http://www.familiesonline.co.uk/LOCATIONS/London-South-West/Articles/Parenting/Mother-and-Baby/What-to-do-if-your-baby-is-choking/(language)/eng-GB#.UZ9_ELXCaM5

Clearing a blockage – babies under 1 year

• Calmly look in the baby’s mouth and if there is something obvious, remove it with finger tips.
• Never finger sweep or put your fingers down a baby’s throat as this can cause serious damage.

• Lay the baby downwards on your forearm or across your legs, supporting them under their chin and using the flat of your hand, give up to five firm back blow between the shoulder blades checking between each blow to see if the blockage has cleared.

• If the blockage hasn’t cleared, lay the baby on their back, place two fingers in the centre of the chest just below the nipple line and give up to five chest thrusts.

 

• If baby is still choking, call 999/112 and continue alternate five back blows and five chest thrusts until emergency help arrives.

 

• If at any point baby becomes unconscious, commence CPR (cardiopulmonary resuscitation) immediately.

 

Written by Emma Hammett for First Aid for Life

 

It is strongly advised that you attend a Practical First Aid course to understand what to do in a medical emergency.

Please visit www.firstaidforlife.org.uk emma@firstaidforlife.org.uk or tel 0208 675 4036 for more information about our courses.

First Aid for Life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.

Acute Allergic Reaction – how to help

Useful links – The Anaphylaxis Campaignhttp://www.anaphylaxis.org.uk/

What is an allergic reaction?
                   Anaphylactic shock - Picture thanks to the Anaphylaxis Campaign         All allergic reactions occur because the body’s immune system reacts inappropriately in response to the presence of a substance that it wrongly perceives as a threat. The body doesn’t react to the irritant directly, but reacts to the histamine produced by the body to fight the irritant.

• An acute allergic, or anaphylactic, reaction is caused by the sudden release of chemical substances, including histamine, from cells in the blood and tissues where they are stored. The release is triggered by the reaction between the allergic antibody (IgE) and the substance (allergen) causing the anaphylactic reaction. This mechanism is so sensitive that minute quantities of the allergen can cause a reaction.

• We have small amounts of histamine in our system normally and it is important for various vital functions of the body including regulating stomach acid and as a neurotransmitter in our nerve cells. However larger amounts of histamine being released leads to symptoms such as sneezing, blocked nose, itching… the sort of symptoms often associated with hayfever and mild allergies. Antihistamine medication can work effectively at resolving these symptoms but typically takes around 15 minutes to work.

Life threatening and systemic allergic reactions are caused by the body producing even more histamine, which dilates small blood vessels and causes them to leak, resulting in swelling in areas such as the lungs – leading to severe breathing problems. Sufferers may have a rash and be flushed due to the increased blood supply to the skin. Their blood pressure could drop dramatically and they may collapse.

• The more times someone is exposed to the substance they react to, the quicker and more severe the reactions may be.

If they don’t have a rash associated with the symptoms, it could still be an anaphylactic reaction, if they have a rapid onset of symptoms and may have been exposed to an allergen, treat as an anaphylactic reaction.   Who is at risk from anaphylaxis?
If a patient has suffered a bad allergic reaction in the past – whatever the cause, this may make them more prone to having further severe reactions. If a significant reaction to a tiny dose occurs, or a reaction has occurred with just skin contact, this could indicate that they are sensitive to this particular thing and greater contact could lead to a more severe attack.  Asthma can put a patient in a higher risk category. 
  Common triggers for reactions

Individuals can react to absolutely anything.  However most common causes include foods: such as peanuts, tree nuts (e.g. almonds, walnuts, cashews, and Brazil nuts), sesame, fish, shellfish, dairy products and eggs. Non-food causes include wasp or bee stings, natural latex (rubber), penicillin or any other drug or injection.

• Exercise can also trigger an allergic reaction some time after the person has been exposed to something that they are allergic to.

How to recognise an acute allergic reaction? A reaction can take any form and people who have reacted one way when exposed to a particular allergen can react completely differently on another occasion when exposed to the same thing. It is therefore extremely difficult to predict what a reaction might look like. The above picture is a very classic reaction and easily recognisable as Anaphylactic shock.
Common symptoms include:
Generalised flushing of the skin A rash or hives anywhere on the body A feeling of anxiety or ‘sense of impending doom’ Swelling of throat and mouth and difficulty in swallowing or speaking Alterations in heart rate – usually a speeding up of the heart Severe asthma attack which isn’t relieved by their inhaler Acute abdominal pain, violent nausea and vomiting A sudden feeling of weakness followed by collapse and unconsciousness A patient is unlikely to experience all of the above symptoms.   How to Treat Anaphylaxis

• The key advice is to avoid any known allergens if you are able to.
• Adrenaline auto-injectors are prescribed for those believed to be at risk. Adrenaline (also known as epinephrine) acts quickly to constrict blood vessels, relax smooth muscles in the lungs to improve breathing, stimulate the heartbeat and help to stop swelling around the face and lips.
• Acute Allergic reactions can be life threatening and it is crucially important that you recognise the problem and know what to do quickly in order to save someone’s life.

Adrenaline (US name: Epinephrine) is the first choice for an acute anaphylactic reaction and it works best if it is given as soon as you recognise that someone is having a reaction.

• You should administer the injector, or help the sufferer to administer it themselves, as quickly as possible and call for an ambulance stating clearly that the person is having an acute anaphylactic reaction.

Adrenaline rapidly treats all of the most dangerous symptoms of anaphylaxis, including throat swelling, difficulty breathing, and low blood pressure. Adrenaline is metabolised very quickly – it is very important that you call an ambulance as soon as an auto-injector has been given as its effects can wear off within about 15 minutes. Another injector can be given 5-15 minutes after the first if necessary.
There are currently 2 makes of Adrenaline Autoinjectors on the market in the UK; Epipen  and Jext.

Epipen is currently the more popular device in the UK.   http://www.epipen.com/ andhttp://www.jext.co.uk/

Some people may have an Anapen, you activate the device by pressing the red button (videos as to how to use this device are widely available on-line.) This device has never been widely used in the UK and was withdrawn in September 2012. Jext has recently launched. This is very similar in design and delivery to the Epipen and may well become a more popular option as it has a longer shelf life of 2 years. If you are prescribed an adrenaline auto injector you should carry it with you at all times and register it to receive a reminder when it is going out of date. If you have been prescribed 2 adrenaline injectors as a duo pack, you need to carry both with you at all times in case a second dose is needed. Teach friends and family what to do if they need to help you or someone else having an anaphylactic reaction. Videos showing how to use adrenaline auto-injector are available on the drug company websites.http://www.youtube.com/watch?v=CjgbwmQy2r8 – shows how to use a Jext auto-injector http://www.youtube.com/watch?v=pgvnt8YA7r8 shows how to use an Epipen

• Hold the injector in your dominant hand, with the other hand remove the safety cap. Put the injector firmly into the upper outer part of the casualty’s thigh and hold it there for 10 seconds. Remove it carefully and they should feel better very quickly. If they do not recover swiftly, you may need to give another injector. Always phone an ambulance.

Patient Positioning for anaphylaxis A child suffering from acute anaphylaxis is also likely to be showing signs of clinical shock Reassuring the child and positioning them appropriately can make a major difference to their treatment. The child should also be kept warm and dry.

• If a child is very short of breath, they should be encouraged to sit, in an upright position to help their breathing, putting something under their knees to help increase their circulation can be very helpful – into the lazy W position.
• If a child is not having difficulty breathing, but is pale, cold, clammy, feeling sick and thirsty – they should lie down with their legs raised to help increase the circulation to their vital organs. Encourage them to turn their head to one side if they are likely to vomit. They should be covered to keep them warm and kept in this position until the paramedics arrive.

After an anaphylactic reaction: An ambulance should always be called if someone is showing the signs of anaphylaxis and they will usually be admitted overnight for observation. This is because some people have a second reaction some hours after the first.

• Don’t forget to replace the used adrenaline auto-injector

It is strongly advised that you attend a Practical First Aid course to understand what to do in a medical emergency. Please visit www.firstaidforlife.org.ukemma@firstaidforlife.org.uk or tel 0208 675 4036 for more information about our courses. First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.

Asthma is a common condition in which their airways go into spasm and cause tightness of the chest and severe difficulty breathing when someone is exposed to something that irritates their airways. 

• coughing

• wheezing

• shortness of breath

• tightness in the chest

• often people find it particularly difficult to breathe out and have an increase in sticky mucus and phlegm

• Take one to two puffs of the reliever inhaler (usually blue), immediately – using a spacer device if available.

• Sit them down, loosen any tight clothing and encourage them to take slow, steady breaths.

• If they do not start to feel better, they should take more puffs of their reliever inhaler

• If they do not start to feel better after taking your inhaler as above, or if you are worried at any time, call 999.

• They should keep taking the reliever inhaler whilst waiting for the paramedics to arrive

• They should make an appointment with your doctor or asthma nurse for an asthma review, within 48 hours of their attack.

Please visit www.firstaidforlife.org.uk for more information about our courses. First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.

How to help a Choking adult

One of the most frequent concerns is what to do if someone is choking. Choking is frightening, but rarely fatal.
·        Always check first to see if someone is able to cough and encourage them to do so as often they are able to clear the blockage themselves.
·        If they are coughing, let them cough.
·        If they are not coughing, remind them to cough as they may be able to clear the obstruction themselves.
If they are unable to cough:
·         Bend them forward supporting them on their chest with the other hand and use the flat of your hand to give a sharp back blow between the shoulder blades. Check to see if the blockage has cleared before giving another blow. If the blockage hasn’t cleared after five blows, try abdominal thrusts/Heimlich manoeuvre:

If the back blows haven’t worked, I would get an ambulance on the way

·         Stand behind them and place one hand in a fist under their rib cage. Use the other hand to pull up and under to dislodge the obstruction. You are using a J-shaped motion to pull up and under their rib cage. Perform abdominal thrusts up to 5 times, checking each time to see if the obstruction has cleared. Anyone who has received abdominal thrusts must be seen by a doctor.
·         If the person is still choking, call 999 (or 112) and alternate five back blows and five abdominal thrusts until emergency help arrives. If at any point they become unconscious, commence CPR.

What to do when a child is choking

·         Babies and young children can choke on anything that can fit through a loo roll. To prevent choking: keep small objects out of reach, cut up food into very small pieces and supervise children while they’re eating, especially if they’re under five years old.
·         If a child shows signs of choking, stay calm and ask them to cough to help remove the object. If this doesn’t work, follow the steps below to clear a blockage.

Choking: Unable to speak or cry, clutching their throat, struggling to breath
Helping a choking child over 1 year

Bend the child forward, supporting them on their chest
·         with the other hand and use the flat of your hand to give a sharp back blow between the shoulder blades.
·         Check to see if the blockage has cleared before giving another blow.

If the back blows haven’t helped I would get an ambulance on the way

·          If the blockage hasn’t cleared after five blows, try abdominal thrusts/Heimlich manoeuvre:
·         Stand behind the child and place one hand in a fist under their rib cage. Use the other hand to pull up and under in a J shaped motion, to dislodge the obstruction. Perform abdominal thrusts up to 5 times, checking each time to see if the obstruction has cleared. Anyone who has received abdominal thrusts must be seen by a doctor.

Make a fist, put the thumb towards the child – do a J shaped movement up and under – between their tummy button and their rib cage.
·         If the child is still choking, call 999 (or 112) and alternate five back blows and five abdominal thrusts until emergency help arrives. If at any point the child becomes unconscious, commence CPR.

What to do when a baby is choking

Clearing a blockage – babies under 1 year

·        First look in the baby’s mouth and if there is something obvious in the mouth, remove it with finger tips.

DO NOT put your fingers down a baby or child’s throat, or finger sweep the mouth, as this can make matters worse by pushing the obstruction further down or by causing swelling.

·         Lay the baby downwards on your forearm or across your legs, supporting them under their chin and using the flat of your hand, give a firm back blow between the shoulder blades.

·          Give up to five back blows and check between each blow to see if the blockage has cleared. If the obstruction has not come out I would get an ambulance on the way

·         If the blockage hasn’t cleared, lay the baby on their back, place two fingers in the centre of the chest just below the nipple line and give up to five chest thrusts.
Warning: Never do an abdominal thrusts on a baby under a year as you could cause damage.
·         Check to see if the blockage has cleared between each chest thrust.
·         If baby is still choking, call 999/112 and continue alternate five back blows and five chest thrusts until emergency help arrives.
·         If at any point baby becomes unconscious, commence CPR.

If the obstruction comes out:
If they are unconscious but breathing – put in the recovery position
If they are unconscious and not breathing start CPR
If they seem absolutely fine – ensure that they don’t have problems swallowing, check there is no pain or bleeding – it is always advisable to have them checked out by a medical professional. If it is not your child, ensure that you have contacted the parents.

If the child has been given abdominal thrusts or chest thrusts, they should always be checked by a medical professional

It is strongly advised that you attend a Practical First Aid course to understand what to do in a medical emergency. Please visit www.firstaidforlife.org.uk emma@firstaidforlife.org.uk or tel 0208 675 4036 for more information about our courses. First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.

What to do if your baby is unconscious and not breathing

First check Danger, Response, Airway and Breathing – If you are not absolutely sure whether or not they are breathing, you will need to start CPR (Cardio Pulmonary Resuscitation)

Tilt the head and lift the chin to horizontal             Give 5 rescue breaths

Carefully tilt the head and lift the chin to roughly a horizontal position to take the tongue off the back of the airway then give 5 rescue breaths to re-oxygenate them. Babies and children are much more likely to have had a breathing problem first and had a Respiratory Arrest – their heart will stop later.

• Seal your mouth around their mouth and nose (if you can fit your mouth over both) and blow into them gently with a puff of your cheeks.

• Make sure their chest rises each time – if it doesn’t, you probably haven’t opened the airway sufficiently – tilt it a little further DO NOT OVER EXTEND IT and try again.
• If they start to gurgle when you breathe into them, you will need to briefly turn them onto their side and empty the vomit from their mouth, before continuing with the breaths.

Push down by a third of their depth

You will then need to circulate the oxygenated blood by pushing down hard and fast on their chest with two fingers or thumbs.

• Push hard and fast on the centre of their chest – roughly between the nipples
• Push down by a third of the depth of their chest – ideally with two thumbs or fingers.
• At a rate of  110 -120 beats per minute – roughly 2 per second

After about 30 compressions…you will need to give them 2 more short sharp breaths and then continue with the compressions again. 30:2:30:2:30:2…

Keep going – You are being a life support machine and keeping them alive.

When you push on the chest – you are being the heart

When you breathe into them – you are being the lungs

If you are on your own, you should perform 1 minute’s CPR before phoning for an ambulance (5 breaths, 30:2, 30:2 is about a minute)

Do not expect them to come back to life until the paramedics are there to help.

Written by Emma Hammett for First Aid for Life

It is strongly advised that you attend a Practical First Aid course to understand what to do in a medical emergency. Please visit www.firstaidforlife.org.uk for more information about our courses.

First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.

Poisoning

A staggering 25,000 under-5s are rushed to A&E each year in the UK with suspected accidental poisoning. One in five of these cases (that’s around 15 every day) will be serious enough for the child to be admitted to hospital for further observation and/or treatment.

Every day, 15 young children are admitted into hospital because it’s thought they’ve swallowed something poisonous.

A poison is any substance (a solid, liquid, or a gas) which can cause damage if it enters the body in sufficient quantities.

A poison can be swallowed, breathed in, absorbed through the skin or injected.

Some poisons cause an all over reaction: and can result in seizures, blurred vision, acute anaphylaxis and can be fatal – be cautious and always get the child quickly seen by a medical professional.

If you suspect that a child has taken a harmful substance. Call an ambulance and explain clearly what has happened. They will advise you what to do.

Prevention:

The Childhood Accident Prevention Trust www.capt.org.uk and Royal Society for the Prevention of Accidents http://www.rospa.com/ both work to prevent accidents in children and their websites are full of really useful tips and advice.

• Keep all potentially harmful substances out of reach of small children and ideally in a locked cupboard. This includes; dishwasher tablets, medicines, alcohol, cosmetics, DIY, cleaning and gardening products
• Ensure that Grandparents, Child Carers and visitors are also mindful about leaving potentially hazardous substances within reach – the contents of many hand bags could be fascinating and lethal to a small child!
• Never decant medication or other products into different containers, always use the original containers, clearly labelled, with childproof lids if possible
• Keep batteries out of reach of small children and ensure that batteries in their toys are firmly secured.
• Fit carbon monoxide alarms and have appliances and alarms regularly checked
• Be aware of harmful plants – many decorative plants (particularly berry bearing Christmas plants) are toxic. Plants can be checked through the Royal Horticultural Society www.rhs.org.uk or by asking your local florist or horticultural nursery.

Poisoning from an ingested (swallowed) substance

You may find the child occupied with something potentially dangerous and be unsure if they have taken anything – ALWAYS GET THEM CHECKED!

Depending what they have taken they may have a burning sensation of their lips and mouth, nausea or vomiting, drowsiness or hyper-manic and possibly a change in their heartbeat.

If a child has swallowed a non-corrosive substance (a product that will not burn them) if the child is completely well:

• keep them still, as moving around will increase their metabolism and speed up the poison circulating around their body.
• Try not to be cross with them as they will not tell you what they have taken if they are scared.
• If they are fine, phone NHS Direct or the ambulance service and get advice from them.
• If the child becomes unconscious – open the airway and check for breathing. Be ready to resuscitate if necessary – use a protective face shield to ensure you don’t put yourself at risk from whatever they have taken.

Tip : If a child has swallowed a berry from a plant – take a photo of the plant and a leaf as well, both of these will help the medical team to identify the berry and establish whether it is harmful or not.

If the child has swallowed a corrosive or burning substance:

Be as calm as you can:

Take small sips of milk or water                                                                                 If unconscious protect yourself when resuscitating

If a child was to mistake a dishwasher or washing machine capsule or tablet for a sweet it could prove fatal – cleaning products are extremely alkaline and can burn the skin or throat.

If a child has accidentally drunk some paint stripper or strong cleaning product:

• Remove it and rinse the product away as quickly as you can. Protect yourself if possible, but attend to them fast.

If they have swallowed some of the product,

• Ideally get them to swill milk or water around their mouth and spit it out and then give them small sips of milk or water to dilute the product down their throat.

DO NOT MAKE THEM SICK as this will cause them to burn again as the corrosive product comes back up.

• Phone for an ambulance and keep giving them small sips of milk or water.
• Look at the box that the substance has come from and read the advice in case of accidental ingestion.

If they have swallowed some of the product, it is possible that it will have burnt both their oesophagus and their airway and this can lead to their airway swelling and becoming obstructed so that they are unable to breathe.

If this happens and they go unconscious and stop breathing, you will need to resuscitate them by giving them breaths followed by chest compressions.

It is important that you protect yourself when giving the breaths – this can be done with a pocket mask or plastic bag with a hole in it – cover the mouth with the bag and breath through the hole in the bag into the nose – thereby protecting yourself and ensuring that you are not burnt as well.

If someone has lost consciousness and stopped breathing after eating something corrosive – protect yourself if doing mouth to mouth resuscitation.

When you go to hospital, take the packaging and the remains of anything you think they have swallowed as this will help the doctors to treat them in the best way possible.

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

Emma Hammett RGN
www.firstaidforlife.org.uk
emma@firstaidforlife.org.uk

• Sophie Dedek lost her fingertip in incident during nursery ‘taster’ session
  
• Father Pavel drove her to hospital after picking her up from nursery
• Parents now demanding compensation for daughter
  

By ELEANOR HARDING

PUBLISHED: 23:13, 3 February 2013 | UPDATED: 23:14, 3 February 2013 MAIL ONLINE

• • A baby’s parents were told she had ‘nicked’ her finger at nursery – only for her father to discover when he arrived that it had been chopped in half.

Staff at the private £900-a-month crèche allegedly failed to realise Sophie Dedek had lost her fingertip until someone spotted it on the floor while they were cleaning.

Her father Pavel, 37, turned up to find nine-month-old Sophie with a blood-soaked towel wrapped around her hand and the severed 1cm of her finger in a cup of ice.

Pain: Nine-month-old Sophie Dedek lost part of her finger at a nursery in Gosforth, Newcastle. Her parents Jana and Pavel are devastated and demanding compensation for their daughter

 

Scene: The manager at Kids 1st Day Nursery called 999, but was advised an ambulance would not be necessary by the operator

Hospital: Mr Dedek drove Sophie to A&E where surgeons spent two-and-a-half hours trying to reattach the fingertip

Horrified that no ambulance was on its way, he drove her to A&E himself while a nursery nurse held her arm in the air to stop the bleeding. Surgeons spent two-and-a-half hours trying to reattach the fingertip, which had been cut at the second joint, but the task was fruitless.

Now Mr Dedek, a manager at an estate agent, and his wife Jana, 31, are demanding compensation for Sophie as she will be maimed for life. He said: ‘When I spoke to them on the phone, they said she had just nicked her finger. I thought I would just be picking her up and putting a plaster on it. I arrived to find Sophie’s hand wrapped in a towel, and next to her a cup with the remains of her finger in it. 

‘As I drove her to the hospital I started crying. It was the worst day of my life.’

 The incident on January 4 came as the Government raised concerns over the number of ‘under-qualified’ people working in childcare. There is no suggestion that the nurse involved in the accident was inadequately qualified.

Sophie was having her second ‘taster’ session at Kids 1st Day Nursery in Gosforth, Newcastle upon Tyne. It is thought the unnamed nurse did not notice the baby had crawled up behind her when she opened a door to put something in a bin.

When she closed the door, she looked down and saw Sophie crying, with blood on the little finger of her right hand. Not realising the full extent of the injury, a fellow nurse wrapped it in a towel while another called her father to ask him to pick her up.

Policies: Newcastle City Council said it found the nursery’s policies and procedures satisfactory following the incident, which has left Sophie maimed for life

Future problems: Sophie has spent weeks in pain and will find some tasks, such as playing musical instruments, harder than her peers when she is older

The nursery manager called 999, but the operator advised an ambulance was not necessary for such a small ailment. Four minutes later, when staff were cleaning the floor, they found the fingertip. 

Sophie has spent weeks in pain and will in future find some tasks, such as playing musical instruments, harder than her peers. Her parents want to sue the nursery so that she has money to pay for plastic surgery on her finger when she turns 18. 

A nursery spokesman said staff acted swiftly after a child trapped a finger under a door, adding: ‘The correct first aid was implemented, all health and safety procedures were followed and the relevant authorities were informed.’

Ofsted, which has rated Kids 1st ‘outstanding’, is investigating. Newcastle City Council said it found the nursery’s policies and procedures satisfactory. 

Last week, education minister Elizabeth Truss proposed introducing a requirement for GCSEs for childcare workers. Critics said plans to increase the number of babies a nursery worker can look after could threaten child safety.

 ’Worst day of my life’:  Mr Dedek said he started to cry as he drove his daughter to hospital following the incident

Read more: http://www.dailymail.co.uk/news/article-2272991/Sophie-Dedek-Our-daughters-finger-severed-nursery-door-staff-realised-floor.html#ixzz2Jwe8rqla

Follow us: @MailOnline on Twitter | DailyMail on Facebook

What to do if someone cuts their finger off!

Amputated tips of fingers and toes are very common injuries and with the right initial First Aid treatment, they can very often be successfully re-attached.

If part of a finger is amputated, the priority is to look after the child. Sit them down, reassure them and grab a cloth to apply direct pressure to the stump, elevate the injured hand above the level of the heart. Do not worry about the amputated part, until bleeding has been controlled and the child is calmer.

Pick up the finger, do not wash it. Wrap it in a cloth, put this in a plastic bag and then put on an ice pack. Do not let the ice come directly into contact with the amputated part as it will cause ice burns and mean that the finger will not be able to be sewn back. You are chilling, not freezing the amputated part to prevent it decomposing. Transport the child and amputated finger to hospital, if necessary by ambulance.

If the finger is still partly attached with a blood supply, bandage the severed part carefully in situ, not too tightly, support and elevate the hand and call an ambulance.

If fingers are crushed and bruised, but there is no amputation, run the damaged area under cool running water for 10 minutes, then apply a wrapped ice pack, elevate the injured hand and seek medical advice.

Written by Emma Hammett for First Aid for Life

It is strongly advised that you attend a Practical First Aid course to understand what to do in a medical emergency. Please visit www.firstaidforlife.org.uk for more information about our courses.

First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.

Babysitting Guidance

When children look after children

While children who choose to work on newspaper delivery rounds, on farms or in retail jobs are covered and hopefully protected by general and specific health and safety law – notably the Health and Safety (Young Persons) Regulations 1997 – those who choose babysitting as a means of earning money fall outside these laws.

With this in mind, RoSPA and the NSPCC recommend that no one under the age of 16 should be left to care for a baby or toddler. The British Red Cross, states that participants must have reached their 14th birthday by the time of their final assessment.

Under some circumstances, parents can be prosecuted and fined if they leave their children in a situation which a court might judge to be “neglectful”. This usually occurs when there is an incident which requires intervention by the emergency services.

Thankfully, the vast majority of babysitting situations do end happily and when you consider the number of parents who engage babysitters to look after children, the disasters are few. But leaving children in the hands of other children increases the risk of harm.

Risk

In simple terms, risk is the chance or probability that an accident could happen

A lot of young people we spoke to, who were expected to look after younger brothers and sisters, felt trapped by their enforced child-minding duties and, in many cases, it had created a great deal of family tension. Some youngsters felt that they were being “blackmailed” into babysitting. A lot of the children felt “used”.

How can risks be reduced?

The most successful sitters had taken courses in child development and first aid. Those who had better babysitting experiences usually sat for other people, for an agreed sum of money, with support nearby. For example: their own parent or other relative would be available to step in and help in a crisis.

Being a babysitter means that you have someone else’s life in your hands and that in itself is a tremendous responsibility. Having to look after one or more children can be tiring, frustrating and sometimes difficult to cope with – even for experienced adults.

Parents need to think about all possible eventualities (i.e. do a risk assessment) before leaving their children in the hands of someone else, particularly someone under the age of 16. Likewise, any prospective babysitter should be well prepared and armed with enough information to be able to cope with most situations that could arise.

Through mutual co-operation and understanding, babysitters and parents can reduce the risk of potential harm and promote a safer environment for the child as well as for the babysitters themselves.

Risk Assessment

This doesn’t need to be complicated – in fact, you probably do your own risk assessments all the time, without realising it. It’s simply about spotting hazards, deciding how likely it is that it will cause harm to someone, and working out how to carry out your activity safely.

Good practice for parents

What should I think about when hiring a young babysitter?

• If you decide to hire a young babysitter under the age of 16, you must be prepared to take some responsibility for anything that should go wrong in your absence. Under some circumstances, the police will charge parents with negligence. You must also be prepared to take responsibility for the care and safety of your babysitter – including making arrangements in advance for the sitter’s safe return home if they are not being collected by a parent or sleeping over. Never let a young babysitter travel home alone late at night
• Remember that the majority of babysitters mean well and genuinely like children. However, these qualities might not be enough if difficulties should occur. You need to know your babysitter is a competent person
• Think about the qualities you are looking for in a good babysitter. They may include: responsible attitude, maturity, reliability, honesty, tolerance, patience, kind but firm, has experience with young children, has first aid experience etc.
• Make sure the babysitter knows how and when to call the emergency services if it should become necessary
• Encourage your babysitter to visit your home and get to know the child or children who will be left in their care. It will also help them understand the particular household and the children’s daytime and night-time routines
• Give an honest opinion when the question arises concerning your babysitter having friends to sit with them (same sex or opposite sex). Use common sense and remember that babysitting can be a lonely business
• Make adequate preparations for your babysitter not only in terms of refreshments but also in giving them enough information to cover all eventualities. Make sure your sitter knows where everything is
• Never take advantage of a babysitter by leaving them to cope with an already sick or upset child who you know will not settle
• Never leave a babysitter alone with several children for long periods of time
• Always return home as close to the time you agreed with your babysitter as you can. If you are going to be late, inform the babysitter if possible
• Talk to your babysitter about the child’s progress and give them up-to-date information, which is particularly important if the sitter does not see your child regularly
• If you feel unhappy about any aspect of the care of your child, talk it over with the babysitter.

Should I use my eldest child as a babysitter?

• As with parents hiring a sitter under 16 years of age, you must also be prepared to take some responsibility for anything that should go wrong in your absence. Remember, you are also responsible for the care and safety of your eldest child even while they are taking responsibility for your other child or children
• Try not to take advantage of your eldest child by expecting them to babysit on too frequent a basis – and certainly not seven days a week. This can lead to resentment and family tension. However, if circumstances dictate there is no alternative, talk things through with your eldest. Understanding why things are as they are can be helpful
• Ask yourself whether your eldest child has the maturity and qualities you would look for if hiring a babysitter from somewhere else. Are they capable of looking after the rest of the children in your absence?
• Give praise where it is due and reward your eldest child for a job well done: this can be anything from pocket money, to a small gift such as a favourite magazine, or just sincere thanks
• In the unlikely event that something does go wrong in your absence, try not to allocate blame. It is not easy being expected to have authority and control over younger family members who have probably already reminded them that they are not you and, therefore, have no authority
• Help your eldest child do a risk assessment of your home. Point out potential hazards and risks and discuss how to control them.

Hazard

A hazard is anything that has the potential to cause harm (things such as heat / fire, chemicals, animals, other people, stress or tiredness)

“Please keep an eye on your younger sister” – new research

Research was published in August 2010 in Injury Prevention, a journal from the British Medical Association, entitled “Please keep an eye on your younger sister”: sibling supervision and young children’s risk of unintentional injury. The abstract can be viewed online.

It is known that when parents supervise their children it reduces the chance that a child will be injured. However, when older siblings supervise younger children there is an increased risk of injury. The idea behind the research was to explore why the risk of injury to young children increased when they were supervised by older siblings.

The researchers found that mothers were more likely to spot and remove hazards, whereas older siblings were more likely to interact with the hazards in front of the younger children (for example, an older child may make themselves a hot drink and put it within reach of a young child, whereas the mother would be more likely to keep hot drinks well away from toddlers). It is well known that younger children tend to copy their older siblings – and indeed, this was found to be the case during the study.

Children also behaved in a more risky manner when they were supervised by a sibling; however, their sibling babysitters were less attentive to that risk than their mothers would be. The problem was compounded by the fact that young children were less likely to listen to their siblings when asked to stop risk taking.

In conclusion, the researchers found that both the behaviour of the younger children and their supervisors contributed to the increase in injury risk when older siblings supervise younger ones.

The full study, for those interested in the methodology and deeper conclusions, is available from the website and in the printed journal; however, this short piece may provide parents with food for thought when asking their elder children to babysit for the younger ones.

We would recommend that parents encourage their children to go on a babysitting course if possible, to enable them to fully understand what they are being asked to do.

Good practice for babysitters

What if my parents ask me to look after my younger siblings?

• Do try and be open with your parent(s) about how you feel about babysitting your younger brothers and sisters. If you have any worries or concerns, try to bring them out in the open. Try to talk about it calmly
• Negotiate. No-one can be expected to babysit every night. Agree to sit a few evenings if you, in turn, can have some nights off to do your own thing
• If you do have to stay in with younger siblings for a whole week, ask if you can have a friend to come and sit with you so that you can share the responsibility of looking after the children
• Try not to resent or blame your younger brothers and sisters for the situation; it is not their fault. Try to look at the situation from all points of view including that of your parent(s)
• Treat your responsibilities as seriously as you would if you were sitting for someone else’s children
• Set up a back-up system. Is there another relative or other adult you can ask for help in an emergency? Would a neighbour help?
• Make sure you know where your parent(s) will be and roughly what time they will be back. Give them a little leeway as it can be difficult to return “on the dot”. Get a contact telephone number, if you can
• In the unlikely event that something major occurs – illness or accident – would you know what to do? Do you know how to get hold of the family doctor and the emergency services? If not, ask a parent to help you find out
• Knowledge of home safety would be helpful to you. Get to know hazards and risks in and around your home. Some things which are safe for you to use can cause harm to small children, e.g. babies will put objects in their mouths, which can cause choking. Identify hazards which have the potential to cause harm to you and the other children. What are the risks? Do you know how to manage and control those risks? Some things are best removed altogether
• Remember your younger brother or sister may misbehave while you are in charge – or play in more risky ways. Think of ways to reward them for playing safely, as well as making sure they can’t injure themselves
• If no-one thanks you or praises you for looking after your younger siblings, then give yourself a pat on the back for doing a good job.

What about sitting for other people’s children?

• Are you aged 16 years and over and able to accept the responsibilities of looking after one or more children?
• Parents are seeking good child care in their absence. You must remember at all times that there is a child in the house in your care. Can you offer such a service?
• Why do you want to babysit? Is it for the love of children or to earn some extra money? Hopefully, it is a combination of both. If it is simply to get away from your own house so that you can do what you like in someone else’s, think again
• Take some basic training in the safe care of young children. Remember that young children are not only prone to illness but also to having mishaps and accidents. It is essential that you can cope with such emergencies. If you can study child development and first aid at school, do so; otherwise, take a first aid course .
• A good working knowledge and understanding of safety in the home environment is important so that you can recognise good and bad safety practices. You should be able to identify hazards and risks, particularly for younger children
• You ideally need some experience of dealing with and looking after small children and should spend some time with a family where there are small children present. Getting to know the child you will be caring for before you babysit is a good idea
• Organise a suitable back-up system – such as having a near relative or neighbour available whom you can call upon in an emergency or simply to ask advice about an uncertain situation
• If you agree to babysit, always be prompt
• Try not to let the child’s parents leave the home before learning where to contact them. Ask for other numbers, too – e.g. family doctor, other relatives etc. You must feel safe, secure and happy to be left alone with the child or children before the parents depart for the evening
• Know, in advance, exactly how you will be getting home after the sitting session. You might also like to negotiate terms of payment and whether or not you are allowed to have a friend sit with you. Make sure you know what you can and cannot do in someone else’s home.

By following these simple guidelines, the babysitter will be rewarded by a feeling of confidence and develop a better relationship with the children in their care while parents will be rewarded by the knowledge that their child is secure and happy in the hands of a well-prepared and trusted babysitter.

Burns 

For All BURNS – TREAT THEM IMMEDIATELY WITH COOL RUNNING WATER

• Immediately, but extremely carefully remove loose clothing covering the burn 

DO NOT TAKE CLOTHES OFF IF THERE IS ANY RISK THAT THE SKIN HAS STUCK TO THEM OR IF THE SKIN HAS BLISTERED.

• Put the affected area under cool running water for at least 10 minutes. Remember you are cooling the burn and not the child,
• Keep the child warm and dry and be aware for any signs of Shock – please link.
• Phone an ambulance, particularly if a large area is affected, or if the skin is broken or blistered and keep the area under cool running water whilst you are waiting for the ambulance.

Assessing the severity of a burn:

In a Burns Unit, staff will assess the burn on the basis of:

Size

Cause

Age

Location

Depth

 Size – the larger the area involved, the more serious it is for the casualty and the more likely they are to suffer from shock

A burn is measured using the size of your hand – your palm is roughly equivalent to 1% of your body

Cause – How the burn was caused can affect on-going treatment

Causes of burns:

A burn can be caused by many different things:

Steam

Flames

Burns caused by hot liquids – scalds

Friction

Hot objects such as irons, electric hobs, heated towel rails

Ice and extremely cold objects

Chemicals

Radiation – sun lamps

If the burn is caused by a chemical, run under cool running water for at least 20 minutes and be careful of the run off as it could still be corrosive and hurt you. Look at the advice on the packaging and see if there are any specific instructions.

Sunburn:

• Cool the area under a shower for at least 10 minutes, or apply repeated cool wet towels for 15 minutes.
• When completely cooled, apply neat Aloe Vera gel to the affected area, this will soothe, reduce swelling and promote healing.
• Give the child plenty to drink and seek medical advice

Electrical burns:

Always ensure that the area is safe if someone has been electrocuted:

• Do not touch them until you have turned the electricity off at the mains. Electrical burns have an entry and exit and burn all the way through the inside. Therefore the electrical burn is unlikely to be the most important injury and should not be a distraction, when they may be losing consciousness and could stop breathing as a result of the shock affecting their heart.

Age – Burns are more serious in babies and children and the elderly

Location – Burns to the; hands, face, feet, genitals, airways, or a burn that extends all the way around a limb, are particularly serious. Keep the burnt area under cool running water until the paramedic arrives.

Depth – superficial, partial thickness or full thickness burns

All burns are serious, particularly when dealing with children. Often people have different depths of burn within a single injury. Whatever the depth of burn, they should all be treated under cool running water.

A superficial burn has just affected the top layer of skin, it is really painful and likely to blister.

A partial thickness burn is really painful. The burn has gone through both the first and second layer of skin

Full thickness burns are often not as painful as the nerves have been very severely damaged too. This is the most severe sort of burn, the skin may appear pale, white or charred it will require extensive treatment and skin grafts.

Treating a burn promptly under cool running water for at least 10 minutes makes a huge difference to the severity of a burn and therefore the amount of pain, scaring, length of time in hospital…that your child may experience.

• Never touch the burn, pop blisters, or put on any creams whatsoever. Take burns very seriously and always seek medical advice.

WEAR STERILE GLOVES WHEN DEALING WITH BURNS

 If it is a child that is burnt, phone for an ambulance and keep cooling their burn under cool running water.

 Dressing a burn

 A burn should never be dressed until it has been cooled for at least 15 minutes. Covering a burn reduces the risk of infection and reduce pain by covering exposed nerve endings.

If a child is burnt and the burn is bad enough that you need to dress it – phone an ambulance, whilst continuing to cool it under running water and the paramedics will dress it for you.

If you want to dress the burn, cling film is a good temporary dressing. Ensure you have cooled the burn for at least 15 minutes before dressing it. Discard the first couple of turns of cling film and place an inner piece loosely over the burn. Plastic bags and non fluffy dressings also make useful dressings. Proper burns dressings are great, but ideally the burn should be cooled for at least 10 minutes before dressing.

Always get a Medical Professional to assess a burn

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

First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.