SIKA FIRST AID

Lesson 16

Paediatric Care


Baby CPR

What is Baby CPR?

CPR stands for cardiopulmonary resuscitation. Knowing how to do CPR can give your baby the best chance of survival.  

Rescue breaths must be performed on a baby, as cardiac arrest in children is likely to be caused by a respiratory problem.

If a baby is unresponsive and not breathing normally, you still need to call 999 or 112 for emergency help and start CPR straight away



What to do

1. After you have performed a primary survey, if you find that the baby is unresponsive and not breathing, you should ask a helper to call 999 or 112 for emergency help while you start CPR.

If you're on your own, you need to give one minute of CPR before calling on a speakerphone.

Do not leave the baby to make the call.

2. Start CPR. Place them on a firm surface and open their airway. To do this, place one hand on their forehead and very gently tilt their head back. With your other hand, use your fingertip and gently lift the chin.

3. Give five initial puffs. Take a breath and put your mouth around the baby’s mouth and nose to make a seal, and blow gently and steadily for up to one second. The chest should rise. Remove your mouth and watch the chest fall. That’s one rescue breath, or puff.

Do this five times.

If their chest doesn't rise, check the airway is open.

It is vital that you perform rescue breaths as cardiac arrest in a baby is likely caused by a respiratory problem.

4. You will then need to give 30 pumps. Put two fingers in the centre of the baby’s chest and push down a third of the depth of the chest. Release the pressure allowing the chest to come back up.

Repeat this 30 times at a rate of 100 to 120 pumps per minute.

The beat of the song ‘Nellie the Elephant’ can help you keep the right rate.

5. After 30 pumps, open the airway and give two puffs. Keep alternating 30 pumps with two puffs (30:2) until:

Emergency help arrives and takes over.

The baby starts showing signs of life and starts to breathe normally.

6. If the baby shows signs of becoming responsive, such as, coughing, opening their eyes, making a noise, or starts to breathe normally, put them in the recovery position.

Monitor their level of response and prepare to give CPR again if necessary.


Paediatric Out of Hospital Care

Resuscitation Council  DOWNLOAD

Choking

Choking is extremely common and very frightening, but in most cases, with the right help, the casualty will make a full recovery.

Babies can choke on anything small enough to fit through a toilet roll.

To Prevent Choking:

  • Keep small objects out of reach
  • Cut food into very small pieces
  • Discourage older children from sharing their food with babies
  • Supervise children and babies when eating

What to do if a Baby is Choking

Look in the baby’s mouth. If there is something obvious, remove it with your fingers.

Never be tempted to put your fingers down a baby’s throat or finger sweep the mouth. This can make matters worse by pushing the obstruction further down or causing swelling.

Lie the baby across your forearm and supported across your legs, supporting them under the chin. Use the flat of your hand to give a firm back blow between the shoulder blades.

Give up to five back blows and check between each one to see if the blockage has cleared.

If they are still choking, call the emergency services and start chest thrusts straight away.

For a baby under a year give up to five firm chest thrusts (1/3 of the depth of their chest), holding them with their head lower than their stomach and checking to see if the obstruction has cleared.

If the baby is still choking, call 999/112 if you haven’t already, and continue to alternate five back blows and five chest thrusts until emergency help arrives. If at any point baby becomes unconscious, commence CPR.


Nappy Sack Safety Campaign:


Paediatric choking flowchart:

Resuscitation Council Download

Damage caused from the ingestion of lithium batteries:



Febrile Convulsions and Seizures

Great Ormond’s Street has reported that 1 in 50 children will have had a febrile convulsion by the time they are five years old. They occur most frequently in babies and young children who are unwell and have a rising body temperature. Their rising temperature acts as a trigger for them to experience a seizure. Although most children grow out of febrile convulsions by the age of about 6 and it is extremely rare for febrile convulsions to be life-threatening or cause long-term problems they can be incredibly frightening for anyone caring for the child when one occurs.

What is a Seizure?

Seizure is the medical term for a fit or convulsion that occurs when there is a sudden burst of electrical activity in the brain which temporarily interferes with the normal messaging processes.

It is possible to reduce a child’s temperature, however, be extremely careful that you do not cause them any distress in cooling them and that you do not over-cool them.

To reduce their temperature:

  • Take off excess clothing.
  • Use a tepid flannel to gently sponge the child under the arms and on their forehead, ensure it doesn’t cause them any distress and doesn’t over-cool them.
  • Give them plenty to drink.
  • If they are feeling unwell, give them Paediatric Paracetamol or Paediatric Ibuprofen to relieve their symptoms – as well as helping them feel better, it will also help to reduce their temperature.

If the child in your care starts fitting:

  • Maintain their safety – remove any objects from around them to prevent injury
  • Protect their dignity and talk to them calmly
  • Cushion their head using a blanket or pillow, but do not restrain them
  • Time how long the fit lasts
  • Loosen any tight clothes/blankets and remove any excess clothing if it is possible to do so.

 Do not try to pick them up or restrain them and do not be tempted to put anything in their mouth whilst they are fitting. It is possible that they may bite their lips or tongue during the seizure but there is nothing you can do. The fit can last from seconds to minutes. During the seizure it is possible that they could go blue and appear to stop breathing (for less than a minute). However, they should start breathing again extremely quickly and spontaneously, but ensure you are checking continually and are ready to give CPR if necessary.

When the seizure has finished it is likely the casualty will feel confused and drowsy. If they are unresponsive, put them into the recovery position.

Unfortunately, once a child or baby has had a seizure, they have shown they have a pre-disposition and therefore are likely to have further seizures if they experience a raised temperature again, you should be very aware if they become ill again and trying and prevent their temperature from rising as far as possible. Fortunately, there is no evidence to suggest that febrile convulsions cause any long-term damage and children usually grow out of them by the time they are 5 or 6 years old.

Phone for an ambulance if:

  • it is their first seizure
  • the seizure lasts more than 5 minutes
  • they have another seizure soon after the first
  • they are injured
  • their breathing does not appear ‘normal’ after the seizure
  • they regularly have seizures and this one is different
  • they are unresponsive for more than 5 minutes after the seizure
  • you are worried for any reason

Never:

  • put your fingers or anything in their mouth to try and prevent them biting their tongue – this could cause serious injury
  • try and move them (unless they are in immediate danger)
  • restrain their movements whilst they are fitting
  • give them anything to eat or drink until fully recovered
  • try and ‘bring them round’

If the casualty is conscious during the seizure, it is most important to ensure their safety, and to reassure them.

Burns on small children and babies

Burns can be particularly serious for small children and babies. They haven’t yet developed the reflex to move away from something hot and their skin is up to 15 times thinner than that of an adult. Damage tends to be more severe because they have a smaller body surface area which means the burn often covers a larger proportion of their body.

Knowing what to do can radically reduce the amount of pain and scarring experienced. It can also mean a full recovery without even needing to be admitted.

How to Treat a Burn:

  • Extremely carefully, remove loose clothing covering the burn.
  • Do not take clothes off if there is any risk the skin has stuck to them or if the skin has blistered.
  • Put the affected area under cool running water for a full 20 minutes. Remember you are cooling the burn and not the casualty, so try and keep the water running over just the burnt area.
  • Keep the rest of the casualty as warm and dry as possible and watch for any signs of shock.
  • Phone an ambulance, particularly if a large area is affected, or if the skin is broken or blistered. Keep the area under the water while you wait for the ambulance to arrive.
  • A burn is measured using the size of your hand, which is roughly equivalent to 1% of your body. Therefore, a burn measuring just the size of a 50p piece or a postage stamp can be very serious for a baby or small child. Burns to the hands, face, feet, genitals, airways, or a burn that extends all the way round a limb are particularly serious.

Never:

  • Remove anything that has stuck to a burn
  • Touch a burn
  • Burst blisters
  • Apply any creams, lotions or fats
  • Apply tight dressings, tapes or use anything fluffy
  • Always get burns assessed by a medical professional.

Measles and Scarlet Fever

Parents are being warned to look out for the symptoms of a range of childhood illnesses that are on the rise after many years.  Cases of measles and scarlet fever have increased considerably this year and parents are also being advised to know the signs of ‘slapped cheek’ too, as the rash can often be very similar to that of scarlet fever.

Measles cases are rocketing across Europe and there has been a considerable rise in cases in the UK too.  It had been hoped that the number of cases would fall, as a result of the effective vaccine, but that doesn’t appear to have been the case and a lack of take up of the vaccine is now having a profound effect.  Cases of scarlet fever are also on the rise and are now higher than they were in the 1960s.  So – what are the signs to look out for and what can be done to help?

Measles

Measles is a highly infectious viral illness that can be extremely unpleasant and sometimes leads to serious complications. It can affect any age group but is most common in young children.

The infection usually lasts from 7 to 10 days however, it can lead to serious and potentially life changing and life-threatening complications in some people if it affects their lungs or brain. Measles is also particularly serious if someone is pregnant.

Symptoms of measles:

The initial symptoms of measles develop around 10 days after infection and can include the following:

  • Cold-like symptoms; such as a runny nose, sneezing, and a cough
  • Sore, red eyes that are often sensitive to light
  • A raised temperature (fever), which could get up to 40C (104F)
  • Small greyish-white raised spots on the inside of the cheeks – these are classic symptoms of Measles.
  • A few days after this, a reddish-brown blotchy rash will appear, this usually starts on the head or upper neck and then spreads to the rest of the body.

When to see your GP:

  • Phone your GP as soon as possible if you suspect that you or your child may have measles. Tell them this is what you think it might be, as this is a highly contagious illness and they will need to make arrangement to reduce the risk of spreading the infection.
  • Please also see your GP if you have had close contact with someone with measles and you are not fully vaccinated or haven’t had the infection before – even if you don’t have any symptoms.

How measles spreads:

Measles is a highly contagious droplet virus which means it is spread through coughs and sneezes. The virus is able to survive on hard surfaces for quite a few hours.  Therefore, if someone touches a contaminated surface and then puts their hands near their mouth or nose, they may become infected.

People with measles are infectious from when the symptoms develop until about four days after the rash first appears.

How you can prevent measles:

  • MMR vaccination
  • Measles can be prevention of by having the measles, mumps and rubella (MMR) vaccine. The more people with the vaccine, the greater the chance of eradicating this disease.
  • The MMR vaccination is given in two doses as part of the NHS childhood vaccination programme. Your child will receive their first dose when they are around 13 months old and their second dose before they start school.
  • There was previously controversy about the safety of the MMR vaccine and a possible link with Autism. These concerns have since been disproved and the MMR vaccine remains a safe and extremely well tested weapon in the fight against this extremely unpleasant illness.
  • Adults and older children can receive the vaccinate at any age if they haven’t vaccinated before. Ask your GP about having the vaccination.
  • If for some reason the MMR vaccine isn’t suitable for you, a treatment called human normal immunoglobulin (HNIG) can be used if you’re at immediate risk of catching measles.
  • Hand hygiene and extreme care when looking after someone with an infection is vital to reducing the spread.

Treating measles:

There are several things you can do to help relieve symptoms and reduce the risk of spreading the infection, including:

  • Ensuring that everyone regularly washes their hands and uses hand sanitizer. They should dispose tissues hygienically (flush them down the loo) and they should always clean their hands after. They should always cover their noses and mouths when coughing and sneezing.
  • Taking paracetamol or ibuprofen to reduce your fever and aching and make you feel better.
  • Drinking plenty of water and keep hydrated.
  • Closing the curtains can help reduce light sensitivity and make it easier for their eyes.
  • Carefully clean their eyes using damp cotton wool and dispose of this hygienically.
  • Staying away from nursery, school or work for at least four days from when the rash first appears.
  • If you or your child are getting worse or experience any complications, get medical advice quickly.

Scarlet Fever

Scarlet fever is a highly contagious infection.  Whilst it mainly affects young children, it can affect adults too. The symptoms for children and adults are the same, but it is much rarer for adults for get scarlet fever.  It usually lasts about a week.

Symptoms:

  • Scarlet fever can start with flu-like symptoms, including a high temperature and swollen glands
  • A rash appear will then appear a few days later
  • The rash usually starts on the chest and/or tummy. It is rough to the touch, pinky/red in colour and can look like sunburn
  • The tongue can also develop a white coating

When to see your GP:

  • If your child has the symptoms listed above, they should see their GP
  • If, a week after seeing the GP, they are still unwell, you should make another appointment.  This is especially important if they have recently had chicken pox.
  • If they are unwell again, even if it is weeks after having had scarlet fever.  This can be a sign of a complication, such as pneumonia.

PLEASE NOTE – as Scarlet fever is very infectious, it is best to tell the receptionist when you call to make an appointment.  They may suggest a telephone consultation with the doctor, to avoid the risk of spreading the infection to those in the surgery.

Treatment:

  • Your GP will probably prescribe antibiotics and, although they will not actually cure the scarlet fever, they will help to prevent any complications developing.  People who suffer from impetigo are more likely to develop complications, so should be extra vigilant.

In addition, you can help the child by:

  • Ensuring they have lots of cooling fluids to drink and soft foods to eat. These will be easier to swallow with a sore throat
  • Giving them child paracetamol to make them feel better and lower their temperature
  • Also, giving them antihistamine and applying calamine lotion to help with the itching from the rash

How to stop spreading scarlet fever:

  • Adhere to strict hand hygiene rules and always use soap and warm water to wash your hands after any contact with the patient.  Also ensure that used tissues are thrown away immediately and that all surfaces that have been touched are wiped down immediately.

Slapped cheek

Slapped cheek can often be mistaken for scarlet fever, but it starts with a rash on the cheek (which looks like the child has been slapped) and can sometimes spread to the body a few days after that.  The rash usually lasts for around two weeks, but can continue after that.

The child may also have a headache, a sore throat and a high temperature.

Treatment:

  • You normally don’t need to see your GP for slapped cheek, but a pharmacist may be able to help with an antihistamine, if the rash is itchy.  Children’s paracetamol can also help reduce their aches and pains and also reduce the child’s temperature and they should drink plenty of fluids.
  • If you are concerned though, please do contact your GP.

Sika First Aid provides this information for guidance and it is not in any way a substitute for medical advice.  Sika First Aid is not responsible or liable for any diagnosis made, or actions taken based on this information. It is strongly advised that you attend a First Aid course to understand what to do in a medical emergency.

Meningitis

Symptoms of meningitis can appear in any order. Some may not appear at all. In the early stages, there may not be a rash, or the rash may fade when pressure is applied.

You should get medical help immediately if you're concerned about yourself or your child.

Trust your instincts and do not wait for all the symptoms to appear or until a rash develops.

Symptoms of meningitis and sepsis include:

  • a high temperature
  • cold hands and feet
  • vomiting
  • confusion
  • breathing quickly
  • muscle and joint pain
  • pale, mottled or blotchy skin (this may be harder to see on brown or black skin)
  • spots or a rash (this may be harder to see on brown or black skin)
  • headache
  • a stiff neck
  • a dislike of bright lights
  • being very sleepy or difficult to wake
  • fits (seizures)

Babies may also:

  • refuse feeds
  • be irritable
  • have a high-pitched cry
  • have a stiff body or be floppy or unresponsive
  • have a bulging soft spot on the top of their head

Someone with meningitis or sepsis can get a lot worse very quickly.

Call 999 for an ambulance or go to your nearest A&E immediately if you think you or someone you look after could have meningitis or sepsis.

Call NHS 111 for advice if you're not sure if it's anything serious.

If you’ve had medical advice and are still worried or any symptoms get worse, get medical help again.