Procedures for Emergency Care for Children

When a child is burned: 

DO:

• Remove the child and yourself away from the heat source
• If they are on fire, cover with a blanket or coat to put out the fire
• Flush burn with large amounts of cool water for a minimum of 15 minutes
• If a chemical burn, flush for 20 minutes and call Poison Center at 1-800-222-1222
• Remove clothing contaminated with chemical and all jewelry if possible
• Gently and lightly cover flushed burn with a dry, clean dressing or bandage

DO NOT:

• DO NOT remove clothing that sticks to the skin
• DO NOT break blisters that may form
• DO NOT apply ointments or creams to burn

CALL 9-1-1 IF:

• The burn causes breathing difficulty (especially burn on the mouth or nose areas)
• Burns are located on the head, neck, hands, feet or genitals
• The child has special health care considerations
• Burns are covering more than one body part
• Burns are a result of chemicals, electricity, or explosions

Consult with your doctor if you have questions or concerns

If a child is unconscious: 

Unconscious Child (Between 1 year and 12 years old)

If you find a child unresponsive, follow these steps: 

1. Send someone to call 9-1-1.
2. If you suspect head or neck injury due to the child falling from a height (stairs) or an accident, limit movement to the head and neck when opening the airway. 
3. Gently tap the child and shout their name to see if they awaken or respond.
4. Position the child face-up and open the airway. Look for chest rise, listen for breath sounds and feel for their breath on your face (no more than 10 seconds).
5. If the child is breathing, roll them onto their side, and stay with them until help arrives. 
6. Check for breathing frequently. 
7. If the child is not breathing or stops breathing, begin the steps for CPR. 

If an infant is unconscious: 

Unconscious Infant (Less than 1 year old)

If you find an infant unresponsive, follow these steps: 

1. Send someone to call 9-1-1.
2. If you suspect head or neck injury due to the baby falling from a height such as a table or down stairs, limit movement to the head and neck when opening the airway.
3. Gently tap their feet and shout their name to see if they awaken or respond.
4. Position the baby face-up and open the airway. 
5. Look for chest rise, listen for breath sounds and feel for their breath on your face (no more than 10 seconds).
6. If the baby is breathing, ensure the airway remains open and stay with them until help arrives. Check for breathing frequently.
7. If the infant is not breathing or stops breathing, begin the steps for CPR.

If a child is choking:

Conscious Choking Child (Between 1 year and 12 years old)

If the child can cough, speak or breathe: Do not interfere. Send someone to call 9-1-1 and stay with the child until help arrives (if alone, bring the phone to you).

If the child cannot cough, speak or breathe: Send someone to call 9-1-1 and  use abdominal thrusts following the steps below: 

• Kneel or stand firmly behind the child and wrap your arms around them so that your hands are in front. 
• Make a fist with one hand and place your other hand inside the fist. 
• Put the thumb side of your fist just above the belly button.
• With your other hand, grasp the fist and give quick upward thrusts into the belly until the object is forces out. The child could cough, speak, breathe, r lose consciousness. If they lose consciousness, begin the steps for CPR.

If an infant is choking:

Conscious Choking Infant (Less than 1 year old)

If the baby can cough, breathe or cry: Do not interfere. Send someone to call 9-1-1 and stay with the baby until help arrives (if alone, bring the phone to you).

If the baby cannot cough, breathe or cry: Send someone to call 9-1-1 and use back slaps and chest thrusts to relieve the choking  infant. Sit on a chair or kneel and follow these steps:             

1. Hold the infant face down on your forearm supporting the head and jaw with your hand. Rest your arm on your lap or thigh keeping the head lower than their diaper. 
2. Give up to 5 back slaps with the heel of your hand between the shoulder blades. If the object does not come out, turn the baby over, keep the head down and remove the clothes from the chest area. 
3. Support the head, and give up to 5 chest thrusts using your middle and index fingers from your free hand on the breastbone. 
4. Alternate 5 back slaps and 5 chest thrusts until the object comes out. The infant can breathe, cough, cry or lose consciousness. If they lose consciousness, begin the steps for CPR.

If a child has a head injury:

Head Injury

Children frequently bump their heads. Even minor cuts can bleed heavily. This does not always mean the injury is an emergency. Watch the child closely after a fall. Some symptoms develop right away and others develop later. If a child begins to play or run immediately after getting a bump on the head, serious injury is unlikely. However, watch the child closely for 24 hours after the incident. 

Serious injury is unlikely if the child:   

• Cries immediately
• Moves normally
• Does not seem sleepy or irritable
• Does not complain excessively about pain

If you are still concerned, take the child to a health professional for evaluation. 

Call 9-1-1 if the child: 

• Is unconscious or hard to wake up
• Is having seizures
• Has vomited more than 2 times
• Is dizzy, complains of blurred vision or has trouble crawling or walking
• You are unable to control bleeding after 5 minutes of direct pressure
• Is unable to move arms or legs
• Has one pupil larger than the other
• Has blood draining from nose or ears
• Complains of severe headache or cries inconsolably (non-stop)

Care of injuries to the head and scalp:

Head injury

DO:

• Place an ice bag or cold pack on the injured area to stop swelling
• Apply pressure to the wound
• Monitor for signs of infection such as fever, swelling, redness, or discharge

DO NOT:

• DO NOT move the child if neck or back injury is suspected
• DO NOT give anything by mouth if the child is unconscious or semi-conscious

Care of children experiencing seizures:

Seizures may cause the entire body or parts of the body to shake. Seizures occur for many reasons, especially in children and can be frightening for the parent or caregiver. If you suspect a child is having a seizure, follow these steps: 

DO:

• Stay calm, most seizures only last a few minutes
• Send someone to call 9-1-1
• Make sure the child is safe, remove objects from around them
• Keep the child on the floor and not on beds or couches where they may fall
• Check for breathing during and after seizure activity
• Note the type of movement and duration of seizure activity
• When the seizure is over, lay the child on their side and make sure the mouth is clear of sliva (drool) or vomit (recovery position)
• If the child stops breathing, follow the steps for CPR

DO NOT:

• DO NOT place or force objects between the child's teeth or in the mouth
• DO NOT hold the child or try to stop the jerking movements
• DO NOT hive the child anything to eat or drink
• DO NOT give the child/infant a cold bath

After a seizure, the child may: 

• Be confused or not remember the seizure
• Complain of a headache or feeling dizzy
• Experience loss of bladder or bowel control during the seizure and need to be cleaned/change of clothes
• Feel sick to their stomach and vomit or have excess saliva (drool) following the seizure
• Be sure to keep the airway open by rolling the child on their side or supporting an infant in your arms

Recovery Positions       

When a child has a fever:

Fevers can be caused by a minor illness such as a cold or by a more serious infection. When you suspect your child has a fever, follow these steps:

DO:

• Take your child's temperature - don't rely on touch or appearance
• Give them lots of clear fluids to drink - don't worry if they are not hungry
• Dress the child in light, loose fitting clothing, diapers or underpants
• Place cool washcloths over the forehead for comfort

DO NOT:

• DO NOT cover the child in heavy clothes or blankets
• DO NOT give aspirin to children
• DO NOT bathe or spray the child in cold water, ice water or rubbing alcohol

Call 9-1-1 if the child/infant:

• Has trouble breathing - if the child stops breathing, follow the steps for CPR
• Complains of a stiff neck or displays limited movement
• Has a seizure - if the child has a seizure, follow the steps for Seizures
• Is extremely difficult to awaken or appears disoriented
• Develops a dark red/purple rash
• Cries inconsolably (non-stop)

Normal Temperature Ranges for Children

Infants (0-4 months) may range 99.6° F - 100° F Rectally

Children (1 year and up) may range 98.6° - 100.3° Orally

Special Note: Infants three months or younger with a rectal temperature of 100.4°. F or higher should be evaluated by a medical professional immediately. 

Acetaminophen (Tylenol® or another brand)

Give every 4 to 6 hours as needed. | For babies 0-3 months, call doctor for approval.

Click here to get dosage recommendations for Acetaminophen. 

Ibuprofen (Advil®, Motrin®, or another brand)

Give every 6 to 8 hours as needed; always with food.

Do NOT give to a baby under 6 months without doctor's approval.

Click here to get dosage recommendations for Ibuprofen. 

When a child has a facial injury:

In children, most facial injuries occur during sports or playtime. Most minor facial injuries in young children can be handled at home. 

EYES

Our eyes make tears naturally to flush objects out but eyes can become very irritated. Small foreign body objects like dirt, sand, stray eyelash or chemicals can fall into the eye and be very painful. 

DO:

• Encourage the child to blink and use natural tears to flush object out.
• Using warm water, flush the eye over the sink. If the eyes were splashed with
  chemicals, flush immediately for at least 20 minutes. While you are rinsing the eye, have someone call POISON CONTROL 1-800-222-1222 and follow their directions.
• If the object does not easily wash out, cover both eyes with dry gauze and seek medical help.
• Apply an ice pack to bruises or redness around the eye following the injury.

DO NOT:

• DO NOT rub or put pressure on the affected eye to dislodge foreign object.
• DO NOT squirt or spray water forcibly into the eye
• DO NOT use your fingers to take an object out of the eye

Call 9-1-1 if:

• An object is impaled (stuck) in the eye
• Blood and/or severe pain in the eye or deformity of the bones around the eye following a strike to the face or fall - follow the steps for Head Injury
• If child has blurred or double vision

EARS

Possible injuries include; ruptured eardrum, infection, cut/abrasion, bruise, burn, bites or foreign body in the ear. 

DO:

• Wash a cut or abrasion (gently) with warm soapy water for 5 minutes
• Cover with sterile gauze or a bandage to keep it clean and dry
• Follow the steps for Burn if one occurs
• See a family doctor if you suspect your child has an ear infection (complaints of pain, fever and itching/discomfort are common signs of infection)
• If a child is bitten, contact your family doctor for guidance

DO NOT:

• DO NOT push items into the ear to retrieve objects from the ear canal or stop bleeding
• DO NOT squirt or spray water forcibly into the ear

Call 9-1-1 if:

• The ears are bleeding after a fall or strike to the child's head - follow the steps for Head Injury
• An object is impaled (stuck) into the ear (do not try to remove it)
• A bite (animal or human) is severe and/or bleeding continues more than 5 minutes

When a child has a facial injury: 

NOSE

Injuries can occur on the outside or inside the nose. Some common conditions
include: broken nose, bloody nose, foreign object in the nose, bruise, swelling, and
abrasions/cuts.

DO:

• To stop external bleeding, apply 10 minutes of pressure with a sterile gauze or bandage.
• Use warm soapy water to (gently) wash any cuts/scrapes and cover with a
  bandage only if it does not interfere with breathing.
• To stop a nosebleed, have the child sit comfortably with head slightly forward. If blood is flowing freely from the nose, provide constant pressure for 15 minutes by pinching the nostrils firmly. Apply a cool compress, wrapped in a cloth, to the nose and provide a cup or bowl if they need to spit.
• To remove something they put up their nose, push the unaffected nostril shut and have them blow out the other nostril to see if the object will come out. Only remove the object with a tweezers if it is visible.
• If you suspect your child’s nose is broken (deformity or swelling may not require a trip to the hospital), call your family doctor for guidance.
• Apply ice to a bruised or swollen nose, but only lightly, without pressure

DO NOT:

• DO NOT use tweezers, cotton swabs or other tools to remove a foreign object you cannot see
• DO NOT apply pressure to a nose you think could be broken

Call 9-1-1 if:

• The child has trouble breathing
• The child is unconscious due to a fall or strike to the nose - follow the steps for Unconscious/Fainting until help arrives

MOUTH

Injuries of the mouth are usually not serious but they can bleed a lot. Along with other emergency numbers, have the number to your child's dentist listed for quick reference. Injuries of the mouth include: broken or chipped tooth, knocked-out tooth, an impaled object and cuts to the tongue, lips or inside of cheeks. 

DENTAL

For a chipped or broken tooth, gather the pieces and call the dental office. Most likely, they'll want to see your child, especially if the tooth is cracked or fractured. Even if the damaged tooth is a baby tooth, it's important to call for professional advice. A permanent (adult) tooth that has been completely knocked out should be placed in a container of milk or water and taken with the child to the Emergency Department. Often times, if the repair happens within an hour of the injury, the tooth can be saved. Don't handle the root of the tooth and don't scrub or clean it. Sterile gauze can be used to stop bleeding where the tooth was knocked out. 

SOFT TISSUE OF THE MOUTH:

Bumps to the mouth can result in injuries to the lips and tongue. Usually applying ice wrapped in a paper towel or a cool washcloth will stop any bleeding and soothe the injured child. If the injury is severe or bleeding does not stop after 10 minutes, the child should be seen bu a health care provider. Lip burns from an electric cord should be seen urgently by a medical professional. 

Call 9-1-1 if: 

• An impaled object is in the child's mouth (do not try to remove it)
• The child is unconscious from the blow to the mouth or fall, follow the steps for Unconscious/Fainting
• The child is having difficulty breathing

Heat Injuries: 

Injuries caused by heat or cold can be serious. If caught early, first aid at home can
be very successful. Remember to dress children appropriately for the weather. Injuries from the heat and cold include: heat exhaustion, heat stroke, heat cramps, frostnip, frostbite and hypothermia. 

Heat:

Babies and young children are very sensitive to the effects of high temperatures. They become dehydrated very quickly because of their small size. They are also unable to help themselves if they become overheated.

Click here to access the chart to learn about symptoms, first aid and follow up for three different kinds of heat injuries. 

DO NOT:

• DO NOT give the child/infant a cold bath or immerse them in ice
• DO NOT let them return to the heart or active play for at least four hours
• DO NOT leave the child unattended during cooling steps or recovery

Cold:

Babies and young children lose heat rapidly. Small ears, fingers and toes are especially vulnerable to cold temperatures and wind chill. Dress children appropriately for the winter and limit exposure to severe weather.

Click here to access the chart to learn about symptoms, first aid and follow up for three different kinds of cold injuries. 

DO NOT:

• DO NOT give the children/infant a hot bath or place affected skin in hot water
• DO NOT rub or massage the skin
• DO NOT use direct heat, like heating pads on the child
• DO NOT disturb any blisters
• DO NOT give medication unless told to do so by a doctor

CPR for an Infant:

(Less than 1 year old)

If you find an infant unconscious or an infant becomes unconscious during a choking episode, follow these steps:

1. Make sure the scene is safe and infant is on a firm, flat surface.
2. Gently tap the infant and shout. Check to see if the infant responds. If infant does not respond, continue to step 3.
3. Send someone to call 9-1-1. 
4. Begin CPR. Even if you have  not been trained in CPR, you can start life saving actions (CPR).

Begin CPR:

• Move clothes out of the way. 
• Position the infant face up. Make sure to turn/move them in a way that limits neck movement. 

Compressions     

• Place 2 fingers just below the nipple line. Push straight down. Give 30 compressions.
• Compress about 1 1/2 inches deep.
• Give between 100-120 compressions per minute. 
• Let the chest come back up to its normal position. 
• Try not to interrupt compressions for more than a few seconds. 

Breaths (If you do not wish to give rescue breaths continue chest compressions as directed).

• After 30 compressions, open the airway with a head tilt-chin lift.
• Check the mouth for foreign objects and remove any objects you see. 
• After the airway is open and clear, take a normal breath.
• Cover the infant's mouth and nose with your mouth. 
• Give 2 breaths (blow for 1 second each).
• Watch for the chest to begin to rise as you give each breath.

Repeat sets of 30 compressions and 2 breaths.

If you are alone after 2 minutes or 5 sets of 30 compressions and 2 breaths, call 9-1-1, and then continue sets of 30:2.

Keep giving sets of 30 compressions and 2 breathes until the infant starts to breathe or move, until someone with more advanced training arrives and takes over, or you become too tired to continue. 

CPR for a Child 

(Between 1 year old to puberty/teenager)

If you find a child unconscious or child becomes unconscious during a choking episode, follow these steps:

1. Make sure the scene is safe and child is on a firm flat surface.
2. Gently tap the child and shout. Check to see if the child responds. If child does not respond, continue to step 3.
3. Send someone to call 9-1-1 and ask them to get an Automated External Defibrillator (AED).
4. Begin CPR.

Even if you have not been trained in CPR, you can start life saving actions (CPR).

Begin CPR: 

• Move clothes out of the way. 
• Position the child face up. Make sure to turn/move them in a way that limits neck movement.

Compressions:

• Put the heel of 1 hand between the nipples on the lower half of the breast bone (use two hands for older children). Push hard and fast.
• Give 30 compressions.
• Compress about 2 inches deep.
• Give between 100 to 120 compressions per minute. 
• Let the chest come back up to its normal position.
• Try not to interrupt compressions for more than a few seconds. 

Breaths:

• After 30 compressions, open the airway with a head tilt-chin lift.
• Check the mouth for foreign objects and remove any objects you see. 
• After the airway is open and clear, take a normal breath.
• Pinch the nose shut. Cover the child's mouth with your mouth. 
• Give 2 breathes (blow for 1 second each). Watch for the chest to begin to rise as you give each breath.

Repeat sets of 30 compressions and 2 breaths.

If you are alone after 2 minutes or 5 sets of 30 compressions and 2 breaths, call 9-1-1, and then continue sets of 30:2.

When the AED arrives:

• Turn it on by lifting the lid or pressing the "ON Button".
• Use child pads/key or switch (use adult pads if no child pads are available).
• Follow the prompts.

Keep giving sets of 30 compressions and 2 breaths until the child starts to breathe or move, until someone with more advanced training arrives and takes over, or you become too tired to continue. 

 

Poison Control 1-800-222-1222

When a child/infant has been poisoned:

A poison is any harmful substance taken into or placed on the body. A poison can be swallowed, inhaled or injected. Some poisons have an immediate affect or problems may be delayed for hours. Children can be poisoned by many things, possible sources include: prescription medication, household cleaning products, vitamins, lead, illegal drugs, carbon monoxide, plants and alcohol.

Signs the child may have been poisoned can include:

• Stains around the mouth or strange smelling breath
• Lethargy (sleepiness)
• Vomiting
• Bright red skin or rash
• Seizures
• Stomach pain
• Confusion
• Headache

If you think it is a poison emergency, call the Poison Center immediately at 800-222-
1222. Do not delay waiting for symptoms to appear. Always call the poison center or
a medical professional BEFORE trying to make the child vomit. Home remedies
should NEVER be used.

If the child/infant is found unconscious or is experiencing immediate distress, call 9-1-1
and follow the steps for Unconscious/Fainting or CPR if they are not breathing.

DO:

• Have drug/poison containers available for medical personnel
• Move the child and yourself away from source of poison
• If conscious, place child in sitting position and monitor breathing
• The child may vomit, provide a bucket for them
• Stay with the child and monitor the airway
• If chemicals have contacted the skin, check with the poison center
  before flushing with water

DO NOT:

• DO NOT give the child anything to eat or drink
• DO NOT make child vomit without direction from a medical professional
• DO NOT wait for symptoms to appear, call immediately if you think poisoning

Allergic reactions:

Allergic reactions can be mild or severe. Most common allergies begin in childhood and some allergies run in families. An allergic reaction is the body's way of responding to an "invader" by using the immune system. Children can be allergic to many things including: food, insect bites or stings, latex, medicine, plants, pollen, pets, and animals.

Not all allergic reactions require medical care. Ask your child's doctor if you think it is allergies. Symptoms vary, but things to look for include: 

• Swelling (near site of contact or bite)
• Itchy skin, red raised bumps (hives) or blotchy skin
• Upset stomach, vomiting
• Runny nose, itchy watery eyes

In some cases, children can experience a severe allergic reaction called anaphylaxis, which can be life threatening. This usually happens within seconds or minutes of exposure.

Call 9-1-1 if the child: 

• Has difficulty breathing - wheezing sound or gasping
• Has a swollen tongue, airway and lips
• Is unconscious
• Has difficulty swallowing or change in voice
• Is vomiting

If a child has been issued an EpiPen® by a medical professional and is having an allergic reaction, use it as directed and monitor the child's airway and breathing. If the child becomes unconscious, follow the steps for Unconscious/Fainting or CPR if the child stops breathing.

When a child falls:

Slips, Trips and Falls

Young children are not aware of the danger s of high places or slippery surfaces. Sometimes falls can be serious and may require more attention. Most falls occur from furniture, stairs, windows, baby walkers, shopping carts and playground equipment. The injuries caused by a fall depend on the distance of the fall and the type of landing surface.

Common injuries from slipping, tripping or falling include: bruises, cuts/scrapes, neck or back injury, facial injury, head injury, and broken bones or teeth. 

DO:

• Follow the steps for Facial Injury if one occurs
• Follow the steps for Bruises/Bumps/Bleeding if one occurs
• Take the child to a medical professional if they have an obvious deformity (lump)
• Check for bleeding, follow the steps for Head Injury if the child strikes their head
• Use window guards to prevent falls - remember screens are only designed to keep bugs out, not to prevent a child from falling
• Use safety gates at the top and bottom of stairs
• Buckle safety straps on high chairs, changing tables, strollers and shopping carts

DO NOT: 

• DO NOT leave an infant or child unsupervised (alone)
• DO NOT try to move the child if you think it is a serious injury
• DO NOT apply pressure to a deformity (bump or lump)
• DO NOT try to straighten bent limbs

CALL 9-1-1 if the child:

• Is unconscious and follow the steps for Unconscious/Fainting
• Cries inconsolably and/or vomits more than 2 times
• Complains of neck or back pain
• Has difficulty walking or moving limbs

When calling 9-1-1, the operator will need to know:

• Exact address or location with cross streets, landmarks and building, floor, or rom number
• Your name and the telephone number you are calling from
• What happened - the nature of the emergency
• Number of victims and types of injuries
• The care provided

When a child is bruising or bleeding: 

Bruises, bumps or bleeding: Children receive bumps and scrape their knees frequently. Most of the time, a band-aid takes care of the problem, however, more serious injuries do occur. 

Bruises and bumps:

A bruise is a blue or black-and-blue mark under the skin surface. The skin is not broken and tender to the touch.

• Crushed ice in a bag or an ice pack wrapped in a towel may provide comfort. 
• Give pain reliever, such as acetaminophen (Tylenol®) or ibuprofen (Motrin®) as directed or call a healthcare provider.
• If the bruise occurs from a twisted joint or is followed by swelling and/or pain, apply ice, elevate (if it is an leg or arm), and call a healthcare provider.
• Bruises that worsen or bumps that swell a lot, may signal a greater injury, so call a healthcare provider.

Bleeding: 

Bleeding can happen with a scrape, cut or any injury that opens the skin. 

• Gently clean the wound with warm soapy water and remove loose gravel, dirt and grime from the injury.
• After drying the area, (apply antibacterial ointment if you wish) then cover with a clean dressing or band-aid. Watch for signs of infection like redness, swelling, or warmth. Call a healthcare provider with concerns. 
• Sometimes pressure is needed to stop bleeding. With sterile gauze, apply pressure and raise the limb to slow blood flow to the area. 
• Do not pull or remove torn skin. After cleaning the wound, gently cover the skin with clean dressing/bandage.

DO NOT:

• DO NOT press directly on the bruise or bump
• DO NOT try to remove embedded objects - call healthcare provider
• DO NOT remove gauze used to stop bleeding, keep bandage in place.

CALL 9-1-1 IF:

• The bleeding is severe or lasts longer than 5 minutes
• The child loses consciousness - see Unconscious/Fainting
• Complains of neck or back pain
• Has difficulty walking or moving injured limbs
• Displays signs of shock which include: chills, blue lips or fingernails, severe pain, dizziness or rapid breathing