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Basic Pediatric First Aid with Rescue Breathing and Choking

Training Module

Learn how to deal with common injuries in this required 2-hour training. This topic is required for all caregiver before they are given unsupervised access to children.

Basic Pediatric First Aid with Rescue Breathing and Choking

In the early education world, injuries occur every day! Most are minor, but some require caregiver and/or medical attention. This training will help teachers provide nurturing care to the child in their care.

Bites (animal or human)
What is it?
  • A bite from a person or an animal. Animals include dogs, cats, rats, or others.
What do you see?
  • The skin may have teeth marks on it.
  • The skin may be broken. There may be some bleeding.
  • The area may be warm and red. Pus may ooze from it.
What to do
  • If there is bleeding, use a disposable towel and apply pressure to the affected area.
  • Wash the skin with soap and warm water.
  • Apply a single piece of ice. Never place ice directly on the skin. Use a plastic bag or cloth to prevent the ice from directly touching the skin.
  • Cover the broken skin with a bandage.
  • If the child was bitten by an animal, find out if the animal is current on its rabies shots.
The child may need medical care if...
  • The bite broke the child's skin, and the skin begins to show signs of infection like fever, redness, pain, or swelling.
  • The bite is from a wild animal.
  • The bite is from an animal that may not have rabies shots.
  • The animal is acting funny.
  • The animal has foam coming out of the mouth.
Bleeding
What is it?
  • Fast bleeding or bleeding that does not stop easily.
What do you see?
  • Bright red blood is coming out of a break in the skin.
  • Child may seem weak.
  • Child may not know where he or she is.
  • Child may go into a deep sleep (faint or pass out)
What do you do?
  • Have the child lie down.
  • Place the bleeding part higher than the heart.
  • Keep your child warm to prevent shock.
  • Take out anything from the cut or sore that is easy to wipe away. Do not try to pull out things that are deep or hard to get out.
  • Do not try to cut anything out.
  • Put a clean, disposable cloth over the bleeding area. Apply pressure.
  • If the cloth gets too bloody, place another cloth on top of that one. Do not take the first cloth off the area.
  • Do not stop applying pressure.
  • Do not press so hard that it hurts.
  • If a bone or something is sticking out of the cut, put pressure around the cut. Do not press right on top of it.
When do you seek medical attention?
  • Call 911 if blood is pouring out and you cannot stop it.
  • A bone or something is sticking out of the cut.
  • You cannot stop the bleeding by pressing on the area.
What else you should know about bleeding?
  • You can lose too much blood from bleeding. This is called shock. Call 911 if the child shows any signs of shock.
  • Signs of shock are:
    • Pupils get big (black dots in the center of the eyes).
    • Skin feels cool and wet.
    • Pulse (heartbeat) is fast and weak.
    • Breathing is fast.
    • Child is sick to the stomach (nausea).
    • Child throws up (vomits).
    • Child wants to drink. Do not give the child anything to drink.
    • Child does not know where he or she is (confused).
    • Child is weak.
    • Child goes into a deep sleep and cannot be woken.
Broken Bone
What is it?
  • A crack or break in a bone. It comes from a fall or accident.
What do you see?
  • The child is in a lot of pain.
  • The area around the bone swells up.
  • The child may refuse to use the leg or arm.
  • The bone under the skin may look bent.
  • You may see the bone if the skin is broken.
  • You may hear the bone crack at the time of the fall.
What you can do
  • Put a splint on an arm or leg that is broken. A splint is anything you can tie to a body part to stop it from moving. A rolled-up newspaper, magazine, or stick may be used as a splint.
  • Never tie the body to the splint so tight that blood can't move to the area.
  • If you think a leg bone is broken, do not let the child walk on it.
  • Ice helps pain and swelling. Do not place ice directly on the skin. Wrap the ice in a towel. Leave it on for 5 minutes or less at a time.
  • Do not give the child anything to eat or drink until you see the doctor.
  • Do not wait to send the child to the doctor or hospital. A broken bone should be examined right away.
When should you seek medical attention?
  • When you think the child has a broken bone.
What can you do to prevent broken bones?
  • Never leave children alone on a high place even for a few seconds. This includes tables, chairs, changing tables, and playground equipment. The child may have a bad fall.
  • Avoid using cribs with rails that lower.
  • Do not use prohibited mobile restraint devices such as baby walkers.
What you should know about sprains
  • The doctor may say that the child has a sprain, and not a broken bone. Sprains are not as bad as a broken bone. A sprain can give the child a lot of pain.
  • Ice helps pain and swelling. Wrap ice in a cloth and put on the sprain. Leave it on for 5 minutes or less as a time.
  • Rest the joint on a pillow higher than the body. Keep the child from using the joint.
  • With parent permission, give the child Tylenol for pain if the child is over 2 years of age.
  • The doctor may tell the parents to use a heating pad or warm damp towel on the sprain after the first 24 hours.
  • Advice parents to call a doctor is the sprain is not better in 3-4 days.
Bruises
What is it?
  • Dark marks on the skin. Bleeding under the skin causes bruising. Bruises happen when children fall or get hurt. It takes about 2 weeks for a bruise to go away.
What do you see?
  • The skin has a black, brown, blue, purple, green, or yellow mark on it.
  • The skin may turn red at first.
  • You may see or feel a bump.
What you can do
  • Most bruises do not need any care.
  • You can put ice on large bruises. Wrap the ice in a cloth. Leave it on for 5 minutes or less at a time.
  • After 34-48 hours, heat may help. Use a heating pad on low or a warm damp cloth.
When to seek medical attention
  • The child gets bruises without falling or getting hurt.
  • You think a bone may be broken.
  • The child has many bruises.
Bug Bites
What is it?
  • A painful or itchy bite from a bug. The bite may be from a bee, tick, flea, ant, fly, spider, wasp, mosquito, or other insects.
What do you see?
  • Area gets bigger (swells).
  • Redness.
  • The child's whole body gets red and swell.
  • The child may find it hard to breathe.
What you can do
  • There may be a stinger left in the skin. Take it out by rubbing it gently with a flat surface, such as a credit card, back and forth up to the stinger. Do not run over the stinger. Try not to break the stinger.
  • Wrap ice in a cloth. Put it on the bite for 5 minutes or less at a time.
  • With parent permission, mix baking soda and water into a paste. Put it on the bite if the child has pain.
  • With parent permission, use insect lotions to stop the itch.
  • Encourage the parent to cut the child's fingernails short so they won't hurt if the child scratches.
When do you seek medical attention?
  • Call 911 if the child finds it hard to breath or his face swells. This is an emergency.
  • The child gets a rash all over the body. Child gets itchy and swollen after the bite. This may be an allergic reaction.
  • There are signs of infection like swelling, yellow pus oozing out of the bite, or fever. This can happen later.
  • The child is in a lot of pain. Child looks and acts sick.
  • The child is younger than 3 months old and gets a bug bite.
What else you should know about bug bites
  • Have children wear long-sleeve shirts and pants during seasons when bugs are bad. This will keep children from getting bug bites.
  • Do not wear perfume or other sweet-smelling lotions outside.
  • Put on insect spray with parent permission. Read the label well and do what it says. Keep insect spray away from the face.
  • Teach children to stay away from beehives and other places where bugs are.
  • Find out where the bugs are. Talk to parents and encourage children to stay away from dogs and cats with fleas or ticks.
  • Avoid going outside at sunset.
Bumps on the Head
What is it?
  • A child gets hit on the head. Child falls and hits the head.
What do you see?
  • The child may have a big lump on the head.
  • The child may have a cut on the head with some bleeding.
  • The child may have a seizure (convulsion).
  • The child may black out (lose consciousness) for a moment.
  • The child may throw up (vomit).
  • The child may be confused.
What you can do
  • If your child has bleeding, hold a towel firmly on the area for 10-15 minutes.
  • Put an ice pack on the bump. You can wrap some ice in a cloth.
  • The child may have had only a light bump to the head. He or she went back to playing after a short cry. In this case, you can take care of the center. Be sure to watch for anything not normal. Call the parent immediately.
  • Wake the child up every two hours for the first 24 hours. Have parents look for changes in the child's eyes. Check for weakness in one side of the body. Watch for vomiting. Ask the child simple questions he should know.
When to seek medical attention
  • The child blacked out after the fall. The blackout may be for only a moment.
  • You can't stop the bleeding from a cut on the head.
  • The child cries for more than 10 minutes. The child will not stop crying.
  • The child has a seizure (convulsion).
  • The child becomes sleepy. He or she is hard to wake up.
  • The child does not know things as well as before.
  • The child does not talk or walk as well as before.
  • The child's eyes do not look the same. The eyes may be crossed, or the pupils are not the same size.
  • Blood or water is coming out of the child's ears or nose.
  • The child has forceful vomiting or vomits more than once.
  • The child seems confused.
How to prevent head injuries
  • Always put a helmet on the child for certain sports and games. These include bike riding, rollerblading, skateboarding and scootering. The helmet should cover the top of the child's forehead.
  • Encourage parents to put children in the back seat of the car. This is the safest place for the child. Children should always be in a car seat when riding in a car.
  • Never allow children alone in a high place where he or she can fall.
  • Keep crib rails up at all times.
  • Keep children away from steps.
  • Never shake or hit a child. The infant's brain is very soft. Shaking can hurt or even kill a child.
Burns
What is it?
  • An injury to the skin. Heat, hot liquids, steam, gas, electric shock, chemicals, or radiation may cause it. There are 3 kinds of burns:
    • 1st degree - The outer layer of skin is burned.
    • 2nd degree - The deeper skin is burned.
    • 3rd degree - These are very deep burns.
What do you see?
  • The skin may be red, hot to the touch, and painful.
  • The skin may be white, brown, or black instead of red.
  • The skin may be puffy.
  • There may be blisters on the skin.
What you can do
  • You can use water to put out fires except for grease fires.
  • Use baking soda or a fire extinguisher for a grease fire.
  • If the child's clothes are on fire, the child will be scared and run. You should:
    • Catch the child quickly/ Roll the child on the ground to put out the fire.
  • Cover the child with a blanket, coat, or rug to put out the fire.
  • Submerge the burned area in tap water for 15 minutes. Wrap the burned area with a damp cloth. Keep the cloth damp.
  • Do not put ice on the skin.
  • Take off burned clothing unless it is stuck to the skin.
  • If the skin is oozing, cover it with a clean cloth.
  • If the skin is dry cover the burn with a cool, wet, clean cloth.
  • Do not put butter, grease, or powder on the burn.
  • With parent permission, give the child Tylenol for pain, if the child is older than 2 years.
  • Do not break open blisters. If blisters break, wash with soap and water. Cover the, with a clean cloth.
When to seek medical attention
  • The burn is larger than the size of the child's hand.
  • There are blisters on the skin.
  • The burn is on the face, hands, feet, private parts, or a moving joint like the knee.
  • You or the parent think the burn is bad.
  • The burned skin is white, brown, or black.
  • There are signs of infection like swelling, pus, or fever.
  • The burn is not better in 3 days.
What you can do to prevent burns
  • Have smoke detectors in all rooms of your program. Put new batteries in every six months.
  • Know how to use fire extinguishers.
  • Teach children to stop, drop, and roll if their clothes catch on fire.
  • Set the water heater at 120 degrees or lower. This will avoid burns from very hot water coming out of the faucet.
  • Teach children what to do in case of a fire.
  • Never hold a child while drinking hot liquids like coffee.
  • Never heat the child's bottle or food in a microwave oven. Some parts may get so hot they can burn the child.
Cuts and Scrapes
What is it?
  • A break or injury to the skin.
What do you see?
  • The skin is red, open, and bleeding.
  • There may be some swelling.
What you can do
  • Stop the bleeding by pressing on the cut with a clean cloth for 10 minutes.
  • Wash the cut well with soap and water. Be sure to wash away any dirt.
  • Keep the cut clean, you can put a medicine ointment on the cut with parent permission.
  • Cover the cut with a bandage.
  • Have the parent put on a fresh bandage every day. Change it whenever it gets dirty.
  • Take the bandage off at least once a day. If the bandage sticks. soak it with warm water.
  • Check the cut for signs of infection like redness, swelling, and pus oozing out.
When to seek medical attention
  • The bleeding does not stop after 10 minutes of pressing.
  • The cut is deep, or the edges of the skin do not stay together.
  • You think the child does not have a tetanus shot.
  • There are red lines on the skin near the cut.
  • There is swelling around to cut, and pus is oozing out of the cut.
  • You see something in the cut that you cannot get out.
Drowning
What is it?
  • A child is under water and cannot breathe.
What do you see?
  • A child's face is under water.
  • Child may cry and cough when pulled out of the water.
  • Child may be limp and not breathing when pulled out.
What you can do
  • Pull the child out of the water.
  • Yell for help. Have someone call 911.
  • Lay the child on his or her back.
  • Check to see if the child is breathing (the chest is not moving).
  • Do CPR if child is not breathing.
When to seek medical attention
  • The child is under water for more than a few seconds.
What can you do to prevent drowning?
  • A young child can drown in a very small amount of water, like a pail of water. Do not leave water in pails or mop buckets.
  • Empty small wading pools when they are not being used.
  • A small child can also drown in the toilet. Bathrooms should be supervised at all times.
  • Never leave children alone near water. Don't risk even a few seconds.
  • Pools must be surrounded by a fence.
Poisoning
What is it?
  • The child eats or breathes something that makes him or her sick. A child can get poisoned from many things. These include cleaning products, vitamins, drugs, medicines, alcohol, paint, and plants. Poisoning is very serious. The child can die.
What do you see?
  • You find a child with a bottle or container of something that is poison. The bottle may be open or empty.
  • The child has burns on the lips or in the mouth.
  • The child feels like throwing up.
  • Child throws up for no reason.
  • The child is hard to wake up.
  • The child has a hard time breathing.
  • The child has stomach pain.
  • The child has a fit (seizure or convulsion).
What you can do
  • If you think a child has swallowed a poison, stay calm.
  • If the child is having trouble breathing or you cannot wake the child, call 911 immediately.
  • If the child is awake, call poison control or 911.
  • Try to tell the 911 operator:
    • The child's age and weight
    • The name of the medicine or poison that was taken, if known
    • The amount that was taken, if known
    • The time the poison was taken
    • Your name and position
  • Do what the 911 operator tells you to do.
OBSTRUCTED AIRWAY: CONSCIOUS CHILD

Do NOT perform this procedure on a conscious child unless complete airway obstruction is present (serious breathing difficulty, ineffective cough, no strong cry) and is due to a witnessed or strongly suspected obstruction by a foreign object. If obstruction is caused by swelling due to infection, the child should be rushed to the nearest hospital, and maneuvers to clear the airway should not be performed. When respiratory distress is present, the infant should be allowed to find and maintain the position that he or she finds most comfortable.

1. Assessment: Determine airway obstruction
Observe breathing difficulties, ineffective cough. Weak (or absent) cry, dusky color
2. Place infant down over one arm and deliver up to 5 back blows
Supporting the head and neck with one hand, place the infant face down, head lower than the trunk, over the forearm supported on your thigh. Deliver up to 5 back blows forcefully between the shoulder blades with the heel of one hand.
3. Turn child face up, supported on your arm, and deliver up to 5 chest thrusts
Supporting the head, sandwich the infant between your hands/arms and turn on his or her back, head lower than the trunk. Deliver up to 5 thrusts in the midsternal regions, using the same landmarks as those for chest compressions. Deliver chest thrusts more slowly than when doing chest compressions.
4. Repeat steps 2 and 3 until either the foreign object is expelled, or the infant becomes unconscious
OBSTRUCTED AIRWAY: UNCONSCIOUS CHILD
1. Assessment: Determine unresponsiveness:
By tapping or gently shaking the shoulder.
2. Call out "Help!"
3. Position the CHILD.
Turn on back, if necessary, on a firm, hard surface while supporting the head and neck.
4. Open the airway.
Use head tilt-chin lift but take care not to tilt the head back far.
5. Assessment: Determine breathlessness.
Maintaining an open airway, place your ear over the infant's mouth and look at the chest for breathing movements, listen for breathing sounds, and feel for breaths on your ear.
6. Try to give rescue breaths.
Use a mouth-over-mouth and nose seal.
7. Try again to give rescue breaths.
Reposition head and check mouth-over-mouth and nose seal.
8. Activate the EMS system.
If someone else is there, that person should activate the system, otherwise activate after 1 minute.
9. Deliver up to 5 back blows.
10. Deliver up to 5 chest thrusts.
11. Perform tongue-jaw lift
and remove object if you see one.
12. Try again to give rescue breaths.
If unsuccessful, reposition the head and try again.
13. Repeat steps 9 through 12 until successful
14. If you are alone and your efforts are unsuccessful:
Activate the EMS system after 1 minute of efforts to clear the airway.
15. When obstruction is removed:
Check for breathing and signs of circulation
16. If there is breathing:
Place in the recovery position and monitor breathing while maintaining an open airway.
If there is no breathing:
Give 1 rescue breath every 3 seconds and monitor signs of circulation.
17. If there are no signs of circulation
Give 2 rescue breaths and start cycles of compressions and breaths.
If there are signs of circulation:
Open the airway and check for breathing.
CPR
Unresponsive, no breathing or abnormal breathing (gasping)
CALL 911
START COMPRESSIONS
Push hard and fast in the center of the chest
Ensure proper depth of compression
After 30 compressions do:
Head Tilt/Chin Lift
2 breaths (1 second each/chest rise)
Head Tilt/Chin Lift and breaths should take less than 10 seconds (Minimize time spent away from compressions)
Back to compressions
Continue uninterrupted until help arrives
Adult Child Infant
Hand Position 2 hands center of chest, lower half of breastbone 2 hands center of chest, lower half of breastbone 2-3 fingers in the center of the chest, lower half of the breastbone
Compression Depth At least 2" About 2" About 1½"
Breathing Look for chest rise/Deliver breaths over 1 second Look for chest rise/Deliver breaths over 1 second Look for chest rise/Deliver breaths over 1 second
Compressions to Breaths 30:2 30:2 30:2
Compression Rate 100/minute 100/minute 100/minute
No liability is assumed with respect to the use of the information contained in class. The authors and instructor assume no responsibility for errors and omissions. Nor is any liability assumed for damages resulting from the use of the information shared. It is not intended as legal advice. This information is intended to be used as a guide and participants should consult with local medical emergency services for applicable advice regarding applicability of provided material to their specific program and/or regarding any changes they make thereto.

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