2.4: Caring for Minor Injuries

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Learning Objectives

By the end of this chapter, you should be able to:

List items to include in first aid and emergency kits.
Outline the responses to minor cuts and scrapes, burns, broken bones, head injuries, bites, and foreign objects in the body.
Describe the lifesaving responses to severe bleeding, choking, and not breathing or being without a pulse.

Licensing Regulations

Title 22 Regulations that relate to this chapter include:

101174 DISASTER AND MASS CASUALTY PLAN

Each licensee shall have a disaster plan of action in writing.
Disaster drills shall be documented and conducted every six months.

101216.1 TEACHER QUALIFICATIONS

A teacher shall complete 15 hours of health and safety training, if necessary, pursuant to Health and Safety code, Section 1596.866.

101224 TELEPHONES

All Child Care Centers shall have working telephone service onsite.

101229.1 SIGN IN AND SIGN OUT

The licensee shall develop, maintain and implement a written procedure to sign the child in/out of the center. The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. All sign in/out sheets shall be kept for one month.

Introduction

An emergency is a situation that poses an immediate risk to health, life, property, or environment. Most emergencies require urgent intervention to prevent a worsening of the situation. Some emergencies will be obvious (such as natural disasters), but others will require early childhood educators to decide if it truly is an emergency.²¹¹

Once an emergency has been identified, it’s important to know what to do. This chapter introduces different first aid and emergency medical responses, the phases of a disaster, and more information about a few different types of emergencies.

Basic First Aid

“Minor accidents and unintentional childhood injuries are not unusual in the child care setting. Even with careful supervision, children frequently sustain scrapes, bruises, cuts, bites, and falls in the normal course of their day. Less frequently, medical emergencies…may require immediate intervention and treatment.”²¹²

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First Aid Kits

Here is a recommended list of supplies for the first aid kit (modified from the Emergency First Aid Guidelines for California Schools):

Current National American Red Cross First Aid Manual or equivalent.
American Academy of Pediatrics First Aid Chart.
Pocket mask/face shield for CPR
Disposable gloves (including latex-free gloves for persons with a latex allergy)
Soap (plain)
Cotton tipped applicators, individually packaged
Assorted Band-Aids (1”x3”)
Gauze squares (2”x2”’; 4”x4”), individually packaged
Adhesive tape (1” width)
Gauze bandage (2” and 4” widths) rolls
Ace bandage (2” and 4” widths)
Splints (long and short)
Cold packs
Triangular bandages for sling & Safety pins
Tongue blades
Disposable facial tissues
Paper towels
Sanitary napkins²¹³

Minor Cuts and Scrapes

Before performing first aid for minor cuts and scrapes, early childhood educators should wash their hands and apply gloves. The cut or scrape should then be washed with cool water. The surrounding area can be washed with soap, but soap should not get into the wound. The cool water will wash away any debris that may be in the wound and will help blood vessels to constrict (become narrower), which helps to stop bleeding. Once the area is clean and the blood has decreased, place gentle pressure on the wound with a clean and sterile gauze pad. If the first gauze saturates with blood, add additional gauze pads. Gauze pads should not be removed, as this could cause any clots that have begun to form to be removed and bleeding to continue. When the wound has stopped bleeding, the cut or scrape can be covered by a clean bandage. Be sure to document the injury and communicate what happened with families.²¹⁴^,²¹⁵

running water on burned hand — Figure 5.1 – You can care for a minor burn by running it under cool water.²¹⁶

Burns

The treatment of burns depends on the type of burn (refer back to Figure 3.20). The first step for any burn is to remove the source of heat. For minor burns that are limited to a small area, a clean cool towel or cloth can be applied to the skin or the skin can be flushed with cool water. Do not use ice. A clean, dry sterile piece of gauze can then be taped over the area when the burn is cooled and is only first degree. Ointments, grease, and oils should never be put on a burn. And blisters should not be broken. Children with second degree burns should be referred for medical care. Emergency care must be sought (call 911) any time a child receives a third degree burn.²¹⁷^,²¹⁸

Broken Bones

If a child breaks a bone, it will require medical treatment. The child should be comforted and not be moved any more than necessary. Any bleeding should be stopped (apply pressure with a sterile bandage or clean cloth), the area should be immobilized, and the family should be contacted to seek medical care. If the child is not conscious, there is heavy bleeding, the bone has pierced the skin, or the break is suspected in the back, neck, or head, emergency medical care should be sought.²¹⁹

Head Injuries

Most trauma to the head is minor and will not require first aid. But trauma that is associated with symptoms of a concussion (such as nausea, unsteadiness, headaches) needs to be evaluated by a medical professional. More serious injury indicated by the following warrant calling for emergency medical care (911). Keep the child skill, stop any bleeding, and monitor vital signs (and start CPR if needed).

Symptoms of severe head injury:

Severe bleeding or bleeding from nose or ears
Change in consciousness
Not breathing
Confusion or slow response to questions
Dizziness, balance problems, or trouble walking
Unequal pupil size
Slurred speech
Seizures
Persistent crying
Refusing to eat
Repeated vomiting
Bulge in an infant’s soft spot²²⁰^,²²¹

Injuries to the Mouth

Injuries to the head, face, and mouth are common in young children. Even when families do their best to keep children safe, oral injuries can happen. Most oral injuries happen when young children are learning to walk. The top front teeth are injured most often.

If the child’s tongue or lip is injured, the area should be cleaned. Ice wrapped in a clean cloth can be placed on the area to reduce swelling. If the bleeding doesn’t stop after 30 minutes, medical attention should be sought.

If a child has an injury to a tooth, families should contact a dentist for advice. Teeth that are knocked out should not be put back in the mouth.²²²

Injuries to the Nose and Nosebleeds

Nosebleeds are not unusual and not usually a health concern. If a child gets a nosebleed they should be reassured. They should sit upright and gently pinch the soft part of the nose for about 10 minutes (or the bleeding may start back up). Discourage nose-blowing, picking, or rubbing.²²³

If a nosebleed is heavy and won’t stop after 30 minutes, the child feels lightheaded, or the nosebleed is the result of an injury that may indicate a broken nose emergency medical care should be sought.²²⁴

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Pause to Reflect

What experiences do you have with first aid (giving or receiving)? How might this affect how you respond to a child getting injured?

In addition to providing treatment for the injury, what else might an injured child need from a caring adult to feel emotionally safe?

Poisoning

If a child ingests a potentially poisonous substance, Poison Control should be contacted at 1-800-222-1222. They will advise about the effects of the substance that has been ingested and what the proper response should be.

Bites

How you will respond to bites depends on what bit (or stung) the child and how severe the injury is. Table 5.1 provides more information.

Table 5.1 – First Aid for Bites and Stings
Type of Bite/Sting	First Aid Response
Insect bites and stings²²⁵	For mild reactions: Move stinger (if needed) Wash with soap and water Can apply a cold compress For severe reactions: Use epi-pen (if the child has one) Call 911 Being CPR if needed
Animal bites²²⁶^,²²⁷	Wash wound with soap and water Apply antibiotic ointment and bandage If unsure if the skin was punctured have family consult a physician
Venomous snakebites²²⁸	Remove the child from the area of the snake Get a good description of the snake Elevate area of snakebite and keep child calm Call 911
Human bites²²⁹	If the bite doesn’t break the skin: Wash with soap and water If the skin is broken: Stop any bleeding Wash with soap and water Apply clean bandage Have family consult a physician

Foreign Objects in the Body

Foreign objects may end up on the inside of a child’s body. Table 5.2 lists ways to safely respond when this happens.

Table 5.2 – First Aid for Foreign Objects in Body
Location of Foreign Object	First Aid Response
Foreign object swallowed²³⁰	Most swallowed items will pass through the digestive tract If the object is a battery, magnet, or sharp object medical care should be sought If blocking the airway, treat according to choking first aid
Foreign object in the nose²³¹	Have child blow nose gently (not hard or repeatedly) Do NOT probe or have child inhale it If easily visible and graspable, remove with tweezers Child will need medical care if the object remains in the nose
Foreign object in the ear²³²	If the object is visible and graspable, remove with tweezers Do NOT probe ear Try using gravity by tipping the head to the affected side If those fail to dislodge the object, refer to the family for additional methods of removal or to have them seek medical assistance
Foreign object in the eye²³³	Flush eye with a clean stream of warm water Don’t try to remove an embedded object Don’t allow the child to rub the eye If unable to remove with irrigation have family seek medical care
Foreign object in the skin²³⁴	If the object is small, such a splinter or thorn just under the surface of the skin Wash hands Use tweezers to remove the object If the object is more deeply embedded in the skin or muscle Don’t try to remove it Bandage the wound by wrapping it with gauze without applying extra pressure

Lifesaving First Aid

Sometimes children will experience incidents or injuries that are a threat to their life. It’s important that early childhood educators know how to respond in these situations. It is recommended that every person working with children become certified in emergency response through an agency such as the Red Cross (licensing requires one staff member that is certified to be on-site at all times).

Situations such as the following are considered medical emergencies and early childhood educators should contact emergency medical services (911) if a child exhibits these symptoms:

Bleeding that will not stop
Breathing problems (difficulty breathing, shortness of breath)
Change in mental status (such as unusual behavior, confusion, difficulty arousing)
Choking
Coughing up or vomiting blood
Loss of consciousness
Sudden dizziness, weakness, or change in vision
Swallowing a poisonous substance²³⁵

While waiting for paramedics, early childhood educators will need to follow appropriate lifesaving procedures. Three of those responses are introduced below (but are not a substitute for becoming CPR and First Aid certified)

Exclamation Mark, Warning, Danger, Attention, Black

These instructions are not intended to be a substitute for becoming certified in first aid and CPR.

Responding to Severe Bleeding

Bleeding from most injuries can be stopped by applying direct pressure to the injury. This keeps from cutting off the blood supply to the affected limb. This procedure was introduced earlier in the section on responding to minor cuts and scrapes.²³⁶

Stopping bleeding with direct pressure — Figure 5.2 – Apply direct pressure on external wounds with a sterile

cloth or your gloved hand, maintaining pressure until bleeding stops.²³⁷

Responding to Choking

If a child is not able to breathe, not able to cry, talk, or make noise, turning blue, or grabbing at their throat, or coughing and gagging the early childhood educator should call 911. If they are able to cough or gag (which indicates they are breathing), no further response is needed. If they are not breathing, an immediate response is important.²³⁸ The response to choking is called the Heimlich maneuver and varies based on the age of the person that is choking. If the child loses consciousness at any point start CPR (which is covered in the next section).

Responding to a Choking Infant (under 1 year of age)

Lay the infant face down, along your forearm. Use your thigh or lap for support. Hold the infant's chest in your hand and jaw with your fingers. Point the infant's head downward, lower than the body.
Give up to 5 quick, forceful blows between the infant's shoulder blades. Use the heel of your free hand.²³⁹
If the object is not dislodged, turn the infant face up. Use your thigh or lap for support. Support the head.
Place 2 fingers on the middle of his breastbone just below the nipples.
Give up to 5 quick thrusts down, compressing the chest 1/3 to 1/2 the depth of the chest.
Continue this series of 5 back blows and 5 chest thrusts until the object is dislodged or the infant loses consciousness.²⁴⁰

position for back blows — Figure 5.4 Positioning for back blows²⁴¹

position for chest thrusts — Figure 5.5 Positioning for chest thrusts²⁴²

Responding to a Choking in a Child (over 1 year of age)

Lean the child forward and make 5 blows to their back with the heel of your hand.
If this does not work, stand behind the child and wrap your arms around the child's waist.
Make a fist with one hand. Place the thumb side of your fist just above the child's navel, well below the breastbone.²⁴³
Grasp the fist with your hand.
Make 5 quick, upward and inward thrusts with your fists.
Alternate between 5 blows to the back and 5 thrusts to the abdomen until the object is dislodged and the child breathes or coughs on their own.²⁴⁴

position for Heimlich maneuver

showing thrust of Heimlich maneuver — Figure 5.3 – Here is the positioning for performing the Heimlich maneuver on a child.²⁴⁵

Responding to Children Who are Not Breathing or Without a Pulse

CPR stands for cardiopulmonary resuscitation. It is a lifesaving procedure that is done when a child's breathing or heartbeat has stopped. This may happen after drowning, suffocation, choking, or an injury. CPR involves:

Rescue breathing, which provides oxygen to a child's lungs
Chest compressions, which keep the child's blood circulating

Permanent brain damage or death can occur within minutes if a child's blood flow stops. Therefore, you must continue CPR until the child's heartbeat and breathing return, or trained medical help arrives.

CPR is best done by someone trained in an accredited CPR course. The newest techniques emphasize compression over rescue breathing and airway management, reversing a long-standing practice. The procedures described here are NOT a substitute for CPR training.

Machines called automated external defibrillators (AEDs) can be found in many public places and can be purchased for homes and early care and education programs. These machines have pads or paddles to place on the chest during a life-threatening emergency. They use computers to automatically check the heart rhythm and give a sudden shock if, and only if, that shock is needed to get the heart back into the right rhythm. When using an AED, follow the instructions exactly.

CPR for Infants (under 1 year of age)

Check for responsiveness. Shake or tap the infant gently. See if the infant moves or makes a noise. Shout, "Are you OK?"
If there is no response, shout for help. Send someone to call 911. Do not leave the infant yourself to call 911 until you have performed CPR for about 2 minutes.
Carefully place the infant on their back. If there is a chance the infant has a spinal injury, two people should move the infant to prevent the head and neck from twisting.²⁴⁶
Perform chest compressions:

Place 2 fingers on the breastbone -- just below the nipples. Make sure not to press at the very end of the breastbone.
Keep your other hand on the infant's forehead, keeping the head tilted back.
Press down on the infant's chest so that it compresses about 1/3 to 1/2 the depth of the chest.
Give 30 chest compressions. Each time, let the chest rise completely. These compressions should be FAST and hard with no pausing. Count the 30 compressions quickly: "1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, off."²⁴⁷

Open the airway. Lift up the chin with one hand. At the same time, push down on the forehead with the other hand.
Look, listen, and feel for breathing. Place your ear close to the infant’s mouth and nose. Watch for chest movement. Feel for breath on your cheek.
If the infant is not breathing:

Cover the infant's mouth and nose tightly with your mouth.
Alternatively, cover just the nose. Hold the mouth shut.
Keep the chin lifted and head tilted.
Give 2 breaths. Each breath should take about a second and make the chest rise.

Continue CPR (30 chest compressions followed by 2 breaths, then repeat) for about 2 minutes.
After about 2 minutes of CPR, if the infant still does not have normal breathing, coughing, or any movement, leave the infant to call 911.
Repeat rescue breathing and chest compressions until the infant recovers or help arrives.

If the infant starts breathing again, place them in the recovery position (see Figure 5.12). Periodically re-check for breathing until help arrives.²⁴⁸

checking for breathing — Figure 5.6 – Check for breathing.²⁴⁹

finger placement for CPR — Figure 5.7 – Position for compressions²⁵⁰

Figure 5.8 – Position for giving rescue breaths.²⁵¹

CPR for Children (1 to 8 years of age)

Check for responsiveness. Shake or tap the child gently. See if the child moves or makes a noise. Shout, "Are you OK?"
If there is no response, shout for help. Send someone to call 911 and retrieve an automated external defibrillator (AED) if one is available. Do not leave the child alone to call 911 and retrieve an AED until you have performed CPR for about 2 minutes.
Carefully place the child on their back. If there is a chance the child has a spinal injury, two people should move the child to prevent the head and neck from twisting.²⁵²
Perform chest compressions:

Place the heel of one hand on the breastbone -- just below the nipples. Make sure your heel is not at the very end of the breastbone.
Keep your other hand on the child's forehead, keeping the head tilted back.
Press down on the child's chest so that it compresses about 1/3 to 1/2 the depth of the chest.
Give 30 chest compressions. Each time, let the chest rise completely. These compressions should be FAST and hard with no pausing. Count the 30 compressions quickly:"1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, off."²⁵³

Open the airway. Lift up the chin with one hand. At the same time, push down on the forehead with the other hand.
Look, listen, and feel for breathing. Place your ear close to the child's mouth and nose. Watch for chest movement. Feel for breath on your cheek.
If the child is not breathing:

Cover the child's mouth tightly with your mouth.
Pinch the nose closed.
Keep the chin lifted and head tilted.
Give two breaths. Each breath should take about a second and make the chest rise.

Continue CPR (30 chest compressions followed by 2 breaths, then repeat) for about 2 minutes.
After about 2 minutes of CPR, if the child still does not have normal breathing, coughing, or any movement, leave the child if you are alone and call 911. If an AED for children is available, use it now.
Repeat rescue breathing and chest compressions until the child recovers or help arrives.
If the child starts breathing again, place them in the recovery position (See Figure 5.9). Periodically re-check for breathing until help arrives.²⁵⁴

checking for breath — Figure 5.9 – Check for breathing²⁵⁵

hand placement for chest compressions — Figure 5.10 – Position for compressions²⁵⁶

Giving rescue breaths — Figure 5.11 – Position for giving rescue breaths.²⁵⁷

diagram of recovery position — Figure 5.12 Recovery position: The mouth is downward so that fluid can drain from the child's airway; the chin is well up to keep the airway open. Arms and legs are locked to stabilize the position of the child.²⁵⁸

Summary

When early care and education programs have staff that are knowledgeable about how to identify and respond to injuries and emergencies, they are prepared to keep children safe. This chapter provided basic information on responding to injuries. This content is not a replacement for the certification that teachers and other staff members should pursue.

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