What every new parent must know
It's every parent's biggest nightmare: A child has a sudden medical emergency or injury when there's no medical help around. How can you help prevent such a situation from occurring and deal with it effectively if it does? First, take a tour of your home from a child's point of view — on your hands and knees — and remove or remedy any obvious hazard. Second, be prepared. "Every parent should have formal first-aid training, including CPR and rescue breathing," says Larry Baraff, M.D., professor of pediatrics and emergency medicine at the University of California at Los Angeles School of Medicine. Even before you enroll in a childbirth education class, take infant CPR and basic first aid. To find a class near you, call your local hospital or check the white pages of your phone book for the local branch of the American Red Cross. The YMCA also offers classes; call (888) 333-YMCA to find one near you. In the meantime, with advice from Baraff; Baxter Larmon, Ph.D., M.I.C.P., associate professor of medicine at the UCLA Emergency Medicine Center; and Brad Schwartz, M.D., F.A.C.E.P., a San Diego emergency physician and director of OnCall Healthcare Communications, a 24-hour telephone nurse advice center, here's how to treat four of the most common emergencies that infants experience.
Choking is among the leading causes of accidental death for children under the age of 1. Look for: Child may be hyperagitated — jumping up and down and/or gesturing wildly — or unable to cry or talk. Fingers and lips may be blue-tinged, with the discoloration spreading to the arms, neck and chest.
What to do: If baby is 1 year or younger and conscious: If the infant is coughing forcefully, allow him to continue coughing to try to expel the object. If he does not stop coughing in a few minutes; begins to cough weakly; makes a high-pitched wheezing sound; cannot cough, cry or breathe; or becomes unconscious, call 911 immediately and follow the steps below until the child stops choking or help arrives.
If baby is 1 year or younger and unconscious: 1) Lay the infant face-up on a firm surface, tilt his head back slightly and lift his chin. Open his mouth and look for a foreign object. If you find one, pull it out — but only if it is in the mouth and can be pulled out easily, without the potential of pushing it in farther. Don't stick your fingers down the infant's throat to try to pull the object out. 2) If you do not find an object in the infant's mouth, place your mouth over his mouth and nose to form a seal. Give two gentle breaths, watching his chest. If his chest doesn't rise, he's probably choking. 3) If possible, have someone else call 911. If you're alone, carry the infant to the phone and call 911 while you follow the next steps to expel the object:
- Cradle the infant upside-down with one arm supporting his chest, his head resting in your hand.
- Strike him between the shoulder blades five times.
- If the object isn't expelled, lay the infant on his back again. Place two fingers on his breastbone, one finger width below the nipples. Using your fingers, give five quick downward thrusts to the chest at a depth of 1/2–1 inch.
4) See if he is breathing: Tip the infant's head back and give two breaths, watching to see if the chest rises. If he isn't breathing, repeat from step 3 until the object is expelled or help arrives.
- Never feed a child under 3 years of age hot dogs, hard candy, nuts, grapes, popcorn or raw carrots. Keep items that are easy to choke on, such as coins, beads, disc batteries, pills and vitamins, and small toys and balls, out of reach.
- Cut up any food not soft enough to dissolve in the mouth, such as meats, into fingertip-size pieces.
- Supervise children while they eat. Make them eat slowly.
- Anything smaller than a pingpong ball (other than food) can choke a child and should be kept out of reach.
- Never give balloons to infants or young children. They are extremely easy to choke on.
Every year, more than 1 million children under the age of 5 are unintentionally poisoned. More often than not, whatever these children ate or drank, they found at home. "Alcohol, plants, bleach, furniture polish, paint — all can kill a child quickly and need to be kept out of reach," Larmon says. Look for: Empty or spilled pill bottles, signs of vomiting and burning around the mouth, the odor of chemicals.
What to do: 1) Call poison control immediately. To find your local poison control center, look in the white pages of your phone book under "poison" or call 911 and ask the operator to connect you. 2) Do not induce vomiting or try to dilute the substance by giving your child milk or water to drink unless told to do so by medical personnel.
Prevention: Buy child-resistant packaging whenever possible. Lock potential hazards, such as laundry and cleaning supplies, cosmetics, all medicines, gasoline, charcoal, fertilizers and trash, in a cabinet out of children's reach.
Any deep wound can be complicated by bleeding and the possibility of damage to nerves and tendons. Look for: What caused the wound? "If it's the result of a fall, it may not be merely the scrape it seems to be," Larmon says. "If your child fell down the stairs but all you see is a scrape or bruise, call 911 or her physician anyway, since she could suffer internal bleeding or a head injury."
What to do: 1) If you think your child suffered a serious fall, check her pulse. If it feels faster than 160–180, lay her down, call 911, and elevate her legs while you wait for help. 2) For a minor cut, elevate the wounded area if possible and apply direct pressure to it for five minutes with an ice bag wrapped in a towel. "This will stop 95 percent of all bleeding," Larmon says. 3) If there is dirt or debris in the wound, numb it with ice and then scrub very gently with a new soft-bristled toothbrush under cool running water. 4) Once the bleeding stops — and if the cut doesn't need stitches — clean the wound with a soap such as pHisoderm and rinse it with cool water. Don't use antiseptic or antibacterial soaps, since they only increase the child's discomfort. 5) Loosely cover the wound with a Band-Aid or a bandage made of sterile 4-by-4-inch gauze and tape. 6) Keep the wound dry until it forms a scab, changing the bandage every 24 hours. Once a scab has formed, dab petroleum jelly on it to keep it moist and prevent it from snagging on clothing and bedding. 7) If you notice redness, swelling, pus or heat developing around the wound, call a pediatrician immediately. 8) Call your pediatrician if a wound keeps bleeding after 5–10 minutes of direct pressure or has edges that gape open. It may need stitches.
Prevention: Keep corners of furniture and fireplaces cushioned and glass out of reach.
Treatment will depend on the cause and severity, but there are steps you can follow for minor burns. Look for: Red, white, dry or blotchy skin; blisters; browned or blackened skin.
What to do: 1) Extinguish flames or remove child from the source of the heat. 2) Rinse the burned area with cool water. If the burn is on a part of the body that can't be immersed, soak towels or sheets in cool water and gently place on the burned area. 3) Cover the burned area with a dry, sterile bandage or clean cloth. If the burn covers a large part of the body, wrap it in a clean, dry sheet and get immediate medical care. 4) Get immediate care for any burn that causes blisters or the skin to appear mottled; affects more than one body part; or is on the head, neck, hands, feet or genitals.
- Lock matches in a cabinet out of children's reach.
- Place space heaters and radiators at least 3 feet away from cribs, curtains, bedding and other flammable materials. Never use them to dry clothing, and always turn them off when you leave the room and before you go to sleep.
- Keep flammable items, such as dish towels and wooden spoons, at least 3 feet away from a hot stove.
- Don't smoke in bed. Always extinguish matches, cigarettes, cigars and pipes under running water.
- Install at least one smoke detector on each level of your home (preferably one in each room). Test batteries monthly and replace with new ones yearly.
- Never leave a child alone in the bathtub.
- Set your water heater at 120 F or less.
- When cooking, always turn pot handles toward the back of the stove, away from a child's reach.