Responsibilities of a paediatric first aider

Maintain your own safety
Contact the emergency services
Give accurate and useful information to the emergency services Support the casualty physically and emotionally
Appreciate your own limitations

Know when to intervene and when to wait for more specialist help to arrive. PEFAP 001 1.2: Describe how to minimise the risk of infection to self and others Wash your hands with soap and water before and immediately after giving first aid. If gloves are available for use in first aid situations, you should also wash your hands thoroughly before putting the gloves on and after disposing of them.

(Plastic bags can be used when gloves are unavailable.) Avoid contact with body fluids when possible. Do not touch objects that may be soiled with blood or other body fluids.

Be careful not to prick yourself with broken glass or any sharp objects found on or near the injured person. Prevent injuries when using, handling, cleaning or disposing of sharp instruments or devices. Cover cuts or other skin-breaks with dry and clean dressings.

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Chronic skin conditions may cause open sores on hands. People with these conditions should avoid direct contact with any injured person who is bleeding or has open wounds.

PEFAP 001 1.3: Describe suitable first aid equipment, including personal protection and how it is used appropriately. (Print off your PPE report) All first aid boxes should have a white cross on a green background. Guidelines published by the National Association of Child Minders, NCMA, as well as Ofsted and experienced paediatric first aid trainers, recommend that the first aid box in a child care setting should contain the items listed include:

1 first aid guidance leaflet

1 large sterile wound dressing
1 pair disposable gloves
10 individually wrapped wipes
2 sterile eye pads
1 pair of scissors
1 packet hypoallergenic plasters – in assorted sizes
3 medium sterile wound dressings
2 triangular bandages
5 finger bob bandages (no applicator needed)
4 safety pins
It is recommended that you do not keep tablets and medicines in the first aid box.

PEFAP 001 1.4: Describe what information needs to be included in an accident report/incident record and how to record it. Details of all reportable incidents, injuries, diseases and dangerous occurrences must be recorded, including: The date when the report is made

The method of reporting
The date, time and place of the event
Personal details of those involved
A brief description of the nature of the event or disease.

Records can be kept in any form but must conform to data protection requirements . PEFAP 001 1.5: Define an infant and or a child for the purpose of first aid treatment. Paediatric first aid focuses on infants and children. An infant is defined as being from birth to the age of one year and a child is defined as one year of age to the onset of puberty. Children are however different sizes and a small child over the age of one may be treated as an infant. Similarly puberty can be difficult to recognise, so treat the child according to the age that you think they are, larger children should be treated with adult techniques.

PEFAP 001 3.2: Describe how to continually assess and monitor an infant and a child whilst in your care. Remember your ABC and continue to monitor the infant or child in your care until you can hand over to a doctor or paramedic. A is for AIRWAY : check that the airway remains open. Always monitor a child while in recovery position. B is for BREATHING: Check that breathing is normal and regular. C is for CIRCULATION: check the pulse (if you are trained and experienced) but ensure you take no more than ten seconds to do this: (a) In a child over one year : feel for the carotid pulse in the neck by placing your fingers in the groove between the Adam’s apple and the large muscle running from the side of the neck . (b) In an infant: feel for the brachial pulse on the inner aspect of the upper arm by lightly pressing your fingers towards the bone on the inside of the upper arm and hole them there for five seconds.

PEFAP 001 4.1: Identify when to administer CPR to an unresponsive infant and a child who is not breathing normally. CPR should only be carried out when an infant or child is unresponsive and not breathing normally. If the infant or child has any signs of normal breathing, or coughing, or movement, do not begin to do chest compressions. Doing so may cause the heart to stop beating. PEFAP 001 4.3: Describe how to deal with an infant and a child who is experiencing a seizure. Witnessing a child having an epileptic seizure is a very unpleasant experience, particularly the first one. However, some young children experience what is termed a Febrile Seizure which is brought on when the child has a high temperature or infection.

Recognition

Stiffening of child’s body
Twitching of arms and legs
Loss of consciousness
May wet or soil themselves
May vomit or foam at the mouth
Usually lasts for less than five minutes
May be sleepy for up to an hour afterwards
Treatment
Protect them with cushioning or padding- do not hold them down. Cool them down by removing some clothing.
When the seizures stop, place the child in the recovery position and monitor signs of life. If they become unresponsive or the seizure lasts for more than 5 minutes then you must call 999/112 for an ambulance.

PEFAP 001 5.1: Differentiate between a mild and a severe airway obstruction. A mild airway is usually a partial obstruction, it means the entire airway is not closed off, so air is able to pass by the obstruction, and the victim can respond and cough forcefully , or may wheeze between coughs. In a serer airway obstruction, the airway is completely blocked off and the victim cannot breathe because air cannot pass by the object. PEFAP 001 5.3: Describe the procedure to be followed after administering the treatment for choking. The child may experience difficulties after having treatment for choking-for example, a persistent cough or difficulties with swallowing or breathing. It is important to monitor and assess the child’s condition and to seek medical help if the problem persists. PEFAP 001 6.1: Describe common types of wounds.

A cut (incision): This can be caused from a sharp edge, such as a tin can ,that can lead to a lot of bleeding. A torn wound (laceration): is a jagged wound that can be caused by a broken toy, a fall or collision. Graze or abrasion: cause by friction or scraping, generally happens when children fall. Bruises or contusion: is bleeding underneath the skin. The blood collects and results in a black/blue mark. Children often have bruises on their skin, chin and head from knocking themselves or falling. Soft tissue bruises should be investigated if you have a concern about them. Puncture wound: cause by the body being pierced by an object, for example , a child falling whilst carrying a pair of scissors. Velocity wound: cause by an item travelling at high speed such as a bullet from a gun.

PEFAP 001 6.4: Describe how to administer first aid for minor injuries. With minor bleeding from cuts and abrasions the emphasis is on keeping the wound clean and to control any blood loss. Wear disposable gloves.

Examine the injury for any embedded foreign objects.
Clean the wound under fresh running water.
Sit the casualty down. If they feel weak and unsteady, position them on the floor. Clean the skin around the wound with wet sterile gauze or sterile non-alcoholic wipes and carefully remove any grit or dirt. Do not remove any embedded object.

Elevate the injury to control any blood loss.
Dry the wound with sterile gauze and apply a plaster or sterile dressing.
Advise the parent or guardian of the child or infant to seek medical attention if necessary.

PEFAP 001 7.1: Describe how to recognise and manage an infant and a child who is suffering from shock. After an initial adrenaline rush, the body withdraws blood from the skin in order to maintain the vital organs – and the oxygen supply to the brain drops. The infant or child will have: Pale, cold, clammy skin that is oftern grey-blue in colour, especially around the lips A rapid pulse, becoming weaker

Shallow, fast breathing.
In an infant
The anterior fontanelle is drawn in (depressed).
In an infant or a child may show:
Unusual restlessness, yawning and gasping for air
Thirst
Loss of consciousness
The treatment is the same for an infant and a child.

If possible, ask someone to call an ambulance while you stay with the child . Lay the child down, keeping her head low to improve the blood supply to the brain. Treat any obvious cause, such as severe bleeding. Raise the child’s leg and support them with pillows or on a cushion on a pile of books. Loosen any tight clothing at the neck, chest and waist to help with the child/s breathing. For an infant: hold the infant on your lap while you loosen her clothing and offer comfort and reassurance.

Cover the child with a blanket or coat to keep her warm. Never use a hot-water bottle or any other direct source of heat. Reassure the child: keep talking to her and monitoring her condition while you wait for the ambulance. If the infant or child loses consciousness, open her airway, check her breathing and be prepared to give rescue breaths. Do not give the child anything to eat or drink: if she complains of thirst, just moisten her lips with water.

PEFAP 001 7.2: Describe how to recognise and manage an infant and a child who is suffering from anaphylactic shock. During an anaphylactic reaction, chemicals are released into the blood that widen (dilate) blood vessels and cause blood pressure to fall. Air passages then narrow (constrict), resulting in breathing difficulties. In addition, the tongue and throat can swell, obstructing the airway. An infant or child with anaphylactic shock will need urgent medical help as this can be fatal. The following signs and symptoms may come all at once and the child may rapidly lose consciousness: High-pitched wheezing sound

Blotchy, itchy, raised rash
Swollen eyelids, lips and tongue
Difficulty speaking, then breathing
Abdominal pain, vomiting and diarrhoea

If you suspect an infant or child is suffering from anaphylactic shock, follow the steps below: Call an ambulance. If the child has had a reaction previously, she will have medication to take in case of more attacks. This should be given as soon as the attack starts, following the instructions closely. Help the child into a comfortable sitting position to relieve any breathing problems and loosen any tight clothing at her neck and waist. Comfort and reassure her while you wait for the ambulance. If the child loses consciousness, open her airway, check her breathing and be prepared to stat rescue breaths.

PEFAP 001 6.2: Describe the types and severity of bleeding and the affect it has on an infant and a child. Even tiny a mounts of blood can seem like a lot to a child. Any bleeding may frighten children because they are too young to realise that the blood loss will stop when clotting occurs. When a child loses a large amount of blood, he or she may suffer shock or even become unconscious. Platelets and proteins come into contact with the injured site and plug the wound. This process begins within ten minutes if the loss of blood is brought under control. There are different types of bleeding:

Bleeding from arteries : This will pump blood from the wound in time with the heartbeat and is bright re in colour. If the bleeding from a major artery will lead to shock, unresponsiveness and death within minutes. Bleeding from veins: The bold will gush from the wound or pool at the site of the wound. This will depend on the size of the vein that has been damaged. The blood will be dark red in colour due to the oxygen being depleted. Bleeding from capillaries: Oozing at the site as with an abrasion or maybe internally from a bruising to muscle tissue and internal organs.

PEFAP 001 6.3: Demonstrate the safe and effective management for the control of minor and major external bleeding. With minor bleeding from cuts and abrasions the emphasis is on keeping the wound clean and to control any blood loss. Wear disposable gloves

Examine the injury for any embedded foreign objects

Clean the injured area with cold water, using cotton wool or gauze Do not attempt to pick out pieces of gravel or grit from a graze. Just clean gently and cover with a light dressing if necessary Sit the child down if they feel weak and unsteady, position them on the floor. Elevate the injury to control any bold loss

Record the injury and treatment in the Accident Report Book and make sure that the parents/carers of the child are in formed. When a child is bleeding severely, your main aim is to stem the flow of blood. With severe wounds and bleeding the emphasis is on controlling blood loss and treating for shock.

Wear disposable gloves

Sit or lay the child down on the floor to help prevent shock Examine the injury to establish the extent of the wound and to check for any foreign embedded objects Try to stop the bleeding:

Apply direct pressure to the wound: use a dressing or a non-fluffy material, such as a clean tea towel Elevate the affected part if possible: if the wound is on an arm or leg, raise the injured limb above the level of the heart Apply a dressing: if the blood soaks through, do not remove the dressing, apply another on top and so on Support the injured part and treat the child for shock. Keep them warm and do not let them have anything to eat or drink Call 999/112 for an ambulance and monitor the child’s condition

Contact the child’s parents or carers

If the child loses consciousness, follow the ABC procedure for resuscitation Always record the incident and the treatment given in the Accident Report Book. Always wear disposable gloves if in an early years setting, to prevent cross-infection.