleed is as follows:

  • Sit the child upright and ask them to tilt their head forward.
  • Using the thumb and forefinger, squeeze the nostrils shut.
  • Hold for at least 10 minutes.
  • Release the hold gently and check for bleeding. If the bleeding has stopped, avoid blowing your nose or picking at it for the rest of the day.
  • If bleeding continues beyond 20 minutes, go to the doctor.

CHOKING: How do treat a child who is choking – never slap a coughing child on the back

Treatment for a choking child or baby is slightly different than for an adult. The most important thing to remember is never to pat or slap your choking child on the back if they are managing to cough. Your actions may dislodge the object and allow it to be inhaled deeper into the airway.

Note that in a young child, their struggle to breathe may not last long and the stopping of frantic activity may signal a serious or life-threatening situation, rather than a sign that they have dislodged the blockage. Look for other signs and symptoms such as the child's responses, a pale face, or cold and clammy skin. These are signs that the child is in shock.

Immediate steps when a child is choking:

  • Immediately check if the child is still able to breathe, cough or cry. If so, they may be able to dislodge the object by coughing.
  • Do not try to dislodge the object by hitting the child on the back or squeezing the stomach – this may move the object into a more dangerous position and cause the child to stop breathing.
  • Stay with the child and watch to see if their breathing improves.
  • If the child is not breathing easily within a few minutes, call triple zero (000).
  • If, after the coughing settles down, there is any continued noisy breathing or coughing, take the child to see a doctor, as the object may have lodged in the windpipe or airway. If this is the case, it will need to be removed in hospital using a special instrument.

UNCONSCIOUSNESS: What to do when the child is not breathing

If the child is not breathing:

  • For a young child (under about five years), place the child face down over your lap so that the head is lower than the chest. For an older child, lay them on their side. Give four sharp blows on the back between the shoulder blades to dislodge the object.
  • Check again for signs of breathing.
  • If the child is still not breathing, call triple zero (000) and ask for an ambulance. The ambulance service operator will be able to tell you what to do next. You will probably be advised to start expired air resuscitation (mouth to mouth) while waiting for help.
  • Do not use the Heimlich manoeuvre (squeezing the abdomen or hitting the child in the abdomen) unless directed to by the ambulance service operator, as this can cause serious damage to organs in the abdomen.

BURNS: Never use ice or iced water

Burns are a very common childhood injury and largely preventable. Children's skin is also much less hardy than adults and burns much more easily. Common causes are hot drinks (not necessarily boiling, just hot); hot water (Australian houses are usually set to 65C water temperature – this is way too hot for a child. Reduce your boiler temperature to 50C); ovens and pans and oils or candles.

If a child or adult is burned, you should:

  • Apply cool running water (not ice or ice water) to the burn for at least 20 to 30 minutes (useful for up to three hours after the burn).
  • Carefully remove wet clothing only if the skin is not blistered or stuck to the clothing.
  • Remove all jewellery and watches. Burns cause swelling and it may hinder circulation.
  • Cover the burn using a clean dressing, a clean sheet, non-fluffy towel/tea towel or gladwrap.
  • If the burn is severe or spread over a large area, keep the child warm and calm, and dial triple zero (000) to call an ambulance.
  • Burns that involve the face, hands, feet, genitals or bottom, or if the burnt area is larger than a twenty-cent piece, should be seen by a doctor as soon as possible.

FEVER: What is a high temperature and when is it dangerous?

As a general rule a temperature of over 37.5 (99.5F) is a fever. You can use a thermometer to find out if your child has a fever.

Most fevers are caused by an infection or other illness and they simply mean your body is helping to fight the infection by stimulating its natural defences. By increasing the body's temperature, a fever makes it harder for the bacteria and viruses that cause infections to survive.

You can usually treat fever in young children at home using infant paracetamol. But if the fever persists and is not reacting to paracetemol and you also notice any of the following symptoms, you should take your child to the doctor immediately. Doctors should never turn down a sick child, regardless of whether their diaries are full or not.

Symptoms that may be a sign of a more serious illness include:

  • being unusually sleepy
  • not drinking for more than eight hours
  • having a non-blanching rash (a rash that doesn't fade when a glass is pressed firmly against the skin; this is known as the tumbler test)

Always go to A & E or call 000 if you are worried your child's condition may be serious. It's better to be safe than sorry.

FITS: What is a Febrile Convulsion?

Febrile convulsions are seizures (or fits) that sometimes happen in children who have a high temperature. They are most common in children under three and are rare after the age of six. About one in three children will have another febrile seizure when they are next ill, especially within the first year of their first seizure.

Febrile convulsions can happen as a result of any illness that causes a high temperature. They can be frightening for parents, but look much worse than they actually are. Febrile convulsions rarely cause any long-term complications.

If the fit has not stopped within three minutes call 000. If it is your child's first ever seizure (or fit) and it has stopped and the child has fully recovered you should still seek medical advice.

The fact is that we could probably all learn more safety tips and procedures. Most parents have never even done a basic first aid course. So make it your mission to do one in the next few months. You never know when you might need to use first aid. You should also always insist on seeing a babysitter's, nanny's or child carer's First Aid certificate or qualifications.

Regardless of whether a carer has been formerly trained in child care, they should, as standard, have had first aid training.

SOURCES: KidSafe and Better Health VIC, St John's Ambulance and NHS UK.

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