Essential First Aid & Emergency Preparedness

Bleeding, burns, seizures, allergic reactions, poisoning, and fever — the everyday emergencies of infancy and early childhood — plus the preparation, safety practices, and documentation that define a professional response.

6.3.1 Safe emergency response: priorities and protection

First aid follows a fixed order of priorities. Whatever the injury, run this sequence before you treat anything:

1. Scene safety. Hot stove still on? Chemical spilled? Sibling about to touch the same outlet? Remove the hazard or move the child.
2. Life threats first. Unresponsive and not breathing → CPR (Lesson 6.1). Severe bleeding → direct pressure. Anaphylaxis → epinephrine. These come before anything else, including calming the child or calling the parents.
3. Call for help when the situation exceeds what first aid can resolve. The thresholds for calling 911 are listed throughout this lesson — learn them, because hesitation is the most common failure.
4. Protect yourself. Gloves before contact with blood or body fluids; wash hands thoroughly afterward. A barrier device for breaths. If you’re exposed to blood through broken skin or mucous membranes, wash immediately and seek medical advice the same day.
5. Treat, monitor, and communicate. Give first aid, watch for changes, and inform the parents promptly and factually.

6.3.2 Bleeding

Minor cuts and scrapes

1. Gloves on. Rinse under clean running water for several minutes to flush dirt; don’t scrub.
2. Apply gentle direct pressure with clean gauze until bleeding stops — usually 2 to 5 minutes.
3. Apply an adhesive bandage or non-stick dressing. Antibiotic ointment only with the family’s permission.
4. Over the next few days watch for infection: spreading redness, warmth, swelling, pus, red streaks, or fever.

Severe bleeding

Bleeding that spurts, flows steadily, soaks through a dressing, or won’t stop with pressure is life-threatening. A toddler has only about 1 liter of blood; a newborn about 250 mL — a volume that would be a nuisance in an adult can be an emergency in a child.

1. Call 911, or direct someone else to.
2. Apply firm, direct pressure with both hands over a thick pad of gauze or clean cloth. Press harder than feels comfortable. Keep pressing continuously — don’t lift to check.
3. If blood soaks through, add more dressing on top. Removing the first layer tears away the clot that is forming.
4. If bleeding from an arm or leg does not stop with pressure and a commercial tourniquet is available, apply it 2 to 3 inches above the wound (not over a joint), tighten until bleeding stops, and write the time on the tourniquet or the skin. Tourniquets are safe for children and should not be loosened once applied.
5. Lay the child down, keep them warm, and watch for shock: pale, cool, clammy skin, rapid breathing, drowsiness, or unusual quietness.

Special cases

• Nosebleeds: sit upright, lean forward, pinch the soft part of the nose for a full 10 minutes without releasing. Seek care if it lasts beyond 20 minutes or follows a head injury.
• Embedded objects: don’t remove glass, a nail, or a stick. Pad around it, bandage to stabilize, and get medical care.
• Amputated part (fingertip injuries are common in toddlers and doors): control bleeding, wrap the part in moist gauze, seal in a plastic bag, place the bag on ice — don’t put the part directly on ice — and bring it to the ER with the child.

6.3.3 Burns and scalds

Scalds — from hot drinks, bath water, and microwaved bottles — are the most common burn in children under 4. A child’s skin is thinner than an adult’s, so the same temperature burns deeper, faster. Water at 140°F (60°C) causes a full-thickness burn in about 3 seconds; many home water heaters are set that high.

1. Stop the burning. Move the child away from the source. For scalds, remove wet clothing and diapers right away unless stuck to the skin — fabric holds heat against the body.
2. Cool with running water for 10 to 20 minutes. Cool tap water, not ice-cold. This is the single most effective step; it reduces depth, pain, and scarring and is still beneficial if started up to 3 hours after the injury. Never use ice, butter, oil, toothpaste, or egg.
3. Remove jewelry, watches, and tight clothing near the burn before swelling begins.
4. Cover loosely with a non-stick dressing or clean plastic wrap laid (not wrapped) over the burn. Don’t break blisters; don’t apply fluffy cotton.
5. Keep the child warm. Cool the burn, not the baby. Infants lose heat fast; cover the rest of the body with a blanket while the burn is cooling.

6.3.4 Seizures

A seizure is a surge of abnormal electrical activity in the brain. In young children the most common type is the febrile seizure: a brief convulsion triggered by a rapid rise in temperature, usually between 6 months and 5 years. Febrile seizures are frightening to witness, but most last under 2 minutes and do not cause brain damage. Seizures can also result from epilepsy, head injury, poisoning, low blood sugar, or a serious infection.

What you may see

• Stiffening followed by rhythmic jerking of the arms and legs
• Eyes rolling back, drooling, lips turning dusky
• Loss of responsiveness; loss of bladder or bowel control
• In infants: subtle signs such as lip smacking, bicycling movements, staring, or brief stiffening
• Afterward: deep sleep or confusion (the post-ictal period), which can last 30 minutes or more

What to do

1. Note the time the seizure starts. Duration determines whether this is an emergency.
2. Lay the child on their side on a safe, flat surface (floor, not a bed they can fall from). Move furniture and hard objects away. Put something soft under the head.
3. Do not restrain the child and do not put anything in the mouth — a child cannot swallow their tongue, and objects break teeth and block airways.
4. Loosen tight clothing around the neck. Stay with the child and speak calmly.
5. When the seizure stops, keep the child on their side, check breathing, and let them rest. Don’t give food, drink, or medicine until fully awake.

6.3.5 Allergic reactions and anaphylaxis

Food allergy affects about 1 in 13 children in the U.S. The most common triggers in early childhood are cow’s milk, egg, peanut, tree nuts, soy, wheat, fish, shellfish, and sesame; insect stings, latex, and some medications also cause reactions. At the start of every contract, ask about allergies, read the family’s written allergy action plan, and confirm where the epinephrine is kept.

Mild reaction

Hives in one area, mild itching, a few sneezes, a runny nose, mild stomach upset. Give an oral antihistamine only if the family’s plan authorizes it, then watch closely for at least an hour — mild reactions can progress. Tell the parents the same day.

Anaphylaxis — a life-threatening emergency

Suspect anaphylaxis when there are symptoms in two or more body systems, or any breathing or circulation symptom after a known exposure:

1. Give epinephrine immediately. It is the only medication that reverses anaphylaxis; antihistamines do not. Use the child’s own auto-injector according to the family’s plan. Give it at the first signs — early epinephrine saves lives, and the risks of giving it unnecessarily are minimal.
2. Call 911 every time epinephrine is given, even if the child improves. Symptoms can return hours later (a biphasic reaction).
3. Inject into the outer mid-thigh, through clothing if needed. Hold for the time the device specifies (usually 3 seconds). Note the time.
4. Position: lying down with legs raised if faint or pale; sitting up if breathing is the main problem; an infant held upright on your lap. Don’t let the child stand or walk.
5. If there is no improvement in 5 to 15 minutes and a second device is available, give a second dose in the other thigh.
6. Be ready to begin CPR if the child becomes unresponsive and stops breathing normally.

6.3.6 Poisoning and ingestions

Children under 6 account for nearly half of all poison exposures reported in the U.S. The most common culprits are medications (including gummy vitamins and adult pills in purses), cleaning products, cosmetics, laundry and dishwasher pods, plants, and nicotine products.

1. If the child is unresponsive, having trouble breathing, seizing, or very drowsy, call 911.
2. Otherwise, call Poison Control: 1-800-222-1222 (U.S., 24 hours, free). Have the container in hand so you can read the label. Follow their instructions exactly.
3. Do not induce vomiting and do not give anything by mouth unless Poison Control tells you to. Vomiting can cause a second burn with caustic substances and can lead to aspiration.
4. For something on the skin, remove clothing and rinse for 15–20 minutes. For something in the eye, flush with lukewarm water for 15–20 minutes.
5. For inhaled fumes, get the child to fresh air immediately.

6.3.7 Fever-related emergencies

Fever itself is a symptom, not a disease, and in most children over 3 months it is a normal immune response. The emergency is in the age and the accompanying signs.

Red flags at any age — call 911 or go to the ER: difficulty breathing; a stiff neck; a purple or red rash that doesn’t fade when pressed with a glass; a bulging soft spot; inconsolable crying or a high-pitched cry; extreme drowsiness or difficulty waking; a seizure; signs of dehydration (no wet diaper in 6–8 hours, no tears, sunken eyes or soft spot); or a child who simply looks very ill to you.

Rectal temperatures are the most accurate in infants under 3 months. Forehead and ear thermometers are acceptable for screening in older children. Never use a glass mercury thermometer. Don’t sponge with cold water or alcohol — it causes shivering, which raises temperature.

6.3.8 Infant-specific safety considerations

Safe sleep

Sudden unexpected infant death remains the leading cause of death between 1 month and 1 year. Every sleep you supervise should follow the American Academy of Pediatrics’ recommendations: alone, on the back, in a crib — a firm, flat mattress with a fitted sheet and nothing else. No pillows, blankets, bumpers, positioners, or soft toys. No inclined sleepers, swings, or car seats for sleep outside the car. Room-sharing without bed-sharing for at least the first 6 months. Avoid overheating; dress the baby in one more layer than you would wear. Offer a pacifier at sleep time once breastfeeding is established. As a professional, you may be asked to accommodate family practices that conflict with these guidelines; document the conversation and your recommendation.

Falls and head injuries

Falls are the leading cause of non-fatal injury in infants — from changing tables, beds, bouncers placed on counters, and arms. Never leave an infant unattended on any raised surface, even for a second; keep one hand on the baby during diaper changes.

After any fall, observe the child closely for 24 hours and tell the parents immediately. Call 911 for: loss of consciousness, even briefly; vomiting more than once; a bulging soft spot; unequal pupils; clear or bloody fluid from the nose or ears; inability to wake or unusual drowsiness; a seizure; a visible dent or large swelling on the skull; any fall over 3 feet in an infant, or from any height onto a hard surface in a baby under 6 months. For minor bumps, apply a cold pack wrapped in cloth for 20 minutes and continue to observe.

Abusive head trauma (shaken baby syndrome)

Shaking an infant — even for a few seconds — can cause bleeding in the brain and eyes, permanent disability, or death. The trigger is almost always inconsolable crying, which peaks between 6 and 8 weeks of age. As a newborn care professional, you are both a protective presence and an educator: teach caregivers that it is always acceptable to put a safely swaddled baby down in the crib and step away for a few minutes to calm themselves. If you ever suspect a child has been shaken (extreme irritability, vomiting, poor feeding, lethargy, seizures, with or without visible injury), seek emergency care and fulfill your mandated reporting duty.

Other infant-specific hazards

• Drowning can occur in 2 inches of water. Never leave a baby alone in a bath, even to answer the door; empty buckets and tubs immediately.
• Strangulation and suffocation: keep cords, strings, necklaces, and plastic bags away. Pacifier clips must be short. No cords within reach of the crib.
• Car seats: rear-facing until at least age 2 and as long as the seat allows; chest clip at armpit level; no bulky coats under the straps. Never leave a child in a vehicle.
• Hot liquids: never hold a baby while drinking coffee or tea. Test bottle temperature on the inside of your wrist; never microwave breast milk or formula.

6.3.9 Your professional first aid kit

Check expiration dates quarterly and restock after every use. Keep the kit where you can reach it in 30 seconds — not in a car trunk.

6.3.10 Documenting and communicating an incident

After any incident — a fall you caught, a minor burn, a reaction to a new food — write it down while details are fresh:

• Date, time, and location
• What happened, in observable terms (“Fell from sitting position on carpet, hit back of head”) — not interpretations
• What you observed afterward (crying, redness, vomiting, behavior)
• What first aid you gave and when
• Who you contacted and when (parents, pediatrician, Poison Control, 911)
• How the child was at the end of your shift

Share it with the parents the same day in plain, calm, non-defensive language, and keep a copy. Documentation protects the child (clinicians get accurate information), the family, and you. For anything involving a 911 call, EMS, or a possible safeguarding concern, inform your agency or supervisor as well.