SAFETY AND FIRST AID

THE MORE PEOPLE HAVE STUDIED DIFFERENT METHODS OF BRINGING UP CHILDREN, THE MORE THEY HAVE COME TO THE CONCLUSION THAT WHAT GOOD PARENTS INSTINCTIVELY FEEL LIKE DOING FOR THEIR BABIES IS THE BEST AFTER ALL.

Dr. Benjamin Spock

Children are curious, and this curiosity often leads to injury. Parents can help protect children by creating a safe environment. You can also teach them to take responsibility for themselves so they develop their own sense of safety and self-confidence. And remember, you will be imitated, so be a positive role model.

This chapter is for reference only. It should not be considered a substitute for an up-to-date first aid or CPR training course. We recommend all parents and caregivers receive CPR training.

FIRST AID SUPPLIES

A first aid kit for home use should contain the following. Remember to check your supplies and replenish them often.

Emergency telephone numbers for EMS, the local poison control centre and personal doctors, as well as the home and workplace phone numbers of family, friends and neighbors who can help

Sterile gauze pads (dressings) in small and large squares to place over wounds

Adhesive tape

Roller and triangular bandages to hold dressings in place or to make an arm sling

Adhesive bandages in assorted sizes

Scissors

Tweezers

Safety pins

Ice bag or instant ice packs

Disposable gloves, such as surgical or examination gloves (non-latex, non-vinyl)

Flashlight, with extra batteries in a separate bag

Antiseptic wipes, soap and hand sanitizer

Pencil and pad

Emergency blanket

Eye patches

Thermometer

Barrier devices, such as pocket mask or face shield

Canadian Red Cross childcare first aid and CPR manual

EQUIPMENT SAFETY

• Always follow manufacturer’s instructions for assembly, installation, use and repair. • Consumer and Corporate

Affairs Canada issues safety guidelines that govern many products for children.

Although these guidelines provide considerable protection, there is no substitute for your own careful inspection and judgment.

TOY SAFETY

• Be aware of appropriate toys for each age group. • Canadian Standards

Association (CSA) and

Canadian Toy Testing Council can recommend toys for various ages. • Health Canada publishes advisories, warnings and recalls for toys.

CAR SAFETY

• Make sure car seats meet federal and provincial/ territorial legislation. • Approved child-restraint systems (car seats, booster seats) are required by law. • Refer to Transport Canada for further information.

FIRE SAFETY

• Ensure smoke detectors are placed in all areas required by your local fire department or other agency that regulates fire safety in your region. • A fire escape plan should be practised several times a year.

ICE AND WATER SAFETY

• Nearly all drownings of babies occur in bathtubs during a momentary absence of supervision by an adult.

Bathtubs are the secondleading location for drownings of children ages 1 to 2. • 50% of swimming pool fatalities in residential pools are toddlers aged 1 to 4.

Almost all occur in pools with inadequate safety gates and during the absence of adult supervision • When boating, you must have correctly sized Transport

Canada or Canada Coast

Guard approved personal flotation devices (PFD) or life jackets on board for each person aboard. • Ice must be at least 15 centimeters (6 inches) thick to support a person. It should be solid, clear blue and not covered in snow before being walked on.

BITES

Care 1. Check the child’s ABCs (airway, breathing, circulation) immediately. 2. Call EMS if there is severe bleeding or if the bite was caused by an unfamiliar animal. 3. If the incident involved an animal, call your local animal control department. Give animal control the exact location of where the bite occurred. 4. If the wound is minor, wash it with soap and water, control any bleeding and put a dressing on the wound. 5. Watch for signs of infection. You might notice swelling, redness and warmth around the wound; pain or tenderness in the area of the wound; or pus or discharge. A more serious infection may cause fever or nausea. 6. Human bites can easily become infected. Be especially careful to wash with soap and water and follow up by seeking medical attention.

INSECT STINGS

Care 1. Check the child’s ABCs (airway, breathing, circulation) immediately. 2. Remove the stinger by scraping it away from the skin. 3. Wash the area thoroughly with soap and water. 4. Apply a cold pack to help control swelling. Keep it on for 20 minutes every hour 5. Watch for signs of an allergic reaction. You might notice rash, itching or hives (raised, itchy areas of the skin); a feeling of tightness in the chest and throat; weakness, dizziness or confusion. If the child develops an itchy rash, apply calamine lotion and cool compresses.

TICKS

Care 1. Check the child’s ABCs (airway, breathing, circulation) immediately. 2. If the tick hasn’t started to dig into the flesh, remove it by brushing it off the skin. If it has started to dig into the flesh, grasp its head with tweezers and pull it out. 3. When the tick is out, wash the area with soap and water. Use an antibiotic ointment to prevent infection. 4. If you cannot remove the tick, the child needs a doctor.

6. If a rash or flu-like symptoms develop within a month of the tick bite, the child may have Lyme disease and requires medical attention immediately.

LYME DISEASE

Lyme disease is caused by a bite from an infected tick.

Early symptoms

• A rash in a small red area at the site of the bite that spreads up to 13 to 18 centimetres (5 to 7 inches) across. • Fever, headache, weakness and joint and muscle pain that may feel like the flu.

Later symptoms (weeks or months after the bite)

• Arthritis, numbness or a stiff neck • Memory loss • Irregular or rapid heartbeat • Problems seeing or hearing • High fever

BLEEDING, CUTS AND SCRAPES

Care 1. Check the child’s ABCs (airway, breathing, circulation). 2. Put on a pair of gloves. If gloves are not available, use another barrier between your hand and the wound. There is usually minimal bleeding with scrapes, but if there’s blood, put direct pressure on the wound until bleeding stops. If possible, have the injured child apply the direct pressure. 3. Wash the wound thoroughly with soap and water. 4. Blot the area dry with sterile gauze. 5. Cover the wound with sterile non-stick dressing. 6. Watch for signs of infection. If there is a great deal of dirt or contamination in the wound, seek medical attention. If the blood soaks through the dressings, add more dressings on top. If you cannot control the bleeding, make sure the person gets medical attention immediately.

CPR

The process for CPR varies depending on the age of the child. Read on for how to perform this procedure as your child ages.

GIVING CPR TO YOUR BABY

Begin CPR immediately if your baby is unresponsive and not breathing, not responding to touch, not moving or showing signs of alertness. If you’re not alone, ask someone to call 911 and get an automated external defibrillator (if available) while doing CPR. If you’re alone and have a smartphone, put it on speaker and start CPR while calling 911. If you’re alone and don’t have access to a phone, start CPR for 2 minutes and then call 911 from a landline. 1. Begin CPR by laying your baby down on a firm, flat surface. Do not spend time trying to find a pulse. Place your 2 fingers on the breastbone, just below the nipple line. Give your baby 30 quick chest compressions (push fast), pressing hard enough so their chest moves approximately 4 centimetres (1.5 inches) down (push hard). 2. Count out loud. You should deliver about 100 to 120 compressions a minute. Wait for the chest to come all the way back to its initial position between compressions. This will get the blood flowing to your baby’s brain and other vital organs. 3. After the first 30 chest compressions, place the palm of your hand on your baby’s forehead. Place 2 fingers on the hard, bony tip of their chin and gently tilt their head back. This will open the airway. Pinch your child’s nose and place your mouth over their mouth and give 2 breaths. Each breath should be just enough to make your child’s chest rise and should be no more than 1 second in length. Make sure you see your child’s chest rise with each breath. 4. Give cycles of 30 chest compressions and 2 breaths during 2 minutes and repeat until the ambulance arrives or your baby starts breathing again. Two minutes usually allow for 5 cycles of 30 chest compressions and 2 breaths. A 2-minute CPR cycle is usually tiring. If you are not alone, switch who is giving CPR every 2 minutes. 5. Once your baby has recovered and started breathing again on their own, your baby may vomit and find it difficult to breathe. Simply put your baby in the recovery position: Their chin should point slightly away from the chest and their face should rest on the surface on which the baby is laying. Make sure nothing is blocking or covering your baby’s mouth and nose. The recovery position will help keep your baby’s airway open.

CPR IN A CHILD (1 TO PUBERTY)

Begin CPR immediately if your child is unresponsive and not breathing, not responding to touch, not moving or showing signs of alertness. If you’re not alone, ask someone to call 911 and get an automated external defibrillator (if available) while doing CPR. If you’re alone and have a

smartphone, put it on speaker and start CPR while calling 911. If you’re alone and don’t have access to a phone, start CPR for 2 minutes and then call 911 from a landline. 1. Begin CPR by laying your child down on a firm, flat surface. Do not spend time trying to find a pulse. Place the heel of 1 or 2 hands over the lower third of your child’s breastbone and give them 30 quick chest compressions (push fast). Be sure to push hard enough so their chest moves approximately 5 centimetres (2 inches) down (push hard). 2. Count out loud. You should deliver about 100 to 120 compressions a minute. Wait for the chest to come all the way back to its initial position between compressions. This will get the blood flowing to your child’s brain and other vital organs. 3. After the first 30 chest compressions, place the palm of your hand on your child’s forehead. Place 2 fingers on the hard, bony tip of their chin and gently tilt their neck back. This will open your child’s airway. 4. Pinch your child’s nose and place your mouth over their mouth and give 2 breaths. Each breath should be just enough to make your child’s chest rise and should be no more than 1 second in length.

Make sure you see your child’s chest rise with each breath. 5. Give cycles of 30 chest compressions and 2 breaths during 2 minutes and repeat until the ambulance arrives or your child starts breathing again. Two minutes usually allow for 5 cycles of 30 chest compressions and 2 breaths. A 2-minute CPR cycle is usually tiring. If you are not alone, switch who is giving CPR every 2 minutes. 6. Once your child has recovered and started breathing again on their own, put them in the recovery position until help arrives. The recovery position will help keep your child’s airway open and prevent them from choking on their own vomit. If your child vomits, wipe it away.

Make sure nothing is blocking or covering their mouth and nose.

CHOKING

BABY UNDER 1 YEAR

Note If a baby is too heavy or large to support with your forearm, treat the baby as you would treat a choking child. • If a baby is coughing or gagging, the choking is mild. Do not interfere. • If the baby is making high-pitched noises, wheezing, can no longer make a sound or becomes too weak to cough, have someone call

EMS and care for the baby. Care 1. Sandwich the baby between your forearms, supporting the head. 2. Turn the baby face-down with the head lower than the body.

3. Lower your forearm onto your thigh. With the heel of your hand, deliver 5 firm back blows between the shoulder blades. 4. If the object has not been dislodged, while still supporting the head, turn the baby face-up, with your arms supported on your thigh. 5. Place 2 fingers on the middle of the chest just below the nipple line and push hard and fast at least 4 centimeters (1.5 inches) or 1/3 to 1/2 the depth of the chest 5 times. 6. Repeat the 5 firm back blows in 5 chest thrusts until the object is coughed up, the baby starts to cry, breathe or cough, or he or she becomes unconscious. 7. Continue until EMS personnel arrive. 8. If the baby becomes unconscious, follow the steps for unconscious choking baby below.

UNCONSCIOUS BABY (UNDER 1 YEAR) CHOKING

Care 1. Start chest compressions: • Place 2 fingers on the middle of the nipple line • Do 30 compressions. Push hard and push fast. • Allow the chest to recoil after each compression. 2. Give 1 rescue breath: • Tilt baby’s head and lift the chin. • Take a normal breath. • Cover the baby’s mouth and nose with your mouth. • Give 1 breath lasting 1 second, with just enough volume to make the chest start to rise. 3 If the baby’s chest does not rise after the first breath, perform the head tilt/chin lift again. 4. Attempt to give another breath. If your breath still does not go in, go to Step 6. If your breath does go in, give a second breath. 5. When both breaths go in, and there is no obvious response to your breaths, start CPR sequence of 30 compressions and 2 breaths. 6. Repeat the cycle of 30 compressions, then look in the mouth: • Grasp the tongue and lower jaw and lift. • If you do not see an object, return to Step 2. • If you see an object, remove it. Turn the head to the side, slide your finger down the side of the cheek to the base of the tongue, and try to sweep the object out. When it is removed, return to Step 2.

7. Continue CPR until: • An AED arrives • The scene becomes unsafe • You become physically unable to continue Note After you reposition the head and attempt to give a second breath once, you do not need to repeat the repositioning step between chest compressions cycles. If there is any change in the baby’s condition during the CPR sequence, stop and check the baby’s ABCs. And if there are 2 people who can assist present, they should alternate every 5 cycles (about 2 minutes).

CHOKING CHILD (1 TO 8 YEARS)

Note To determine if choking is mild or severe ask, “Are you choking?” If the child can speak, cough or breathe, it is mild choking. Care 1. Encourage the child to continue coughing and do not interfere. The obstruction might clear itself. 2. If the child is unable to speak, cough or breathe, or is wheezing or making high-pitched noises, it is severe choking: • Stand (or kneel for a small child) behind the child and wrap 1 arm diagonally across the child’s chest. • Bend the child forward at the waist until the child’s upper airway is at least parallel to the ground. • With the heel of your hands, deliver 5 firm back blows between the shoulder blades. 3. If the object has not been dislodged, make a fist and place it just above the child’s belly button. • Place your other hand over your fist and pull sharply in and up, doing 5 abdominal thrusts. • Continue the cycle of 5 firm back blows and 5 abdominal thrusts until the object comes out or the child begins to breathe or cough or becomes unconscious. 4. If the object comes out, ensure the child is able to breathe easily again. 5. Provide continual care and seek medical attention 6. If the child becomes unconscious: • Support the child to the ground protecting the head and placed the child on his back. Recheck the child’s ABCs. • Call EMS, get an AED and follow the steps for unconscious choking child on the next page. Note To deliver effective back blows, you may need to stand behind and slightly to the side of the child rather than directly behind the child.

UNCONSCIOUS CHOKING CHILD

Care 1. Start trust compressions: • Place the heel of 1 hand on the middle of the child’s chest. Place the other hand on top. • Do 30 compressions. • Allow the chest to recoil after each compression. 2. Give 1 rescue breath: • Open the airway using the head tilt/chin lift. • Pinch the child’s nostrils closed. • Take a normal breath. • Cover the child’s mouth with your mouth. • Give 1 breath lasting 1 second, with just enough volume to make the chest start to rise. 3. If the child’s chest does not rise after the first breath, perform the head tilt/chin lift again, tilting the head farther back and attempt to give another breath. 4. If your breath still does not go in, go to Step 6. If your first breath goes in, give a second breath. 5. When both breaths go in, and there is no obvious response to your 2 breaths, start the CPR sequence of 30 compressions and 2 breaths. 6. Repeat the cycle of 30 compressions, then look in the child’s mouth. • Grasp both the tongue and lower jaw and lift. • If you do not see an object, return to Step 2 • If you can see an object, remove it. Turn the head to the side, slide your finger down the inside of the cheek to the base of the tongue, and try to sweep the object out when the object is out of the child’s mouth, return to Step 2. 7. Continue CPR until: • An AED arrives • More advanced care takes over • The scene becomes unsafe • You become physically unable to continue Note: If your breath does not go in, go back to compressions. After you reposition the head and attempt to give a second breath once, you do not need to repeat the repositioning step between chest compression cycles. If there’s any change in the child’s condition during CPR, stop and check the child’s ABCs.

BROKEN BONES

Bone, muscle and joint injuries are almost always painful. Without first aid, they can lead to serious injuries and even permanent disabilities. In some cases, they can be life-threatening. Signs of a break include: • Pain • Deformity • Swelling • Bruising • Limited use of, or an inability to move, the injured body part due to pain • Broken bone or broken fragments sticking out of a wound • Sensation or sound of bones grading • Possible muscle cramps • Shock • The sound of a snap or a pop when the injury happened General care is the same for all bone, muscle or joint injuries. You do not need to know the specific injury.

Call EMS when:

• There is a problem with the ABCs. • The injury involves the head and or neck. • The injury makes walking difficult. • You suspect that there may be more than 1 injury. • There are injuries to the thigh bone or pelvis. • The child has an altered level of consciousness. Though you may not need to call 911 for a potential broken bone, a hospital visit is in order. Head to the emergency room for immediate diagnosis and treatment. The ER care team will advise you on follow-up care depending on the injury.

CHEMICAL BURNS

1. Ensure the child’s ABCs are present. • Wear protective equipment and brush off excess dry chemicals. • Flush with large amounts of cool running water for at least 15 minutes. • Remove any clothing covered in chemicals from the child. 2. Refer to the appropriate material safety data sheets (MSDS) or call your local poison control centre. Seek immediate medical attention.

HEAT BURNS

This is any burn caused by overexposure to excessive heat, such as fire, steam and sun. Care 1. Ensure the child’s ABCs are present 2. Cool the burn with running or standing water for at least 10 to 20 minutes. If the standing water becomes warm, add more cool water. 3. Depending on the severity of the burn, you will decide on the course of treatment. Mild burns cause redness and swelling and can be treated at home, with an over-thecounter pain reliever, antibiotic ointment and vigilance for signs of infections. More severe burns may require emergency attention. A second-degree burn may blister in addition to causing pain, but if it’s a small burn, it can also be treated at home. A large second-degree burn may require further medical attention. Third-degree burns always require emergency medical care, such as calling 911, as they involve all levels of skin and fat. They may even involve muscle and bone. With third-degree burns, the injured may not feel pain because the nerve endings have been destroyed. With all electrical burns, call for an ambulance and look for possible entry and exit burns that may need treatment. Carefully watch for breathing problems.

ELECTRIC SHOCK

Do not touch the child until the power has been switched off. Care 1. Ensure the child’s ABCs are present. Electricity and lightning may affect the heart, so monitor the ABCs closely. 2. Treat the child as if he or she has a head and/or spine injury. Stabilize the child’s head and neck by placing your hands on either side of the child’s head. Gently support the child’s head in the position in which you found it until EMS personnel arrive. 3. If the child is wearing a helmet, leave it on unless it makes it difficult for you to ensure the child’s ABCs are present. 4. Provide continual care until EMS personnel arrive. 5. Look for 2 burns (an entry point and an exit point). They will be open wounds that need to be treated.

HYPERVENTILATION

What to look for

• Uncontrolled gasping for air • Dizziness • Panic • Anxiety Care 1. Ensure the child’s ABCs are present. 2. Comfort the child. Encourage the child to take long, slow breaths and holds the breaths before breathing out slowly. 3. Place the child in the recovery position so that blood can start flowing to the brain and the airways stays open. Then watch the child’s breathing closely. 4. Provide continual care until EMS personnel arrive.

INHALED POISONS

What to look for

• Breathing difficulties • Irritated eyes, nose, throat • Dizziness • Vomiting • Seizures • Unusual smell in the air • Blueish colour around the mouth • Unconsciousness Care 1. Ensure child’s ABCs are present. 2. Call EMS and call your local poison control centre if the child has an altered level of consciousness or has difficulty breathing. 3. Get the child into fresh air, but do not enter the hazardous atmosphere yourself to do so. Wait for EMS in this case. 4. Provide continual care on the advice of medical professionals.

ABSORBED POISONS

What to look for

• Burns • Rash • Itching, burning • Blisters

• Unconsciousness • Swelling • Hives (raised, itchy areas of skin) Care 1. Ensure the child’s ABCs are present. 2. Remove the substance from the skin. Flush the skin with large amounts of water for at least 15 minutes. To prevent any further injury, make sure the water flushes away from any unaffected areas. 3. Seek medical attention and provide continual care.

INGESTED POISONS

What to look for

• An open container of poison nearby • Burns around the mouth • Increase production of saliva and or saliva that isn’t abnormal colour • Seizures • Abdominal cramps and vomiting • Dizziness and or drowsiness • Unconsciousness • Diarrhea • A burning sensation in the mouth, throat or stomach Care 1. Ensure the child’s ABCs are present. 2. Call your local poison control centre and take their advice. If advised, have someone drive you and the child to the hospital. Take the container or a sample of the poison in any vomit with the child to the hospital. If the child has an altered level of consciousness or difficulty breathing, call 911. Note Never induce vomiting if the child is unconscious, having seizures or has swallowed a corrosive or petroleum product. Give water or milk or induce vomiting only if directed to by EMS or the poison control centre.