Emer­gency First Aid

Your Baby & Toddler - - Emergency & First Aid -

All you need to know in a hurry from A-Z

1ANAPHYLAX­IS (AN AL­LER­GIC RE­AC­TION)

Ana­phy­lac­tic shock is a se­vere whole body al­ler­gic re­ac­tion to a sub­stance such as some foods ( peanuts), stings or drugs. Ana­phy­laxis hap­pens im­me­di­ately after ex­po­sure to the al­ler­gen. It is se­vere and in­volves the whole body. It’s ter­ri­fy­ing, but ac­tion must be taken im­me­di­ately. CAUSES • FOOD Peanuts are a com­mon allergy cul­prit in chil­dren, and even a trace of peanut can bring on ana­phy­laxis in an allergy suf­ferer. Other com­mon food in­sti­ga­tors are fish, shell­fish and fruit, as well as cer­tain spices, food colourants and ad­di­tives. • STINGS Bees, wasps and

jel­ly­fish. • DRUGS Par­tic­u­larly medicines like peni­cillin, anaes­thet­ics and painkiller­s. SIGNS AND SYMP­TOMS Symp­toms de­velop quickly (of­ten within sec­onds) and may in­clude the fol­low­ing: • Anx­i­ety. • Ab­dom­i­nal pain. • Ab­nor­mal (high- pitched) breath­ing sounds and/or wheez­ing. • Chest dis­com­fort or

tight­ness. • Cough­ing. • Dif­fi­culty in breath­ing. • Dif­fi­culty in swal­low­ing. • Dizzi­ness or

light- head­ed­ness. • Hives, itch­i­ness. • Nasal con­ges­tion. • Nau­sea or vom­it­ing. • Pal­pi­ta­tions. • Skin red­ness. • Slurred speech. • Swelling of the face, eyes

or tongue. • Un­con­scious­ness. WHAT TO DO • Im­me­di­ately call for emer­gency as­sis­tance. If you are aware that your child has life-threat­en­ing re­ac­tions to an al­ler­gen, your doc­tor should have pre­scribed an epipen, which needs to be used as directed.

• Lie your child down or cra­dle your child in your arms. If there is vom­it­ing or bleed­ing from the mouth, turn your child onto his/ her side. Do not give any­thing to eat or drink. If there are no signs of breath­ing, start CPR (see pages 20 to 23). • Get emer­gency treat­ment for your child even if the symp­toms start to im­prove. Your child will need hos­pi­tal­i­sa­tion for ob­ser­va­tion as it’s pos­si­ble that symp­toms may re­oc­cur.

2BLEEDING

If your child is in­jured, your pri­or­i­ties are to get emer­gency as­sis­tance and limit blood loss. The first thing to do is to ap­ply firm pres­sure on the wound with a clean cloth. Hold for 10 min­utes or un­til the bleed­ing stops. Once bleed­ing has stopped, do not re­move the dress­ing. Do this only in hos­pi­tal. WHAT TO DO FOR MI­NOR BLEED­ING • Gen­tly wash the wound

with warm, soapy wa­ter. • Cover the wound with an antiseptic cream or oint­ment and ap­ply a sterile dress­ing or plas­ter, de­pend­ing on the size of the wound. • Wash the wound daily

and reap­ply the antiseptic cream and dress­ing un­til heal­ing is com­plete. If the wound shows signs of in­fec­tion ( be­com­ing red, ten­der or pro­duc­ing pus), call your doc­tor. • If the bleed­ing doesn’t stop or the wound seems deep, es­pe­cially if the edges of the wound do not come to­gether by them­selves, treat the wound as out­lined here and take your child to the doc­tor. WHAT TO DO FOR SE­RI­OUS BLEED­ING • Get some­one to phone the emer­gency ser­vices, or, if you are alone, first try to stop the bleed­ing and then take your child with you to the phone. • Cut away your child’s cloth

ing to ex­pose the wound. • Ap­ply pres­sure with a clean cloth or dress­ing. Do not use any med­i­ca­tion on the wound un­til your doc­tor has seen it. • If there is any ob­ject in the wound, don’t re­move it. Ap­ply pres­sure on ei­ther side of it. • Lay the child down and raise the wounded area above the level of the heart, if pos­si­ble. So, for ex­am­ple, for an arm wound, raise the arm above the head. • If blood seeps through the dress­ing, put an­other dress­ing on top and pro­vide more pres­sure to stop the bleed­ing. • Keep the child warm

and calm. • If the blood is spurt­ing in time to the heart­beat and is a bright red colour, an artery may have been cut. Ap­ply di­rect pres­sure and el­e­vate the af­fected area. • Call the emer­gency ser­vices as heavy bleed­ing can be life threat­en­ing.

NOSE BLEEDS

• If your child has a nose bleed, have him lean his head for­ward while sit­ting or stand­ing. • Ap­ply pres­sure and don’t

block the child’s nos­trils. • Keep squeez­ing for 10 min

utes and then re­lease your hold and check to see if there’s still bleed­ing. • If the bleed­ing hasn’t stopped, ap­ply pres­sure for an­other 10 min­utes and if it still con­tin­ues, con­sult your doc­tor. • En­cour­age your child to spit out any blood in the mouth. He may vomit if he swal­lows any blood.

IN­TER­NAL BLEED­ING

WHAT TO LOOK FOR • Bleed­ing from the nose, ears, mouth, vagina or anus. • If you sus­pect in­ter­nal bleed­ing, call the emer­gency ser­vices im­me­di­ately and treat the child for shock if signs of shock are present. Lay him down, keep him calm and cover him with a blan­ket.

EM­BED­DED OB­JECTS

• If an ob­ject (like a piece of glass) is em­bed­ded in the wound, don’t re­move it as it may cause fur­ther bleed­ing. DO THE FOL­LOW­ING • Cover the wound lightly with gauze. Sur­round it with bandage rolls that have been built up to the same height as the em­bed­ded ob­ject. • Once you have se­cured

the pro­tec­tive bandage

cov­er­ing in place, you can now take your child to the hos­pi­tal or call emer­gency ser­vices for as­sis­tance.

3BREAKS AND SPRAINS

Bro­ken bones are very painful for your child and re­quire med­i­cal treat­ment. Fol­low these in­struc­tions when you sus­pect your child has a bro­ken bone: • Try to sta­bilise the af­fected area by ap­ply­ing a splint. In cases where the child has suf­fered any in­jury to a long bone such as the thigh, or the bone is stick­ing out of the skin, call for emer­gency as­sis­tance. • In most in­stances, a par­ent can splint the af­fected limb be­fore trans­port­ing the child to a doc­tor or emer­gency depart­ment. • If your child is in such se­vere pain that you can­not move him/ her, or if you are un­sure if mov­ing your child is safe, call for as­sis­tance. AM­PU­TA­TION Am­pu­tated fin­gers and toes can some­times be suc­cess­fully reat­tached. The key is to get the child to hos­pi­tal as soon as pos­si­ble and to look after the am­pu­tated body parts cor­rectly. • Call emer­gency ser­vices. The paramedics have the nec­es­sary train­ing to care for your child. • Place a clean pad or sterile dress­ing on the in­jury and press on it gen­tly to help staunch the bleed­ing. • If pos­si­ble, raise the in­jured part above the head. • Place the sev­ered part in a clean plas­tic bag or cover it in cling film. • Wrap it in some­thing clean and soft, like a towel, and place it in an­other plas­tic bag filled with ice. • Do not freeze the sev­ered

body part. SPRAINED AN­KLE A sprain is ac­tu­ally a tear in the lig­a­ments and tis­sues around a joint, caus­ing pain and swelling. • Lay or sit the child down and gen­tly re­move his shoes and socks. • Keep the an­kle raised. • Place a cold, damp cloth over the an­kle. Put an ice pack on top to re­duce swelling (a bag of frozen veg­eta­bles works well). • Put a thick layer of cot­ton wool around the an­kle to pro­vide sup­port. • Bandage it in place. If you don’t have cot­ton wool, you can even use a pil­low. • Have the in­jury as­sessed by your doc­tor or the emer­gency depart­ment. BACK AND NECK IN­JURIES If the child is con­scious, en­cour­age him to lie still in the po­si­tion in which you found him. Stay with him, re­as­sure him, and get some­one to call the emer­gency ser­vices. If you think your child has sus­tained a neck in­jury, do not move him, no mat­ter what po­si­tion he is in. It could be very dan­ger­ous. Wait for the emer­gency ser­vices to ar­rive.

4BRUISES

Ac­tive tod­dlers and young chil­dren suf­fer many mi­nor knocks and falls as they grow and be­come more mo­bile, of­ten re­sult­ing in bruises. They sel­dom re­quire any treat­ment. A cold com­press placed on the area will help if the bruise is more se­ri­ous.

If the child com­plains of ex­ces­sive pain or can­not move the af­fected limb, seek med­i­cal at­ten­tion.

Un­ex­plained ex­ces­sive bruis­ing with­out any sign of in­jury or ex­pla­na­tion needs med­i­cal in­ves­ti­ga­tion.

5BURNS AND SCALDS

Burns oc­cur rapidly and may progress with­out emer­gency care. Whether the burn is caused by heat, elec­tric­ity or chem­i­cals, the trea­ment re­mains sim­i­lar. Burns are di­vided into three cat­e­gories:

SU­PER­FI­CIAL BURNS are red and the skin may be blis­tered. PAR­TIAL THICK­NESS BURNS are very painful and the skin is usu­ally blis­tered. FULL THICK­NESS BURNS leave the skin charred and black, or hard and white.

WHAT TO DO FIRST

• Re­move the source of the burn and cool the burned area by flush­ing it with cool (not cold) wa­ter un­til the pain goes away. • If the child’s clothes are on fire, fol­low the STOP, DROP and ROLL pro­ce­dure. Lie the pa­tient flat down on the ground, then roll him over un­til the flames have all been put out. • Throw wa­ter down­wards to stop any flames reach­ing the face. • If there’s no wa­ter nearby, wrap the child in a blan­ket to de­prive the fire of oxy­gen, or roll him on the floor.

WHEN TO CALL EMER­GENCY SER­VICES

• If the burn area on the child’s body is larger than the child’s palm. • If you sus­pect the child has in­haled any smoke. • If the burn is on the face, gen­i­tals, joints, hands or feet. • If he was burnt by an elec­tric shock. • If the burn is right around a limb no mat­ter what the size.

FIRST AID FOR MI­NOR BURNS

• Gen­tly run cool (not cold) wa­ter over the af­fected area un­til the pain goes away. • Cover with a sterile dress­ing or a clean plas­tic bag to pre­vent in­fec­tion. • Do not ap­ply cot­ton wool or cloth that has fluff that will stick to the burn. • Don’t ap­ply but­ter, ice or any­thing to the area ex­cept for recog­nised burn relief dress­ings like a hy­dro­gel dress­ing. • Never pop the blis­ters, as they have a job to do: they pro­tect against in­fec­tion and help the heal­ing process.

SMOKE IN­HALA­TION

• Smoke in­hala­tion is very dan­ger­ous and is a com­mon re­sult of fires. • Get your­self and your child into fresh air as soon as pos­si­ble. Crawl along the ground where the smoke is less thick. • Call emer­gency ser­vices and the fire depart­ment for help. • If your child is un­con­scious or not breath­ing, lay the child down and open the air­way by tilt­ing his head back, lift­ing the chin gen­tly with one hand and plac­ing the other on his fore­head. • Check for breath­ing. If the child is breath­ing, place him in the re­cov­ery po­si­tion. If the child is not breath­ing, fol­low the ABC of re­sus­ci­ta­tion (from page 20).

FIRST AID FOR SE­RI­OUS BURNS

• Call the emer­gency ser­vices for as­sis­tance. While you are wait­ing, con­tinue with these steps: • Re­move or cut away any clothes from the burnt area, un­less the clothes are stuck to the skin. Re­move any jew­ellery over the burnt area. • Hold the burnt area un­der run­ning wa­ter un­til the pain goes away, or cover it with a cloth or sheet soaked in wa­ter. • Do not put any lo­tion,

but­ter, pe­tro­leum jelly or any­thing on the wound be­sides a hy­dro­gel dress­ing.

FIRE SAFETY

It’s a good idea to dis­cuss with your staff and fam­ily what you would do in the event of a fire. Bur­glar bars can trap peo­ple in­side, so con­sider your es­cape route care­fully. • Your first pri­or­ity is to get your fam­ily out and to safety, so don’t waste time try­ing to save your pos­ses­sions. • If you can, close the door of the room where the fire is. • Lay blan­kets or tow­els, prefer­ably soaked in wa­ter, along the gap at the bot­tom of the door. • If there is smoke, stay down and crawl out. • On your way out, close the doors be­hind you. • Be­fore open­ing any door, check if there is a fire be­hind it. Feel the door with the back of your hand. If it is hot, do not open. • If you can’t es­cape, open a win­dow and shout for some­one to call the fire depart­ment. If it is pos­si­ble, and only with­out en­dan­ger­ing your­self, soak the walls and doors near­est the fire with wa­ter. • Never go back into a burn­ing house.

6CHOKING

Chok­ing can sim­ply be defined as when an ob­ject (food, toys or any­thing small) gets stuck in your wind­pipe or tra­chea. To pre­vent this, small chil­dren should not play with small items, for ex­am­ple, any­thing that can fit through the in­side of a toi­let roll tube.

SIGNS OF CHOK­ING

• They can­not breathe or speak. When chok­ing, the per­son can’t make a sound. • They ap­pear anx­ious or

se­verely un­com­fort­able. • They start turn­ing a bluish

colour. • When you ask them if they are chok­ing, they may in­di­cate they are by nod­ding. • They may clutch at their

throat. • They may be try­ing to

cough. If the per­son has an ob­ject stuck in their air­way, but they are able to still breathe or speak, then all you can do is get them to a med­i­cal fa­cil­ity to have it re­moved. It is when there is ab­so­lutely no air mov­ing that you are deal­ing with a life-threat­en­ing med­i­cal emer­gency.

IF A CHILD OR ADULT IS CHOK­ING

• Firstly, try to en­cour­age them to cough. Force­ful cough­ing can suc­cess­fully ex­pel many ob­jects. • If this doesn’t work, stand or kneel be­hind them to per­form the Heim­lich ma­noeu­vre. • Wrap your arms around them, and make a fist with one hand. Place your fist against their stom­ach, just above the belly but­ton. • Place your other hand over your fist. Po­si­tion your body up against them. • Give a series of five hard, force­ful squeezes. You are try­ing to force the air out of the vic­tim, in an at­tempt to dis­lodge the ob­ject. • If this doesn’t work, then you can try us­ing a series of back blows to ex­pel the ob­ject: • Po­si­tion the pa­tient with their head as low as pos­si­ble. • Hit them force­fully be­tween the shoul­der blades. Re­peat this ac­tion five times. • Keep re­peat­ing Heim­lich thrusts and back blows un­til the ob­ject is re­leased.

IF A BABY IS CHOK­ING

• Lay the in­fant face down along your arm, with the head lower than the rest of the body. • Give five hard slaps to the

baby’s back. You should do this with the in­ten­tion of shak­ing the ob­ject loose, so don’t be too gen­tle. • If the ob­ject doesn’t come out, turn the baby onto his back. While sup­port­ing the en­tire body, place two fin­gers on the mid­dle of the chest. Give up to five hard chest thrusts. • Keep re­peat­ing black slaps and chest thrusts un­til the ob­ject comes out. Keep check­ing in the mouth to see if you can see the ob­ject. If you can see it, pull it out. • If the ob­ject does not come out in the first few sec­onds, call for pro­fes­sional help. Don’t try to re­trieve the ob­ject if you can­not see it.

CHEST THRUSTS

• If five back slaps are un­suc­cess­ful, hold the baby’s head with your other hand and turn him face up to lie along your op­po­site arm, while rest­ing his body on your thigh. • Keep the baby’s head po­si­tioned lower than his body, with the back of his head rest­ing in the palm of your hand. If there’s no ob­vi­ous for­eign ob­ject vis­i­ble in the mouth, place two fin­gers on the cen­tre of the baby’s chest, just be­low an imag­i­nary line be­tween the nip­ples, and give up to five quick down­ward chest thrusts. Press down ap­prox­i­mately half of the di­am­e­ter of the baby’s chest (about 4cm).

RE­MEM­BER

If at any time the baby, child or adult be­comes un­re­spon­sive, place them gen­tly onto the floor. Be­gin CPR (as de­scribed on pages 20 to 23). Get some­one to call emer­gency ser­vices. When giv­ing breaths, take a mo­ment to look in the mouth and see if you can see the ob­ject, and re­move it if pos­si­ble. Per­form CPR un­til help ar­rives.

7CRUSHED HAND/ FIN­GERS

• First re­lease the trapped fin­gers or hand from the door or drawer as quickly as you can. • If the skin of the fin­gers is not bro­ken, hold the fin­gers un­der cold run­ning wa­ter, or hold an ice pack or a bag of frozen veg­eta­bles wrapped in a dish­cloth or towel against them. • If the child has dif­fi­culty mov­ing his fin­gers, there may be frac­tures. See a doc­tor. • See a doc­tor if there is

a deep cut, se­vere pain, de­for­mity or blood un­der the nail. • If there are wounds to the hand or fin­gers, cover them with a clean, sterile dress­ing and el­e­vate the hand.

8DROWNING

Re­mem­ber that it doesn’t take long for a child to drown; nei­ther does it take much wa­ter (any­thing from as lit­tle as 2cm of wa­ter can cause drown­ing).

Al­ways keep an eye on your child if you are near wa­ter – even if he can swim. Drown­ing doesn’t just oc­cur in swim­ming pools; even a shal­low pond or wa­ter fea­ture can pose a risk, as can a toi­let or a bucket of wa­ter.

SAV­ING A DROWN­ING CHILD

• If a child is in trou­ble in the wa­ter, ap­proach him cau­tiously from be­hind. If he is old enough to un­der­stand, talk to him and quickly move closer to him. • Tell him, if he can un­der­stand, to stretch his arms away from you. • Grab a piece of cloth­ing or cup a hand un­der his chin. Pull him back to the shore

A doc­tor should check any child who has had a near drown­ing im­me­di­ately, even if his life is not in dan­ger.

or to the edge of the pool. • If the child is not breath­ing, start CPR and call emer­gency ser­vices im­me­di­ately. Tell them you are do­ing CPR on the pa­tient. • If he is breath­ing, turn him onto his side and stay with him un­til the emer­gency ser­vices ar­rive.

9 EYE IN­JURY

This can be ex­tremely painful and it may be quite dif­fi­cult to calm your child down enough in or­der for you to see the ex­tent of the in­jury. Do not force the eye open. If the child can­not open the eye with­out forc­ing it, med­i­cal at­ten­tion is needed.

WHAT TO DO

• Hold his head still and use a clean pad to cover the in­jured eye. If an ob­ject is stuck in the eye, be care­ful not to push it fur­ther into the eye. Put a pad on ei­ther side of the ob­ject. • Hold the pad in place with a clean bandage wrapped around the child’s head. Do not put any pres­sure on any ob­jects stuck in the eye. • Bandage both eyes only if there is an ob­ject in the other eye too. • Call the emer­gency ser­vices for help.

BLACK EYE CAUSED BY BLEED­ING, LEAD­ING TO BRUIS­ING

A black eye is quite of­ten a mi­nor in­jury, but it can also ap­pear when there is sig­nif­i­cant eye in­jury or head trauma. A visit to your doc­tor or an oph­thal­mol­o­gist can rule out any se­ri­ous in­jury.

WHAT TO DO

• Ap­ply cold com­presses in­ter­mit­tently – on for five to 10 min­utes, and off again for 10 min­utes. Cover the ice with a towel or cloth to pro­tect the del­i­cate skin of the eye­lid. If there is no ice avail­able, use a can of cooldrink wrapped in a cloth. • Take your child to the doc­tor to have the in­jured eye as­sessed. • Prop the child’s head up with an ex­tra pil­low at night, and en­cour­age him to sleep on the un­in­jured side of his face for com­fort.

SOME­THING IN THE EYE

If there is some­thing em­bed­ded in the eye, don’t touch it. Take your child to the doc­tor or emer­gency depart­ment im­me­di­ately. Dust, grit and sand of­ten find their way into eyes and are usu­ally easy to re­move. Only try to re­move some­thing in the eye by flush­ing with wa­ter, as any other method could re­sult in in­jury. If it does not flush out after the first at­tempt, seek med­i­cal as­sis­tance. Don’t let your child rub his eyes; rather make him blink re­peat­edly.

WHAT TO DO

• Gen­tly pull down the lower lid and ask the child to move the eye around un­til you can see the ob­ject. • Pull the up­per lid down over the lower lid. Get your child to blink. • Tilt the child’s head so the af­fected eye faces down­ward. Pour a small amount of sterile ( boiled and cooled) wa­ter from a jug into the eye. His re­flex will be to close his eye when you do this, so you may have to phys­i­cally keep it open to wash it out. • Do not fid­dle with the eye if these steps have not worked. If flush­ing does not dis­lodge a for­eign body, it will prob­a­bly be nec­es­sary for a med­i­cal prac­ti­tioner to flush the eye. Close both eyes and take the child to a doc­tor. • Since a par­ti­cle can scratch the cornea and cause an in­fec­tion, the eye should be ex­am­ined by a doc­tor if there con­tin­ues to be any ir­ri­ta­tion af­ter­ward.

CHEM­I­CALS IN THE EYE

• Wash the eye gen­tly un­der run­ning wa­ter. Make sure the wa­ter doesn’t run from the af­fected eye into the other eye. You may have to hold the eye­lid open. • Cover the eye with a sterile dress­ing. • Seek med­i­cal as­sis­tance.

SEEK MED­I­CAL AS­SIS­TANCE IF YOUR CHILD EX­PE­RI­ENCES THESE SYMP­TOMS

• In­creased red­ness. • Drainage from the eye. • Per­sis­tent eye pain. • Any changes in vi­sion. • Any vis­i­ble ab­nor­mal­ity of

the eye­ball. • Vis­i­ble bleed­ing on the white part of the eye (sclera), es­pe­cially near the cornea.

10HEAD IN­JURY

A po­ten­tially se­ri­ous head in­jury must al­ways re­ceive im­me­di­ate at­ten­tion.

EX­TER­NAL HEAD IN­JURY

The skull is well de­signed to pro­tect the brain and most child­hood falls re­sult in in­jury to the scalp only. The scalp is rich with blood ves­sels, so even a mi­nor cut to the scalp will bleed pro­fusely. The “egg” or swelling that some­times ap­pears on the scalp re­sults from leak­ing fluid or blood un­der the scalp and may take days or even weeks to dis­ap­pear.

WHAT TO DO

Call the emer­gency ser­vices if your child or in­fant has lost con­scious­ness, even mo­men­tar­ily. While you wait for them to ar­rive: • If the fall oc­curred with great force (down stairs or off a chang­ing ta­ble), if the child is un­con­scious or dazed, or paral­ysed, spinal in­jury is a pos­si­bil­ity. Don’t move the child at all. Call emer­gency ser­vices. • Try to keep a child with a

head in­jury calm and still. • Lay him down, while at the same time keep­ing his head and neck still. • For mi­nor bumps ap­ply an ice pack (or a cold cooldrink can wrapped in a cloth) to the area for 20 min­utes. • Cover the wound with a dress­ing and press gen­tly to con­trol bleed­ing. You will recog­nise a se­ri­ous cut be­cause the edges peel apart and won’t stay to­gether. If you are in any doubt about the se­ri­ous­ness of the head in­jury, go to the emer­gency depart­ment or call emer­gency ser­vices. • Fol­low­ing a head in­jury, ev­ery child should be ob­served for any ab­nor­mal be­hav­iour or symp­toms. Look out for vom­it­ing, con­tin­u­ous cry­ing, ir­ri­tabil­ity and a very sleepy child. • If the in­ci­dent has oc­curred close to bed­time or nap­time and your child falls asleep soon af­ter­wards, check him ev­ery few hours for dis­tur­bances in colour or breath­ing, or twitch­ing limbs. • If his colour and breath­ing are nor­mal, let your child sleep. But if his colour and/ or breath­ing are ab­nor­mal, or if you are not com­fort­able with your child’s ap­pear­ance (al­ways trust your in­stincts), sit your child up. Your child should fuss a bit and at­tempt to re­set­tle. If he does not protest, try to awaken him fully. If he can­not be awak­ened, call the emer­gency ser­vices.

CON­CUS­SION

• After a blow to the head, watch for un­usual be­hav­iour, dizzi­ness or vom­it­ing. • En­cour­age your child to

rest. • If he’s not fully back to nor­mal in half an hour, he may have con­cus­sion or a more se­ri­ous head in­jury. • If the child loses con­scious

ness, even if only for a very >

short time, he needs to re­ceive med­i­cal at­ten­tion. • If you are in doubt about the se­ri­ous­ness of the in­jury, rather call an am­bu­lance.

SUS­PECTED SE­VERE HEAD IN­JURY

A child should re­ceive im­me­di­ate med­i­cal at­ten­tion if he dis­plays any of the fol­low­ing symp­toms after a head in­jury: • Blurred vi­sion. • Neck pain. • Con­fu­sion. • Blood or clear, wa­tery liq­uid com­ing from the ears or nose. • Pupils of dif­fer­ent sizes. • A loss of con­scious­ness. • A fit or seizure. • He can’t re­mem­ber what

hap­pened. • He’s sleepy and you can’t

wake him eas­ily. • Vomits per­sis­tently. • Not speak­ing or walk­ing

nor­mally. • Has a deep cut, or one that won’t stop bleed­ing, de­spite in­ter­ven­tion. Call for med­i­cal as­sis­tance if any of these symp­toms ap­ply. At the hos­pi­tal your child will be ex­am­ined and, on oc­ca­sion, may need a CT scan that will show if there are any signs of brain in­jury or bleed­ing in the brain. Your child may need to be ad­mit­ted to the hos­pi­tal.

11INSECT BITES AND STINGS

In most in­stances, in­sect bites cause a lo­cal re­ac­tion (red­ness and swelling). In some in­stances, the child may have an al­ler­gic re­ac­tion, and in cases of se­vere allergy, an ana­phy­lac­tic re­ac­tion (see page 26).

WASPS AND BEES

• If a wasp or bee stings your child, don’t try to re­move the sting with your fin­gers, as this will force more poi­son into the flesh. • Use a blunt, flat ob­ject like a plas­tic ruler, credit card or but­ter knife to scrape over the area. Use a mo­tion that is flush with the skin.

TICKS

• To re­move a tick, cover it with pe­tro­leum jelly. Us­ing tweezers, hold it as close to your child’s skin as pos­si­ble and pull it straight out with steady pres­sure. Ap­ply dis­in­fec­tant to the area of skin. • Watch for symp­toms of tick bite fever, such as headaches, nau­sea and flu- like symp­toms. • Put some bath oil in your child’s bath for the next cou­ple of nights in case you have missed any other ticks. • Be sure to look be­tween your child’s toes and through his hair for any other ticks.

SPI­DERS AND SCOR­PI­ONS

• Spi­ders can give quite nasty, painful bites. Scor­pi­ons can cause painful stings, too. How­ever, rel­a­tively few spi­ders and scor­pi­ons are dan­ger­ous. • If a thick-tailed scor­pion stings your child, seek im­me­di­ate med­i­cal at­ten­tion. These scor­pi­ons have po­tent venom and a sting can be fa­tal if un­treated.

12POISON

A child who has swal­lowed a poi­sonous sub­stance needs im­me­di­ate med­i­cal at­ten­tion.

SIGNS AND SYMP­TOMS

• Burns or red­ness around

the mouth. • Empty or half empty bot­tles or con­tain­ers ly­ing nearby. • Pieces of plants or berries

in his mouth. • Drowsi­ness and/or un­con

scious­ness.

COM­MON POI­SONS

• Oven, drain and toi­let

clean­ers. • Paint strip­per. • White spir­its or methy­lated

spir­its. • Bleach. • Anti-freeze. • Paraf­fin. • Rat or in­sect poi­son. • Wash­ing pow­der and disin

fec­tant. • Pills or medicines.

OTHER POI­SONS

Com­mon gar­den and house­plants that are poi­sonous: Ole­an­der, Fox­glove, Wis­te­ria, Ele­phant Ear, Aza­leas, Arum Lily.

SWAL­LOWED POI­SONS

• As­sess what has been swal

lowed, when and how much. • Call for med­i­cal as­sis­tance. Call the poi­son cen­tre or your doc­tor to get im­me­di­ate emer­gency ad­vice. The num­bers are on page 50. • Re­move any vis­i­ble ob­jects

from the child’s mouth. • DO NOT try to make him vomit. If he swal­lowed some­thing cor­ro­sive (like bleach), it will burn on the way back up. • Keep the con­tainer of the prod­uct he’s swal­lowed with you and tell the paramedics ex­actly what the child has taken. • DO NOT give him any­thing to drink as this may dis­perse the poi­son more quickly around his body.

13TOOTH IN­JURY

A dis­lodged baby tooth can be re­placed, but a per­ma­nent tooth will grow in its place any­way. A per­ma­nent tooth can of­ten be saved if prompt ac­tion is taken. Re­mem­ber that the del­i­cate tis­sue cov­er­ing the root, called the peri­don­tal lig­a­ment, must be pro­tected to en­sure suc­cess­ful reim­plan­ta­tion. Take your child to the den­tist for this.

A DIS­LODGED PER­MA­NENT TOOTH

• Hold the tooth by the top,

not the root. • If the child is co­op­er­a­tive and old enough not to swal­low the tooth, re­place the tooth in its socket. • Have the child bite down on a gauze pad to keep the tooth in place. • If the tooth can’t be rein­serted, take it with you to the den­tist. • Give the child a gauze pad or clean hand­ker­chief to bite down on. This will help to re­duce the bleed­ing. • Go to the den­tist. If the in­ci­dent hap­pened after hours, go to your clos­est emer­gency depart­ment.

BRO­KEN PER­MA­NENT TOOTH

• Col­lect all the bits of tooth and rinse the mouth with clean wa­ter. • Hold a cold com­press on

the tooth. • Take your child to the den

tist right away.

14 SHOCK

When there is a sig­nif­i­cant drop in blood pres­sure, your child may go into shock. This can be dan­ger­ous.

CAUSES

• A loss of blood or body

flu­ids. • Spinal in­jury. • Poi­son­ing. • Se­vere allergy (to food or a

sting). • Se­vere in­fec­tion.

SYMP­TOMS AT FIRST

• Rapid pulse, grey colour

ing, sweat­ing. • Nau­sea, vom­it­ing, thirst. • Weak­ness, dizzi­ness. • Rapid or shal­low breath­ing. • Anx­i­ety.

LATER

As oxy­gen sup­ply to the brain de­creases, the child may yawn, gasp for air, get very thirsty and be­come anx­ious. Even­tu­ally, he will lose con­scious­ness.

WHAT TO DO

• Call the emer­gency ser­vic

es im­me­di­ately. • Treat any ob­vi­ous cause,

such as bleed­ing (page 27)

or burns (page 31). • Lie him down with his legs higher than his chest and undo any tight cloth­ing on his neck, chest or waist. • Turn him onto his left side if he’s un­con­scious or vom­it­ing. • Re­as­sure him and stay near him. Talk to him in a calm, com­fort­ing tone to try ease anx­i­ety. • Put a blan­ket over the child

to help keep him warm. • Do not, un­der any cir­cum­stances, give the child any­thing to drink. • Keep check­ing his breath­ing and pulse, and pre­pare to give him CPR if in­di­cated (see pages 20 to 23).

ELEC­TRIC SHOCK WHAT TO DO

• Break the elec­tri­cal cur­rent be­fore you touch your child. If you touch him, you will get a shock too. Switch off the cur­rent at the mains or pull the plug out. If you have to move him man­u­ally to break the cur­rent, stand on some­thing made of non- con­duct­ing ma­te­rial like wood or plas­tic and push him with some­thing non- con­duc­tive, for ex­am­ple, a broomstick. • Ex­am­ine your child. He may be in shock, be burnt or have lost con­scious­ness. • Check for burns (see

page 31). • Elec­tri­cal burn in­juries are of­ten more se­ri­ous than they ap­pear and can cause in­ter­nal dam­age, so your child should be seen by a doc­tor right away. • If your child is un­con­scious, place him on his side and call an am­bu­lance. • If nec­es­sary, start CPR (see

pages 20 to 23).

15 SWAL­LOW­ING A FOR­EIGN OB­JECT

A for­eign ob­ject that was swal­lowed can get stuck along the gas­troin­testi­nal (GI) tract. This can lead to an in­fec­tion or block­age or even a tear in the GI tract.

Small chil­dren (age one to three) are most likely to swal­low a for­eign ob­ject. These items may in­clude a coin, mar­ble, pen­cil eraser, but­tons, beads, other small items or a bat­tery.

If the ob­ject passes through the oe­soph­a­gus (food pipe) and into the stom­ach with­out get­ting stuck, it will prob­a­bly pass through the en­tire GI tract.

Ap­prox­i­mately 75% of chil­dren who have an im­pacted for­eign body will have it

at the level of the up­per oe­sophageal sphinc­ter.

OB­JECTS THAT CAN BE DAN­GER­OUS TO SWAL­LOW

• Coin- sized but­ton bat­ter­ies can be found in many house­hold de­vices such as car re­motes, elec­tronic can­dles, watches, singing greet­ing cards and other elec­tronic de­vices. Small coin-shaped bat­ter­ies can cause se­ri­ous harm if they do not pass through the body quickly, as the chem­i­cals in­side can leak out and burn the sur­round­ing tis­sue, or they can cause a small elec­tric cur­rent which can also do harm. • Ob­jects that are small enough to swal­low, but larger than about 18mm across, may get stuck on the way down in small chil­dren. • Ob­jects that are pointed such as open safety pins, tooth­picks, stiff wire, fish and chicken bones can pierce the gut, so if you think your child may have swal­lowed one, the child needs to be seen by a doc­tor as soon as pos­si­ble.

SIGNS AND SYMP­TOMS

If you see your child swal­low­ing some­thing and you can­not stop it hap­pen­ing, or your child may have swal- lowed some­thing, look for these signs that there could be a prob­lem re­quir­ing emer­gency treat­ment: • Chok­ing. • Cough­ing. • No breath­ing or breath­ing trou­ble (res­pi­ra­tory dis­tress). • Wheez­ing • Trou­ble swal­low­ing food. • Drool­ing. • Pain in the chest or neck. • Noisy breath­ing.

Some­times, only mi­nor symp­toms are seen at first. The ob­ject may be for­got­ten un­til symp­toms such as in­flam­ma­tion or in­fec­tion de­velop.

WHAT TO DO

If there are any symp­toms: • Do not give the child any

thing to eat or drink. • Do not try to make the

child vomit. • Take the child to be seen by a doc­tor as soon as pos­si­ble, or take the child to a hos­pi­tal emer­gency depart­ment. • If the ob­ject was likely to be dan­ger­ous ( bat­tery, pointed ob­ject, tablets, poi­son, lead sinker, coin), take the child to a doc­tor as soon as pos­si­ble or call the emer­gency ser­vices on 082-911. • If the ob­ject was small, smooth and not likely to be poi­sonous (small mar­ble, small coin or but­ton), and there are no symp­toms, it is prob­a­bly rea­son­able to wait for a while and watch the child, but take the child to a doc­tor if there are any con­cerns. • Watch the child's poo to

see if the ob­ject is passed. • If it has not passed in sev­eral days, and you are sure that the child did swal­low some­thing, take the child to your doc­tor for ad­vice. • Do not give the child laxa

tives or ex­tra fi­bre. • In se­vere cases, surgery may be needed to re­move the ob­ject.

You may wantw to use dis­pos­able gloves to re­duce the risk of in­fec­tion to the pa­tient when treat­ing a bleed­ing wound. Also, make sure you wash your hands be­fore and after treat­ment.

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