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A Guide to Baby First Aid

One of the best ways that new parents, grandparents, and babysitters can prepare for the unexpected is to take classes in first aid and infant cardiopulmonary resuscitation (CPR). Knowing what to do in the event of an emergency will help you remain calm, think quickly, and take action with confidence so that you can help your child. Here's how to handle some of the most common injuries and emergencies that affect children under a year of age.

Head and eye injuries
Head bumps and eye irritations should be treated with care -- babies' developing brains and eyes are very fragile. Even if it doesn't seem serious, it's a good idea to check with the doctor.
Head injuries
This type of injury is common in young children because a child's head is relatively large in proportion to the rest of her body. A child who falls from a significant height (two or more feet) or is in a motor vehicle accident could have a head, neck, or back injury. Call 911 if your baby loses consciousness, has a seizure, oozes blood or fluid from the ears or nose, has bruising around the eyes or behind the ears, or acts lethargic. Do not move her, as this could cause further injury. Call a doctor even for apparently mild head injuries; your child might have suffered a concussion.
Eye injuries
All eye injuries (common ones include bruising around the eye, scratches on the cornea, and cigarette burns) should be evaluated by a doctor. If an irritating substance is splashed into the eye, flush it with water for at least 15 minutes and seek medical care. Don't rub the eye, apply medication, or try to remove an embedded object yourself.

Marianne Neifert, M.D., is the author of Dr. Mom's Guide to Breastfeeding.

If your baby has a skin wound...

Skin wounds
Most minor cuts can be treated at home; more serious wounds will require medical attention. Your child may need stitches or a dose of DTaP vaccine, which protects against tetanus.
Minor cuts and scrapes
If the injury barely breaks the skin, wash the affected area with soap and water, pat it dry, and then apply an antibiotic ointment (such as bacitracin or Neosporin) and a nonstick bandage. Keep the wound clean and replace the bandage at least once a day to prevent it from falling off and becoming a choking hazard (watch to make sure your child doesn't pull it off, as well). Call a doctor if the area becomes swollen or red, there is a pus discharge, or your child has a fever or acts ill.
Bruises
A bruise results when blood vessels are damaged, causing bleeding under the skin. The area may be red or purplish, then fade to yellow-green. Apply a cold compress (wrapped in a cloth) to decrease pain, swelling, and further bleeding. Call your doctor for large bruises, swelling, ongoing pain, or abdominal bruising.
Deep cuts
If the wound is severe and continues to bleed for more than five minutes, call 911 and apply firm pressure with sterile gauze or a clean cloth to the bleeding site. Elevating the injured limb above the heart will help control bleeding. If a sharp object such as a nail is deeply embedded in the skin, don't remove it. Wrap it in bandages (to keep it from moving), and seek medical care.

If your baby is choking...

Choking
A baby's airway can be blocked by a small object or risky foods such as nuts, whole grapes, hot dogs, and popcorn. A child who is coughing while choking is able to get some air into the lungs -- watch her carefully as her reflexes work to clear the airway. If she doesn't cough up the object and her cough weakens, she can't make a sound, or she stops breathing, have someone call 911. If you're alone, provide one minute of care (see below), and then call.

1. Give five back blows. To do this, first position the infant facedown on your forearm, resting your arm on your thigh for support. Support her chin with your hand, and make sure her head and neck are lower than her torso. Then use the heel of your free hand to give her five firm back blows between the shoulder blades.

2. If she doesn't cough up the object, turn her onto her back. Rest her on your forearm, using your thigh to support her body and your hand to steady her head. Make sure that her head and neck are lower than her torso. Give five chest compressions (as described in the CPR printable pullout).

3. Repeat back blows and chest compressions until the object is coughed up or the baby starts to breathe or cough. See the doctor afterward, even if your baby seems fine.

4. If a choking baby becomes unconscious, deliver two rescue breaths (see steps 1 and 2 of the CPR section on page 87 for technique). If the breaths don't go in, the airway is probably blocked. Tilt the baby's head farther back, lift her chin, and give two more slow rescue breaths. If the breaths still don't go in, give five chest compressions.

5. Look for a foreign object. Open the baby's mouth and look for an object that is blocking the airway. If you see it, use your little finger to remove it. (Don't fish for it if you can't see anything.)

6. Give another rescue breath. If the chest still does not rise, continue the cycle of five chest compressions, looking for a foreign object, and giving a rescue breath until help arrives. If the breath goes in, and the chest rises, give a second breath and check for breathing and circulation.

If your baby is burned or ingests a dangerous substance...

Burns
A baby's skin is far more sensitive to heat than adult skin. Burns are classified by severity as first degree (redness), second degree (blistering), and third degree (charring of the skin). Follow these steps if your child is burned.

1. Remove the baby from danger and cool the burned area by flushing it with cool water (unless it is an electrical burn, as described below). Remove the baby's clothing unless it's stuck to the skin.

2. Loosely cover the burn with a clean, dry gauze dressing to reduce pain and prevent infection. Never apply ice directly on the burn, and do not put any ointment on a significant burn, as it can seal in heat. Likewise, stay away from home remedies such as butter, grease, or powder; they don't work to heal the burn, and they can actually cause infection.

• For a serious burn (second-degree), call 911; severe burns can cause loss of fluid from the body and breathing difficulties. If the burn has affected a large portion of the baby's body, wrap him in a clean sheet and cover him with a blanket (to keep him warm) after stopping the burn and cooling it with water.

• For a chemical burn caused by contact with a household product such as paint remover, drain liquids, oven cleaners, or household bleach, call 911 and flush the area with cool running water until help arrives. If possible, remove clothes with any chemical on them.

For an electrical burn, such as when a child puts a metal object into an outlet or bites an electrical cord, call 911 but don't cool the burn with water; just cover it with a dry, sterile bandage. Electrical burns may appear deceptively minor yet can cause severe harm.

Poisoning
Keep the number of the poison control center (PCC) -- 800-222-1222 -- near the phone. If you suspect that your baby has ingested a toxic substance -- medicine, cleaning product, or pesticide -- call the center immediately (even if she has no visible symptoms). Report exactly what was ingested (read the ingredients from the label), how much is missing, and the time of the event. The PCC will tell you whether to give home care or call 911.
The American Academy of Pediatrics does not recommend syrup of ipecac or activated charcoal as routine at-home poisoning treatments. If your child vomits spontaneously, turn her on her side to prevent choking. Save some of the vomited material in case it is needed for analysis.

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