First Aid

For Cuts and Scrapes

If an injury has excessive bleeding or pain, see a physician immediately. For minor cuts and scrapes, follow these four steps:

• Wash up!
  If you're the one who will be administering the treatment, always wash your hands with soap and water first, says Christy Zacchero, a registered nurse in Pittsburgh. The National Safety Council's First Aid Institute recommends wearing disposable medical exam gloves, if available, to avoid spreading germs when cleaning or treating a wound.
• Keep it clean.
  For a skinned knee or other cuts and scrapes, wash the injury with a mild soap and lukewarm water. Next, irrigate the wound by letting water from a faucet run over it. Any small objects that weren't dislodged by irrigation can be removed with sterile tweezers. A dirty abrasion or other wound that isn't properly cleaned will leave a scar or "tattoo" on the skin.
• Keep it covered.
  Moms love to blow on a scrape once it's been cleaned, unfortunately, this can put germs onto a clean wound. To keep germs out, use an antibiotic ointment on the wound, then cover with a sterile adhesive strip. "Kids like the idea of wearing a bandage, and it will keep them from picking at it," she says.

Cuts and scrapes on areas like the hands and feet should also be kept covered. Your hands can come into contact with germs while you're eating, cleaning or doing the dishes. A scrape on your leg may rub on your pants, so cover that, too. However, let cuts dry at night by taking the bandage off.

As a rule of thumb, if the injury is larger than a 1 or 2 centimeters (about a half inch), see a physician.

Get professional help. Any wound, large or small, can become infected. Once an infection begins, damage can be extensive. Most infected wounds swell and become red. They may give a sensation of warmth and develop a throbbing pain and pus discharge. To avoid an infection, learn how to properly clean a wound and visit a physician immediately after an injury.

High-risk wounds, such as those with embedded foreign material (like gravel), animal and human bites, puncture wounds, and ragged wounds, should always receive medical attention. The National Safety Council's First Aid Institute recommends that anyone who has not had a tetanus vaccination within 10 years (5 years in the case of a very dirty wound), should obtain a tetanus immunization shot within 72 hours.

For First-Degree Burns:

• Remove clothing from burned area immediately.
• Run cool water over the burned area or hold a clean, cold compress on the burn until pain subsides. (If water is not available, any cold, drinkable fluid can be used.) Do not use ice. Call your child's doctor for burns to the eyes, mouth, hands, and genital areas, even if they seem mild.
• Do not apply butter, grease, powder, or any other remedies to the burn.
• If the burned area is small, loosely cover it with a sterile gauze pad or bandage.

For Second- and Third-Degree Burns:


Follow the instructions for first-degree burns. Remove all clothing from the burn, except for clothing that is stuck to the skin. Do not break blisters.
Call your child's doctor. Keep your child lying down with the burned area elevated.

For Chemical Burns:

• Flush the burned area with lots of running water for 5 minutes or more. If the burned area is large, use a tub, shower, buckets of water, or a garden hose.
• Do not remove any of your child's clothing before you've begun flushing the burn with water. As you continue flushing the burn, you can then remove clothing from the burned area.
• If the burned area is large, call for emergency medical help. Continue to flush the burned area.
• If the burned area is small, flush for another 10 to 20 minutes, apply a sterile gauze pad or bandage, and call your child's doctor.
• Chemical burns to the mouth or eyes require immediate medical evaluation after thorough flushing with water.

For a Suspected Broken Bone:

• If the injury involves your child's neck or back, do not move him unless the child is in imminent danger. Movement can cause serious nerve damage. Phone for emergency medical help. If your child must be moved, the neck and back must be completely immobilized first. Keeping your child's head, neck, and back in alignment, move the child as a unit.
• If your child has an open break (bone protrudes through the skin) and there is severe bleeding, apply pressure on the bleeding area with a gauze pad or a clean piece of clothing or other material. Do not wash the wound or try to push back any part of the bone that may be sticking out.
• If your child must be moved, apply splints around the injured limb to prevent further injury. Leave the limb in the position you find it. The splints should be applied in that position. Splints can be made by using boards, brooms, a stack of newspapers, cardboard, or anything firm, and can be padded with pillows, shirts, towels, or anything soft. Splints must be long enough to extend beyond the joints above and below the fracture.
• Place cold packs or a bag of ice wrapped in cloth on the injured area.
• Keep your child lying down until medical help arrives.
   

Head Injuries:

Head injuries fall into two categories:

Suspected External Head Injury

Fortunately, most childhood falls or blows to the head result in injury to the scalp only, which is usually more frightening than threatening. An internal head injury has more serious possible implications, since the skull serves as the protective helmet for the delicate brain.

The scalp is rich with blood vessels, so even a minor cut to the scalp can bleed profusely. The "goose egg" or swelling that may appear on the scalp after a head blow results from the scalp's veins leaking fluid or blood into (and under) the scalp. It may take days or even weeks to disappear.

What to Do:

• Call your child's doctor if your child is an infant or has lost consciousness, even momentarily.
• If your child is not an infant, has not lost consciousness, and is alert and behaving normally after the fall or blow, apply an ice pack or instant cold pack to the injured area for 20 minutes. If you use ice, always wrap it in a washcloth or sock; ice applied directly to bare skin can cause frostbite damage.
• Observe your child carefully for the next 24 hours. If he shows any of the signs of internal injury (see below), call your child's doctor immediately.
• If the incident has occurred close to bedtime or naptime and your child falls asleep soon afterward, check him every few hours for disturbances in color or breathing, or twitching limbs.
• If color and breathing are normal, and you observe or sense no other abnormalities, let your child sleep (unless your child's doctor has advised otherwise). There is no need to keep a child awake after a head injury.
  If color and/or breathing are abnormal, or if you are not comfortable with your child's appearance (trust your instincts), arouse him partially by sitting him up. Your child should fuss a bit and attempt to resettle. If he does not protest, try to awaken him fully. If he cannot be awakened, or shows any signs of internal injury (see below), call your child's doctor or an ambulance.

Suspected Internal Head Injury

The brain is cushioned by cerebrospinal fluid, but a severe blow to the head may knock the brain into the side of the skull or tear blood vessels. Any internal head injury - fractured skull, torn blood vessels, or damage to the brain itself - can be serious and possibly life-threatening.

What to Do:

Call an ambulance if your child shows any of the following symptoms:

• unconsciousness
• abnormal breathing
• obvious serious wound or fracture
• bleeding from the nose, ear, or mouth
• disturbance of speech or vision
• pupils of unequal size
• weakness or paralysis
• dizziness
• neck pain or stiffness
• seizure
• vomiting
• loss of bladder or bowel control
   

Until help arrives, do not move your child unless absolutely necessary.

• If your child is unconscious or dazed, or there is any paralysis, do not move him at all - there may be injury to the spine. Place your hands on either side of his head, and keep him in the position in which you found him.
• If he vomits, roll him to the side keeping his head and neck immobile. If he is not breathing, administer mouth-to-mouth resuscitation.
• If your child is conscious, do your best to keep him calm and still. If he vomits, sit him up slightly and help him lean forward, unless you suspect a neck injury; in that case, keep head and neck immobile and roll him to the side.
• If he has a seizure, keep his airway clear.
• If there is swelling, apply an ice pack or cold pack.
• If there is bleeding, apply a sterile dressing (bandage).

Do not attempt to cleanse the wound, which may aggravate bleeding and/or cause serious complications if the skull is fractured.
Do not apply direct pressure to the wound if you suspect the skull is fractured.
Do not remove any object that is stuck in the wound.

Heat Cramps

Heat cramps are brief, severe cramps in the muscles of the leg, arm, or abdomen that may occur during or after vigorous exercise in extreme heat. They are painful but not serious. Children are particularly susceptible to heat cramps when they have not been drinking enough fluids.

Most heat cramps do not require special treatment. A cool place, rest, and fluids should ease the child's discomfort. Massaging cramped muscles may also help.

Heat Exhaustion

Heat exhaustion is a more severe heat illness that can occur when a person in a hot climate or environment has not been drinking enough fluids. Symptoms can include dehydration (intense thirst), fatigue, weakness, and clammy skin. There also may be headache, nausea and/or vomiting, hyperventilation (rapid breathing), or irritability.

If a child shows signs of heat exhaustion, resting in a cool area and drinking fluids are the keys to recovery.

What to Do:

• Bring the child indoors or into the shade.
• Loosen or remove clothing.
• Encourage food and drink.
• Give a bath in cool (not cold) water.
• Call the doctor for further advice. If the child is too exhausted or ill to eat or drink, intravenous fluids may be necessary.

If left untreated, heat exhaustion may escalate into heat stroke, which can be fatal.

Nosebleeds

• Stay calm and reassure your child.
• Sit the child upright in a chair or in your lap and have him tilt his head slightly forward. Gently pinch his nose (just below the bony ridge) shut with a tissue or a clean washcloth. Keep pressure on the nose for about 10 minutes; if you stop too soon, bleeding may start again. Ice wrapped in a paper towel applied to the nose may also help.
• Do not have your child lean back. This may cause blood to flow down the back of the throat, which tastes bad and may initiate gagging, coughing, or vomiting.
• Keep your child quiet for several hours following the nosebleed. Discourage blowing, picking, rubbing, and any rough play.
   

Here are some tips for preventing future nosebleeds:

• To prevent picking, keep your child's nails short.
• Following a nosebleed, discourage strenuous activity, which may increase pressure on blood vessels and start the bleeding again.
• Keep the inside of your child's nose moist with saline nasal spray or dab Vaseline gently around the opening of the nostrils.
• If the air in your home is dry, humidify your child's room with a vaporizer (be sure to keep the vaporizer clean to prevent mildew).
   

Call your doctor, or head for the emergency room, if:

• your child gets a nosebleed as the result of a blow to the head or a fall
• you are unable to stop the nosebleed
• nosebleeds are frequent, or they last longer than 15 minutes
• your child has difficulty breathing
• there is bleeding from another place, such as the gums
• your child has just started taking new medicine
• there is a foreign body stuck in your child's nose

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