Healthy Living

First aid tip for parents covering 19 different scenarios

More than 20 children die each day in the US from preventable, unintentional injuries, which is more than the mortality due to all other diseases combined, and yet it remains the under-recognized cause. Globally injuries in children result in 875,000 deaths each year and about 10 to 30 million hospital visits. 1

As first 19 years of life are characterized by fast growth, reasons for injury keep changing with each year. Thus during the first year of age suffocation is the primary reason for fatal outcomes, while fall is the leading cause of nonfatal injuries. In toddlers apart from fall, other causes of injuries are fire and drowning, while in those above the age of ten and above motor vehicle accidents are the primary cause of fatal injuries. Poisoning is another important cause of injury among children and young adults. 2 It means that parents should be prepared to deal with various kind of scenarios, they must possess skills to provide first aid.

Cultivate a habit of caution.

~ Author unknown

Cut or Scrape

The first thing to do is to stop the bleeding immediately by pressing the site of cut with the help of clean cloth or gauze if the wound is contaminated than clean it with uncontaminated cool water. Keep the wound covered to control bleeding and prevent wound contamination. Remember not to use hydrogen peroxide, iodine, or alcohol, as they would irritate the wound and cause needless pain. Alcohol can only be used if the wound is too dirty. The decision to cover or leave the injury open would depend on its debt and risk of becoming dirty.

Once the bleeding has been stopped, you have to consider tetanus immunization. Antibiotics must not be used without consulting the specialist. Further, keep checking the wound to ensure that it does not get infected.
Sometimes cuts or wounds are too deep, and bleeding would not stop at home, then it is better to seek medical attention. If there is fracture or tendon injury, such cases cannot be handled at home. Even in cases of small injuries seek medical care, especially if you see signs of infection like redness, pain, pus, and fever.

Bleeding Wound

Sometimes the wounds are more profound or caused due to piercing object, and there could be profuse bleeding that is difficult to stop. First and the foremost thing is to apply pressure, if not with hands than with cloth, or even your shirt. In some instances, like motor vehicle accident there may need to apply pressure above the wound (especially if any large blood vessel is damaged) to stop blood flow to the area or limbs. One can tie the limb tightly with cloth, or belt.

When the wound is bleeding heavily, do not wash it as that would only increase bleeding. If there is an object in the wound, do not try to remove it by yourself as that may make bleeding worse.
If the bleeding would not stop and the child looks pale or starts feeling cold, it is a reason to call emergency services. If you see that a child is feeling dizzy, it may indicate that a child is going into shock. In such situation apart from controlling the bleeding, raise the legs above rest of the body (especially heart), to ensure proper blood flow to the brain. Further, wrap the child in warm blanket or clothes while waiting for emergency help.

Burns

Fire or burns remain the most common cause of injury among the children of various ages. These burns can be anything from mild to life-threatening. Burns from hot water or other liquids are most common. So as soon as a child gets a burn, run the area under cool water to ease the pain (do not apply ice), remove the clothing from the area of the burn. If the blister is formed due to burn, never break it. Do not use ointment, butter, or other oily ointments on the burn.

Though once the acute phase is over one can apply an antibacterial ointment to prevent infection. Aloe Vera extract can also be used as it promotes healing, reduces inflammation, and prevents bacterial growth. 3 Avoid exposing the burn to direct sunlight by covering it with clothing.

Though minor burns can be treated at home, but seek medical help if burn area is large, especially if such burn came from fire or electricity or chemical, similarly, any burn on the face or genitals should be taken seriously. Even in case of small burn better not treat at home if it looks infected.

Splinter

It is a trauma caused by penetration of sharp foreign object inside the body especially wood, though such injury may be caused by anything like plastic, glass, fish hook, some natural objects. Often the small particles or pieces of the foreign object remain in the body causing pain; if not removed they may migrate inside the body causing damage, pain, and infection. Thus these foreign materials must be removed immediately. You can watch the video by American Academy of Dermatology here to see how to remove a splinter.

After removing a splinter with a tweezer or sterilized needle, clean the area with alcohol or wash it with water. One may or may not apply an antiseptic ointment, and depending on the trauma one may cover it with a bandage. There is also a need to consider the anti-tetanus vaccine.
However, seek medical care if the splinter is too deep, or it is bleeding. In some cases, it may get infected thus necessitating the care by a specialist.

Insect bite/sting

There is barely any child who has never been bitten by an insect, while mosquito bites are most common, followed by bees, and other insects. Usually, the place of insect bite become red, itchy, and symptoms would disappear in few days. In some cases, the stinger may be visible and can be removed with a tweezer. In most situations, there is no need to do anything. However, some children may be allergic to insect bites, and things may get worse.

If insect bite pains too much one can apply an ice pack, or use some other standard remedies, one should be on the look for symptoms of allergy like tightness in chest, swelling of face and mouth, wheezing, difficulty in breathing, and dizziness or fainting.

In case of severe allergic reactions, a child must be injected with epinephrine (EpiPen), and if it is not available then give diphenhydramine, and call emergency service immediately.

Do not treat a child at home if he or she is known to be allergic to insect bites. Also, seek medical attention if the site of insect bite gets infected or swelling and pain does not subside after few days.

Tooth pain

Tooth pain is considered to be among the worst kind of pains, and in children, it is mostly caused by tooth decay. Losing of primary teeth happen between 5-7 years though it rarely causes severe pain. Other causes could be an accumulation of food debris between the teeth, or trauma.

A toothache often requires treatment by a dentist, but one can do few things at home to relieve symptoms like rinsing the mouth with warm water few times a day, using dental floss to remove food particles. One may give over-the-counter pain reliever for mild pains. In some instances, local application of anesthetic benzocaine may help, though it must be used sparingly as many children are allergic to it. If a toothache is the result of trauma than cold pack may help.

Better visit a dentist if a toothache persists for more than two days or a child develops a fever. Foul tasting discharge, smell, red gums, trouble swallowing may all be indicators of infection.

Ear pain

During the young age earaches, may happens after the respiratory infection. A common cause of ear pain is the accumulation of fluid behind the eardrums (in the middle ear). Pain, leakage from ears, vomiting, headache, fever, are all signs of ear infection.

Considering the importance of hearing, and the fact that ear pain develops gradually, it is best treated by the medical specialist. In case of mild pains, one can give over-the-counter pain relievers, use cold or warm compresses. One may use naturopathic ear drops too. Home remedies are best avoided as there is a risk of infection getting worst. Fortunately, most ear infections would subside with time.

Seek medical attention when there is redness behind the ear, or you see pus-like fluid coming out of the ear or if the child continues to get worse even on antibiotic therapy. Pneumococcal and flu vaccines may help to prevent the ear infections and pain.

Broken bone

Bones in children are soft, and they rarely get broken into two, unless the trauma is severe. Thus identifying the fracture remains a challenge, but one should always think about it if the pain is severe, there is swelling over the bone, pain keeps getting worse, one can see deformity of the arm or leg or loss of functionality.

If a child has been injured, first take care of bleeding. In case of fracture, do not try to realign the bones unless you have been trained to do so. The best approach is immobilization by splinting the fractured area. Apply splint above and below the fractured area along with sufficient padding. An ice pack may help to reduce the pain. Elevate the legs if a child feels dizzy.

Fractures are not something that can be treated at home, thus immediately seek medical help. One can either call emergency services or take a child to the emergency department by car. At emergency room imaging (like an x-ray) would confirm the diagnosis and severity. Bone healing is a natural process, but it requires immobilization, which specialist would often do with the help of plaster casts. Severe trauma may need operative procedure and fixation. Duration of healing would depend on the severity of injury and location.

Eye Trauma

Eyes are the most important of all the sense organs, and first aid would depend on the kind of trauma, whether it is mild and blunt trauma or piercing trauma (by an object).

In case of mild trauma received during playing, first aid may help a lot. Start by flushing the eye with water, use lukewarm water. Keep checking the eye regularly to ensure that things do not get worse; one may use specific over-the-counter eye drops in some instances.

Piercing trauma is something that cannot be treated at home, and do not try to remove the object from the eye as it may only worsen the things. Seek immediate medical help in case you see some foreign object in an eye. In case of blunt trauma seek medical attention if irritation, redness, and eye discomfort continue, the eye becomes swollen, or there is pain around the eye, or eye has become sensitive to light. Blood in the eye, trouble seeing are all dangerous signs. In case of chemical trauma, it is always better to seek immediate medical attention even if things do not look dangerous.

Nose Bleed

It is a common problem as blood vessels in the nose are quite fragile. Fortunately, it is rarely a cause for worry, and most nosebleeds would stop after some time. Few children are more prone to it, nosebleed may say about respiratory allergies, nose or sinus infection, sometimes bleeding may occur due to trauma.

First, comfort your child and ensure that the child is not crying as is only increases the nosebleed. Ask a child to sit with head tilted little forward. Apply pressure with fingers on soft part of the nose for about 10 minutes. A cold pack or a cold cloth on the forehead may also help. In some cases, nasal decongestant drops or sprays may help as they are vasoconstrictors.

Seek medical help if nosebleed continues after 10 minutes. If nosebleeds are frequent, then seek medical advice as reason maybe some infection, an allergic condition, a disease of the blood, and even anemia.

Head injury

Children often bump their head while playing, or they may get head injury due to a fall. Fortunately, in most cases, the damage is mild, and all that is required is enough of rest and application of cold pack at the place of injury to control swelling and pain. Though in some cases symptoms may be more severe, sometimes brain may be shaken inside the skull resulting in an injury called concussion and a child may feel drowsy or even dizzy.

If a child has a head injury, always look for specific red flags like dizziness, unresponsiveness, headaches, sometimes a child may feel sick and confused, may vomit, may complain of blurred vision, or may even not remember the cause of head injury. Quite often a child may not say anything after the head injury. However, things may gradually get worst in a day or two as inflammation ensues. Thus always keep an eye on a child after an injury. If you see any of the red flags mentioned above, urgently seek medical attention.

Food Poisoning

First and foremost, one has to identify the source of food poisoning, if it is due to mushrooms or seafood, then it is an emergency situation and should not be treated at home. In colder regions, food poisoning may also occur after eating tinned food, which may also be life-threatening. Once a person has excluded something severe causes, one can provide help or first aid at home.

A child would often vomit after the food poisoning, thus avoid giving him or her any solid food items. Instead feed with liquids or soft food items like banana, puree, rice. Another important thing is to treat dehydration, thus ask a child to keep sipping liquid. Do not ask a child to drink too much of fluid, instead ask to drink in small portions. Adding oral rehydration salt to water may help. Avoid medications for nausea or diarrhea, as these medications may mask the symptoms, which is dangerous.

Seek medical attention if vomiting or diarrhea would not stop, and there is severe belly pain or headaches, fever is another bad sign. Similarly look for symptoms of dehydration like dry mouth, dizziness, increased heart, and breathing rate, reduced urination.

Allergic reaction

It is not always easy to identify the source of the allergy; it may be anything from pollens to food items like milk, eggs, or peanuts. Symptoms of allergy would differ. Skin rashes are most common sign of allergy, followed by wheezing, runny nose, and itchy eyes. Some may get stomach upsets due to food allergies. In some cases, the cause may be identified as one would see the fixed pattern of allergy after exposure to specific food items or environmental factors (like having an allergy at a fixed time of the year). Confirmation of source of allergy may require clinical testing.

Primary care in case of allergy would depend on its severity. Of course, the first strategy is always to avoid exposure to an allergen, though it is not always possible. In many cases, anti-histamine drugs like diphenhydramine (Benadryl) may help to relieve the symptoms.

Among all the allergic reactions, anaphylactic shock is an emergency; it is a life-threatening condition if not treated immediately. In anaphylactic shock person has breathing difficulty, blood pressure drops rapidly, there may be nausea and vomiting. If a person knows that a child is prone to anaphylactic shock on exposure to specific allergens or insect bite, then it is better to carry an epinephrine auto-injector (EpiPen, Auvi-Q), and learn to use it. As sometimes emergency help may be far away, or not accessible for reasons.

Choking

It is common and among the leading cause of death among the infants. Quite often infant would put some small object in his or her mouth (due to reflex and curiosity to discover the world around), and this object or even food item may block the airway. Often caretakers or parents would not have enough time to call emergency services and about four minutes are enough to cause severe brain damage. Identifying choking is not hard, based on the reactions of a child, breathing would stop, the face would redden, and a child may lose consciousness quickly.

First aid procedure to dislodge an object from airway is called Heimlich maneuver, and there is the difference in how it is done on a child and infant. In a child it is more similar to the way it is carried out in adults, that is you approach a child from behind and put both your arms around a child around the waist, but keep the arms off from the rib cage. Give quick inward and upward thrusts in an area between the ribs and waistline. One may need to repeat the action several times and maybe a bit strongly until the object is coughed out.

If it is an infant, then place the infant on your lap with the face looking below and spine towards you, do not forget to support his or her face with one hand. Give forceful blows on the back with the heel of your hand. If this does not work, then give forceful thrusts to the chest at the level of nipples.

Poisoning due to foreign substance/pills

Poisoning due to accidental ingestion of foreign materials is most common among the children below the age of 6, and the most common reason is accidental ingestion of medications (almost 50%), followed by ingestion of the corrosive substance, and inhalation of carbon monoxide. 4 Other things commonly ingested are cosmetic items, and other materials regularly used at home.

Always suspect a poisoning if a child is having difficulty in breathing, feeling drowsy, vomiting, has some smell in the mouth, or redness of mouth. Your first action should be to immediately call emergency services, as treatment would depend on the type of poisoning.

If poisoning is due to inhalation, immediately take a child outside in fresh air, if it is due on the skin or eye, then remove the remains of the poisoning agent and rinse the eyes or skin. In case a child has swallowed something, then follow the instruction on the label or container of an agent that was ingested.

Seizure

Unlike adults, seizures are more common in children and are not necessarily due to diseases of the brain like epilepsy. Among children most common cause of seizures is febrile seizures, that is due to high fever caused by specific infections. Individual children are more prone to them, and seizures often repeat in them.

Seizures are characterized by involuntary movements, usually of arms and legs. In rare cases, a child may also lose consciousness. Seizures may also result in the spontaneous emptying of bladder or bowel.

If a child has a fit of seizure, immediately remove the things from nearby that may hurt him or her. Then lay the child on the side to avert choking from saliva. Loosen the tight clothing, especially around the chest and neck region. Do not attempt to stop your child from shaking as it would only worsen the things. Do not give medication immediately, instead wait for some time, and allow your child to rest after the seizures.

Seek medical attention if seizures repeat, or child has a trouble breathing or remains unconscious for some time after the seizures.

Sunburn/Dehydration

Some children are more sensitive than other and may quickly get a sunburn. Quite often redness and discomfort would be felt few hours after the exposure to sunlight. Skin of a child may become red, the child may complain about the pain and itchiness. In severe cases, there may be headaches, nausea, dizziness, and even fever and chills.

The first step is to minimize the further exposure to sunlight. Give your child a bath or shower with cool water (not cold), or apply cool compresses. Continue to give extra fluid for next 2-3 days (consider giving water with rehydration salts). One can also give ibuprofen or acetaminophen to relieve pain. Moisturizing cream or aloe may help in many cases. Further, ensure that child wears long clothes when going out till the skin has healed.
In rare cases there may be a need for medical attention if a child has swelling in the face, sunburn covers an extensive area, and a child develops a fever or chills.

Drowning accidents

Though drowning accidents are common among the children of all ages, they are especially prevalent among the age of 1-4 years.

If one realizes that a child is drowning, he or she should be immediately pulled out, and the next step would depend on whether the child is conscious or not. If a child is unconscious, immediately start CPR to prevent fatal outcome and at the same time ask someone to call emergency services, while providing CPR check for respiration from time to time. Ensure that a child is breathing and not just gasping. CPR should involve giving two breaths followed by 30 chest compression, and cycle should be repeated till the emergency services arrive, or the child is revived.

In case of drowning it is not relevant whether the child is conscious or not, every instance of drowning requires medical attention.

Car accidents

Motor vehicle injuries are often severe and are the number one cause of injury-related mortality in children above the age of one. In fact, after the age of 5 more than half of the fatal injuries are motor vehicle injuries. Nature of such injuries is diverse; sometimes a child may be hit by a car while walking, riding a bicycle, motorcycle, or as a passenger in a vehicle.

Both due to the severity of injuries in car accidents and diverse nature, there is no fixed rule for first aid, everything would depend on the kind of injury, whether it is a brain injury or broken limb. Is the child conscious or not? To start with, first look for the signs of consciousness, if a child is unconscious then begin CPR. In case of open wounds try to control bleeding. However, do not remove the foreign objects from the body, and do not move the child too much. Immobilization of the patient has a special place in accidents. Finally, call the emergency services as soon as possible.

First aid kit essentials

It is impossible to foresee a kind of injury a child may sustain or what illness may happen. Thus your first aid kit must have a wide variety of things. It should have bandages, plasters of various size and shapes, gauze dressing, sterile gloves, tweezer, scissor, cleansing wipes, skin cream and spray, painkillers like ibuprofen or acetaminophen, cough medications, antihistamines, distilled water, and thermometer. It is a good idea to buy some good first aid manual and keep it along with the kit. Further, do not forget to check the expiry date of medications from time to time.

Conclusion

There is need to understand that children are more prone to injuries, in fact, in modern-day injuries are a much more significant problem in children and young adults than infections or other diseases. Being prepared for emergencies would help to tackle injuries effectively, and may even help to save a life. Finally, there is need to understand the pattern of injuries in various age groups and take precautions accordingly, like a young child is more probable to die of suffocation while a teenager is at a higher risk of motor vehicle injuries.


  1. Borse N, Gilchrist J, Dellinger AM, Rudd RA, Ballesteros MF, Sleet DA. CDC Childhood Injury Report: Patterns of Unintentional Injuries Among 0-19-Year-Olds in the United States, 2000-2006: (572462009-001). CDC.gov 2008. doi:10.1037/e572462009-001

  2. Borse N, Gilchrist J, Dellinger AM, Rudd RA, Ballesteros MF, Sleet DA. CDC Childhood Injury Report: Patterns of Unintentional Injuries Among 0-19-Year-Olds in the United States, 2000-2006: (572462009-001). CDC.gov 2008. doi:10.1037/e572462009-001

  3. Khorasani G, Hosseinimehr SJ, Azadbakht M, Zamani A, Mahdavi MR. Aloe versus silver sulfadiazine creams for second-degree burns: A randomized controlled study. Surg Today. 2009;39(7):587-591. doi:10.1007/s00595-008-3944-y

  4. Sahin S, Bora Carman K, Dinleyici EC. Acute Poisoning in Children; Data of a Pediatric Emergency Unit. Iran J Pediatr. 2011;21(4):479-484.

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Dr. Preet (MD)

Dr. Preet B. is a doctor with specialization in diabetes from Royal Liverpool Academy, U.K. He has a particular interest in non-communicable diseases and has experience in both the clinical practice and medical research.

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