✓ Pediatric first aid

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Pediatric first aid

Drowning, unblocking, febrile convulsions, resuscitation, head trauma and burns. How should we behave in the face of these small or large emergencies? Francesco Luzzana, surgeon at the ICCS Città Studi emergency room in our city, clarifies everything by illustrating techniques, positions and myths to dispel for each situation and prevention measures.

Who is Dr. Francesco Luzzana

Francesco Luzzana, specialist in thoracic surgery, doctor in experimental surgery and microsurgery. He works in the emergency room of the ICCS Città Studi in our city and in Sesto San Giovanni (Mi).

E' istruttore di ATLS (Advanced Trauma Life Support), certificato PBLS (Pediatric Base Life Support) e BLS-D (Basic Life Support and Defibrillation).

For some time it has been involved in health training and, in collaboration with Mamma & Lavoro, offers courses for lay staff, dedicated to the management of health emergencies in pediatric age.

Drowning

If the child has accidentally ended up in the water and is in danger of drowning or if there has been a drowning, what should be done?

What to do in case of drowning?

First, you need to evaluate whether the child is conscious or not.

When is the baby conscious? It is if we see him breathing, opening his eyes, if he coughs. In these cases we have to put him on his side, to make him breathe better, in the lateral safety position (which you see in the video above).
If the child does not seem conscious, he does not open his eyes, he does not seem to breathe, we first check: we stand sideways and put our ears close to his face and listen if we hear noises or see if the chest expands. If none of this happens, keeping the baby lying down with his head extended, close the baby's nose with two fingers and blow his mouth twice (the correct position is shown in the video).

Now let's see if anything happens. If nothing happens, we uncover the chest, locate the nipple line and start making a heart massage. The pace is: 30 compressions, two breaths.

How to prevent the risk of drowning?

Children should never be left alone in the water, especially if they are under four years old. Even just 20 centimeters of water can be very dangerous.

Febrile seizures

Seizures in children can happen. Above all, feverish affects 4% of children under the age of 4. They are not caused, as is believed, by a high body temperature, but by a rapid increase in temperature itself. But sometimes this phenomenon can occur due to a lowering very fast of body temperature.

What are the symptoms of febrile seizures?

A child in the grip of convusions becomes unconscious, has the rolled-up eyes, strong muscle contractions e losses of various kinds (saliva, urine). It's a pretty impressive scene, but don't panic.

What to do in case of febrile convulsions?

Seizures do not cause permanent damage and resolve on their own within 5-10 minutes. However, you can practice some simple maneuvers to manage the situation:

Place the child on a safe surface, on the floor or on the bed (better on the ground, so there will be no risk of falls), away from objects of any kind.
Keep your head still
Remove your clothes and, if possible, do some sponging with cold water, wetting the forehead, groin and armpits.
Ask for help

Seizures usually last a few minutes, but the first time such an episode occurs, it is always best to have the child visit the hospital.

Read also: Children: seizures during fever, what to do

Pediatric unblocking

The baby suddenly finds it hard to breathe or even can't breathe anymore. It is possible that we are facing a case of obstruction of the airways, if the child has inhaled a small object or a candy or bite of food has gone wrong. What to do, then, in these cases?

Partial (or incomplete) obstruction: what to do

The inhaled object it does not completely obstruct the airways, whereby air passes and the child can breathe (sometimes noisily), cough, cry or speak (if older).

In this case, one simply has to encourage the child to coughand, staying in the position he prefers. "This - writes Ferrando - is the best solution, and often the child manages to free himself without consequences for his health".

Warning: if the obstruction is partial, the maneuver to clear the airways MUST NOT BE DONE. If despite the coughing, the situation does not unblock, alert 112.

Total (or complete) obstruction: the clearing maneuver

No air passes through, so the baby cannot breathe, cough, cry or speak. Also, he puts his hands around his neck and changes color. In this case, if the child is still conscious, the anti-suffocation maneuver, in different ways depending on the age of the child.

- Infant under one year of age

Lay him face down on your forearm, supporting his back and head.

Practice 5 interscapular pats with open palm;
If the pats do not resolve the obstruction, turn the child onto his back and perform 5 deep compressions (but not more than 4 cm) on the sternum, with the tips of two fingers;

Continue with the maneuvers until the infant expels the foreign body and resumes breathing or until he loses consciousness. In this case, you have to start the cardiopulmonary resuscitation sequence. If you don't know it well (having taken a special course), the 112 operator will guide you through the sequence.

- Big child, over the year (or adult)

Alternate 5 interscapular pats with 5 abdominal compressions (Heimlich maneuver).

For the pats: hold the child slightly bent forward and give him 5 strokes on the back, between the shoulder blades.

for Heimlich maneuver: place a hand clenched into a fist between the breastbone and navel and grasp your fist with the other hand; carry out 5 firm compressions under the breastbone towards the top of the child's abdomen (ie towards yourself and upwards, with a so-called "spoon" movement).

Continue with the maneuvers until the child expels the foreign body and resumes breathing or until he loses consciousness. In this case, the cardiopulmonary resuscitation sequence must be initiated. Again, if you don't know it well (having taken a special course), the 112 operator will guide you through the sequence.

What not to do in case of obstruction

Do not put your fingers or other objects down your throat, to grab the foreign body or make the child vomit. You risk pushing the choking object even lower.
Do not grab the child by the feet to put it upside down.
Do not do the anti-suffocation maneuver if the obstruction is partial.

Also read: When to take your baby to the emergency room

Resuscitation

A child is sick, he is lying on the ground and does not seem conscious. First of all we have to ask ourselves two questions:

Is the child conscious?
Is the baby breathing?

How to behave

First thing to do is place the baby on his stomach and try to call him e touch it. If we have an answer, the child is conscious, so help can be expected. Conversely, in the absence of an answer, it is necessary check that you are breathing, by reclining the baby's head and moving closer to listen to the breath (passage of air or some noise) and check if the chest expands. If the baby is not breathing, you need to:

Unfold the baby's head.
Shut his nose.
Give her mouth five breaths.
If there is no response, uncover the chest, locate the nipple line, and perform a heart massage with thirty quick compressions.
At the end of the cycle, carry out two more ventilations.
Repeat until help arrives.

Head trauma

The child falls and hits his head: it is a head injury, a difficult case to manage. How should one behave?

Check from what height he fell. If the child falls from a height of more than one meter, a visit by a doctor is necessary.
Check if the baby is different from usual after the fall. If, for example, he vomits for no reason, then this is an alarming sign.
Check the pupils. If the pupils have different diameters between them, it is necessary to check. In this case the best thing to do is to call 118 and follow the directions to reach the indicated hospital.

The myth of the bump

The bump is just the sign of a trauma. If it develops it is not a negative sign (it is not "venting something"), just as there is not automatically something positive if it does not develop.

Read also: Head trauma, what to do if the baby hits his head

Burns

The baby is scalded. What needs to be done? When can he be treated at home and when would it be better to take him to the hospital?

What is a burn?

The burn it is a lesion of the skin and surrounding tissues.

It occurs when the skin comes in contact with:

something very hot (fire, hot objects);
an irritant, such as a very acidic or basic chemical;
the sun;
the electric current.

How do you tell if a burn is severe?

The degree and extent are assessed. Based on severity, there are 3 degrees of burns:

1st degree: in the mildest form the skin appears red. The pain is bearable.
2nd degree: the skin swells, is painful and red. Fluid-filled blisters appear. The pain increases.
3rd degree: in its most severe form, the burn also affects the deeper tissues (including muscles and nerve endings). The skin is blackened and charred.

Then it evaluates extension: one thing is a finger or a foot, another thing is when the burn affects several parts of the body, the abdomen or the face.

When is the baby taken to the hospital?

It depends on type of burn and its extent.

If it is a redness of the skin or some bubbles have appeared in a small part of the body, it can be easily managed at home. If it involved the face or multiple districts, it is best to go have a medical evaluation.

How do you act?

Superficial first and second degree burns in limited areas of the body can be managed wrapping the affected area. In other cases, the better go to the emergency room.

How to prevent a burn?

Attention must be paid to the daily management of the little one, considering that one of the most dangerous areas is the kitchen. If possible, then avoid keeping the baby in the kitchen while you are cooking.

Also avoid letting your child play with a lighter or matches. Also pay attention to hot water in the bathroom.

Pediatric first aid