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Dr. Mom's Guide to First Aid

While it goes without saying that creating a safe environment for your baby is the best way to prevent an accident, even the most vigilant parents can expect to face a trip to the doctor (or possibly the emergency room) after their child's injury. In fact, each year one in four children is hurt severely enough to need medical attention. 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 CPR. Knowing what to do in the event of an emergency will help you remain calm, think quickly, and take action with confidence. Here's how to handle the most common injuries and emergencies that affect children under a year of age.

Bites

Bug bites are uncomfortable, but are rarely cause for alarm. Animal or human bites, on the other hand, usually require more care.

Stings and bites If the insect has a stinger, remove it by scraping it with your fingernail or a credit card or using tweezers. Wash the site with soap and water, cover it to keep it clean, and then apply a cool compress to reduce pain and swelling. Contact a doctor if the area becomes infected. If your child shows signs of an allergic reaction (hives, vomiting, wheezing), call 911, as a severe allergic reaction can be life-threatening.

Animal or human bites Dog, cat, and other animal bites can cause infection, scarring, and the remote chance of rabies. Wash minor human and animal bites with soap and water, and apply an antibiotic ointment and a bandage. For serious bites, apply pressure to control bleeding, and seek medical attention. Stitches, antibiotics, a dose of DTaP vaccine (which protects against tetanus), and rabies prevention shots may be required. If you think the animal might have rabies (if it acts strangely), call 911 and ask that animal control be dispatched.

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 with cool water. Remove 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. Do not put any ointment on a significant burn, as it can seal in heat. Home remedies like butter or grease are worse and can cause infection.

3. For a serious burn, have someone call 911, as severe burns can cause loss of fluid from the body, impair temperature control, and cause breathing difficulty. If no one else is available, make the call yourself after providing care for one minute. All second-degree (blistering) burns in infants should be seen by a physician, especially those involving the hands, feet, face, or genitals. If the burn has affected a large portion of the body, wrap your baby in a clean sheet and cover her with a blanket (to keep her warm) after stopping the burn and cooling it with water.

4. For a chemical burn caused by contact with a household product such as paint remover, drain or oven cleaners, or household bleach, flush the area with large quantities of cool running water until emergency medical personnel arrive. If possible, remove clothes with any chemical on them.

5. Most electrical injuries in young children involve household currents, such as a child putting a metal object into an outlet or biting an electrical cord. If this happens, 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.

Choking

A baby's airway can be easily blocked by a small object or risky foods such as nuts, whole grapes, hot dogs, or popcorn. A child who is coughing forcefully 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 on your forearm, with your hand supporting her head and neck and her legs straddling your arm. Lower her onto your thigh, keeping her head lower than her chest. Then use the heel of your free hand to give her five firm back blows between the shoulder blades.

2. Give five chest thrusts. To position the baby correctly, rotate her so that she is face-up on your opposite forearm, and support her head and neck with your hand. Lower her onto your thigh, keeping her head lower than her back. With your free hand, use two fingers to give five chest compressions, depressing the breastbone 1/2 to 1 inch. (The correct position for your fingers is in the center of the breastbone just below the nipple line.)

3. Repeat back blows and chest thrusts 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 "If a baby becomes unconscious," below, for technique.) If the breaths do not go in, the airway is probably blocked. Tilt the baby's head farther back, lift his chin, and give two more rescue breaths. If breaths still do not go in, give five chest thrusts.

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.

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 airway clears, give a second breath and check for breathing and circulation.

CPR

To begin CPR, feel for a baby's pulse on the inside of the upper arm (between the elbow and shoulder) and check for other signs of circulation such as breathing or movement. Ask someone to call 911, or, if you are alone, give one minute of care before calling. If possible, bring the baby with you to the phone while you continue giving CPR. The best way to learn infant CPR is to take a course, and then follow these steps as a refresher.

1. Place the baby on his back on a firm, flat surface, such as a table. Keep one hand on his forehead to open the airway.

2. Give five chest thrusts, using two fingers (placed in the center of the breastbone just below the nipple line) to depress the chest 1/2 to 1 inch, at a rate of 100 times per minute. (That's three seconds to deliver five compressions.)

3. After five compressions, give one rescue breath.

4. Continue the cycle of five chest thrusts to one rescue breath for a full minute. Then recheck for signs of circulation.

5. If there are no signs of circulation, continue the cycle of five chest compressions and one rescue breath until emergency medical help arrives. Every few minutes, recheck for signs of breathing and circulation.

Head and Eye Injuries

Head injuries are 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.

Common eye injuries in a baby include bruising around the eye, a scratch on the cornea, and a thermal burn from a cigarette. Any eye injury should be evaluated by a physician. If an irritating substance is splashed into the eye, gently flush with water for at least 15 minutes. Do not rub the eye, apply medication, or try to remove an embedded object; cover the eye with a paper cup and seek medical care.

Poisoning

Keep the number of your local poison control center (PCC) near the telephone. If you suspect that your baby has ingested a toxic substance, such as a medication, cleaning product, or pesticide, call the center immediately (even if your child has no apparent symptoms) for advice about treatment. Report exactly what was ingested (read the ingredients from the container label to the PCC personnel), how much is missing, the time of the event, and how your child acts. Personnel at the PCC will tell you what home care to give and whether to take your child to the emergency room or call 911. You may be instructed to make your child vomit by giving syrup of ipecac, or asked to administer activated charcoal to absorb a swallowed poison. (Never administer either substance without being directed by PCC personnel.) Since a young child will probably not cooperate by drinking either of these solutions, they may have to be given in the emergency room. 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.

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 Wash the affected area with soap and water, and then apply an antibiotic ointment and a nonstick bandage. Keep the wound clean, and 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, call 911 and apply firm pressure with a clean cloth to the bleeding site. 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.

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