Every child will definitely experience some falls and minor accidents while growing up. Here are some simple first aid techniques that every parent should know learn in case of emergency.
Open wound with bleeding (usually from cuts)
All wounds will stop bleeding with time as they will form a clot. Clean under running water and then use a clean cloth to press over the wound for a few minutes. When the bleeding has stopped, apply antiseptic lotion or antibiotic cream and cover with a plaster if the wound is small. Larger or deeper wounds especially if the skin edges are jagged, need to be stitched by a trained doctor to prevent infection and poor healing causing unsightly scars. If the cut is from a dirty metal object or animal bite, you will need a tetanus injection from your doctor (if you have not been vaccinated before) and antibiotic to prevent skin infection.
Apply antibiotic cream or change the plaster every 2-3 days until fully healed. Do not pick at the scab as it delays healing. Try to avoid the sun as the newly formed skin is more sensitive to being sun burn. If the wound looks red, tender or has pus, see a doctor as soon as possible because this suggests that the wound has infection.
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Swelling or bruise (usually from blunt trauma or from a fall)
Most blunt trauma results in a swelling (due to inflammation) and bruising (if there is internal bleeding). Quickly apply cold compression (using ice cubes wrapped with a clean cloth) around the area to reduce the amount of the swelling and bruising. Do NOT rub the area as it will make the swelling worse.
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Sprained ligament (usually the ankle, wrist or thumb)
A sprain is an injury to the ligaments which connects and hold the bones in place. It causes pain and swelling very quickly but fortunately, recovers within 1-2 weeks. Follow the acronym RICE (Rest, Ice, Compression & Elevation). Rest the limb, apply ice pack compression and elevate the affected limb to reduce the swelling. The ice pack can be applied for 15-20 minutes each time and repeated 4-8 times a day. Most important is NOT to move or weight bear on the leg. If injury looks worrying, go to a hospital emergency department to rule out a fracture by having an X-ray done.
Danger signs of sprains for which you need to see an orthopaedic doctor:
- Inability to weight bear on the injured leg (or hand) or the joint feels unstable (suggestive of completely torn ligament)
- A pain directly over the bone of an injured joint (suggestive of fracture)
- Redness, swelling and hot over the area suggestive of infection
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- For arms, apply an arm sling. You can make one by folding a large piece of clean cloth (such as a sarong or towel) into triangular shape and tie into an arm sling to support the arm.
- For legs, reduce movement and avoid weight-bearing on the affected leg. Elevate the leg.
In both cases, take some pain relief such as paracetamol and go to a hospital emergency department as soon as possible.
Burns or scalds
Get the child away from the heat source immediately and put the affected area under cold running water for 10-15 minutes to cool it down. This will prevent deeper and more severe burns. Remove any clothing but do not peel anything that may be stuck to the skin. Seek medical attention if the burnt area is large or deep.
Don’t pop any blisters yourself but let them heal naturally. If the skin breaks, apply an anti-biotic cream and cover the area with a bandage or gauze until it’s healed. Watch for any redness, swelling, tenderness or pus discharge which are all signs of infection.
Lay the child down gently onto the floor and clear the surroundings from any hard or sharp objects that may cause injury. Lie the child to one side to allow any vomit or saliva to dribble out and prevent choking. Loosen any clothing around the neck. Do not attempt to put anything inside the mouth as it may cause further injury. Monitor breathing and seek medical attention if it is the first episode of seizure or if the seizure lasts more than 5 minutes.
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If the child is choking, the first thing you would notice is the child suddenly starts coughing. You may hear wheezing in between the coughs. They may clutch their throat with their hands. They may not be able to speak or cry. If the condition worsens, the child’s lips may turn blue and lose consciousness. If they are coughing, encourage them as it may dislodge the object. Do not leave them alone. You may attempt to remove the object only if you can see it clearly.
There are Basic Life Support (BLS) steps that can be done to help a choking child. These steps are taught during BLS courses along with CPR techniques in accordance with the American Heart Association guidelines.
There are two techniques that can be performed depending on the age of the child and is divided into infants (less than 1 year old) and child (over 1 year old).
Infant technique (back slaps and chest thrusts)
- Sit down/kneel and place the baby in your lap with the face down and head slightly lowered
- Hold the head and jaw with your hand while the body rests on your forearm
- Rest your forearm onto your thigh for support
- Give 5 back slaps in between the shoulder blades using the heel of your other hand. Do it forceful enough to dislodge the object
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- If unsuccessful, turn the baby around and hold the back of the head with your other arm and sandwich the baby between your arms. Turn the baby over while ensuring the head and neck is fully supported
- Now rest the baby onto your forearm, facing up but head slightly lower along your thigh
- Give 5 chest thrusts at a rate of 1 per second. Push downwards at the lower half of the breast bone, again, forceful enough to dislodge the object
- If still unsuccessful and baby is still conscious, turnover the baby again and deliver another 5 back slaps
- Repeat these steps until the object is dislodged
Child technique (Heimlich manoeuvre same as for adults)
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- Stand/kneel behind the child so that you can wrap your arms around their waist.
- Make a fist with your hand (usually left hand with the thumb enveloped by the other fingers)
- Place it with the thumb side against the abdomen, at the soft area between the navel and the lower border of the breastbone.
- Wrap your other hand around your fist.
- Give a quick, forceful thrust in an inner, upwards direction. Forceful enough to dislodge the object.
- Repeat these steps until the object is dislodged.
If the above fails, call for help. Dial 999 (or 911) and ask for an ambulance in a composed manner. State your address or location with any obvious landmarks. State what the emergency is and inform if it is an adult or a child. Afterwards, perform CPR while waiting. If there is another person around, tell them to call for an ambulance while you perform CPR. Tell them to get back to you to confirm that they have called the emergency services. If possible, ask them to bring an Automated External Defibrillator (AED) which should be available in major shopping malls or office buildings.
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Prevention is always better than cure
Children like to explore their surroundings and tend to put small objects (such as marbles or beads) into their mouth, nose or ears. Therefore, ensure their surroundings are free from these objects or else keep them at a higher place where they cannot reach. Always keep your surroundings clean and tidy.
During bottle feeding time, do not leave your baby unattended even for a few seconds. You may get distracted and take longer than anticipated which could raise the possibility of an untoward incident happening. Try not to feed your baby when you are sleepy. Check their solid food for any large or hard food sizes or fish bone before feeding them.
Dr. Mohd Ridzuan Razak
General Medical Physician