First aid for children: acting correctly in emergencies

A brief moment of not paying attention and it can happen: the child has scalded themselves with hot water, eaten a poisonous berry or is in danger of choking on a small toy. Dr Michael Dördelmann, Chief Physician at the DIAKO Clinic for Paediatrics and Adolescent Medicine in Flensburg and operator of Pädicus, an advice portal for preventive healthcare in childhood, knows how parents should react in such situations. In an interview with MAM, he explains how dangerous situations can be avoided and what measures parents should be aware of if something does happen. He also dispels some myths circulating about first aid for children

Disclaimer: This interview often refers to German first aid recommendations, which may differ from local variations.

MAM: Dr Dördelmann, you offer first aid courses for children. Why is this topic important to you?

Michael Dördelmann: Many parents are unsure how to react if their child gets into an accident or sustains an injury. I want to show mums and dads how they can react calmly and without fear. In an emergency, it is important to remain calm. Fear is also transferred to the child. If parents know what to do, they won't panic so quickly. However, there are some myths surrounding first aid for children. I would like to help clear this up.

What are these first aid myths?

In almost every hazardous situation, there is also misinformation about what to do. Let's start, for example, with the behaviour for croup . These are virus-induced coughing fits with shortness of breath that occur mainly at night. The affected children seem to struggle to breathe, which can naturally cause great anxiety. It is often said that the child needs cold, moist air in this situation. However, this has proven to be ineffective, at least for moist air or water vapour. And even for cold air, there is only a little data from a completely new study.¹

According to this, cold air can at least bring some improvement for lightweight to moderate coughing fits.

What should parents do if their baby has croup?

In the event of a croup attack, parents should first and foremost distract and reassure the child. The sentence "Everything will be fine!" can make such a big difference. The respiratory distress appears greater than it really is - the main problem is the anxiety and the associated tension or constriction of the upper airways. Parents can also give medication containing cortisone to reduce the swelling of the mucous membranes. If the child continues to have difficulty breathing despite these measures, or if there are signs of a lack of oxygen, parents must call the emergency services.

 A baby can also suddenly gasp for air while eating or if it has swallowed a small toy. Should caregivers always try to actively remove the foreign object?

No, a distinction must be made here between complete and incomplete obstruction of the airway. If breathing is not completely blocked, i.e. the baby is still coughing strongly and effectively and is still vocal, parents should act as follows: sit the child upright, continue to encourage them to cough and allow the cough reflex to work. The natural cough reflex is by far the most effective way of removing a foreign object from the airways. And this highly effective protective reflex should not be disturbed by unnecessary or even counterproductive measures. Therefore, if the airway is incompletely obstructed, it is not at all helpful to pat the baby on the back or even try to remove the foreign object with the fingers. 

Why could this be counterproductive in this situation?

The object could slip from a rather harmless place and completely block the windpipe. A complete obstruction of the airway would be the result and is a disaster with a high mortality rate, to say the least. Only in this situation is it correct to give up to five back blows and apply compressions to its chest. In this case, immediate action must be taken to move the foreign object.

Poisoning is one of the most common emergencies in children. What myths are circulating about first aid in this regard?

When children swallow poisonous substances, such as cleaning products, medicines, poisonous berries or batteries, many people think it is necessary to induce vomiting. This is wrong and can cause even greater damage. In the case of corrosive substances, the oesophagus would be attacked twice; tablets or batteries could also be aspirated. Giving milk is also one of the first aid mistakes in cases of poisoning, as this can accelerate the absorption of some substances in the body.

When we adults burn or scald ourselves, we run to the tap to cool the affected area of skin. Is this also the right thing to do for children?

Yes, but not without exception. In the event of scalds or burns, parents need to react very quickly and start cooling immediately under running, albeit lukewarm, water. The positive effect of protecting the body tissue from heat damage is only felt in the first few seconds. After that, the water mainly relieves the pain. However, babies and small children in particular can quickly become hypothermic. The NHS recommends anyone under the age of ten should seek medical advice after a burn which is particularly important if the burn has happened on a baby under 1. If the person has on any clothing or jewellery near the burn this should also be removed including a baby’s nappy unless this is stuck to the skin. You can keep a baby or child warm by wrapping a blanket or additional clothing on the non-affected skin or body. After cooling the burn, a layer of cling film or a clean plastic bag can be placed over the affected area. Raising the area after cooling can also help to reduce swelling too.

Preventing accidents is the most ideal. What tips do you have for preventing dangerous situations?

One major danger, for example, is drowning. Many people don't realise this: Children can drown in water as little as 10 to 20 centimetres deep or even in puddles. The fatal thing is that this generally happens very quietly. When immersed in water, children can suffer a glottal spasm, which makes crying and breathing impossible. In deep water, children simply sink like a stone. Parents should therefore never leave their child unattended near pools, garden ponds, rain barrels or bodies of water. It is also a misconception that children are safe if they wear swimming aids when splashing around, as these can come loose or even fail.

There have been reports of children dying hours or days after being rescued from drowning. This has worried many parents. Can there be consequences later on if a child swallows water while bathing?

There is a big difference between a child choking while splashing around and almost drowning. In the latter case, inhaling a large amount of water, for example with other foreign substances, can lead to lung dysfunction. However, these do not remain asymptomatic. In the cases described, the causes of death were not related to the near-drowning. I can reassure parents here: If a child swallows a small amount of water while bathing, this usually poses no danger. The coughing stimulus protects the lungs.

Sudden infant death syndrome is a particularly threatening scenario: when an infant dies unexpectedly and without recognisable cause in its sleep. What can parents do to reduce this risk?

A safe sleeping environment is crucial here. Anything that could cause the baby to overheat or hinder their breathing should be avoided. If possible, the baby should sleep in their own bed in the parents' bedroom, on a firm mattress, without pillows, blankets or cuddly toys. Up to the age of one year, it is recommended that children sleep on their backs. However, some babies manage to turn from their back to their tummy even before this - from around four to six months months . Many parents are then unsettled. However, if the child can turn onto its stomach independently, they can stay in this sleeping position. Even if the child is not yet able to do this, it is still possible for them to lie on their stomach or side - but always on the condition that the parents keep an eye on their child while they sleep.

What is recommended regarding breastfeeding and sudden infant death syndrome?

Infants should be breastfed for a year or longer, but at least for the first four to six months. This has proven to be protective. Once breastfeeding has become established, parents can offer their child a pacifier to sleep with. Studies have shown that soother use is associated with a lower risk of sudden infant death syndrome. ^2,3 Interestingly, the protective effect remains even if the baby loses the pacifier while sleeping. It is therefore not necessary to keep putting it in the mouth at night.

Many parents want the greatest possible safety. Are home monitors useful for monitoring vital functions?

The use of home monitors or mats that monitor the baby's breathing movements or pulse is not recommended. Neither pauses in breathing nor a low pulse rate can reliably predict the risk of sudden infant death syndrome. Instead, the oxygen saturation in the blood should be measured. However, this requires a medical monitor. If there is a particularly high risk, parents can use such a device at home. However, the additional safety also comes with disadvantages: false alarms disturb sleep and anxiety can put a strain on the parent-child relationship. It is therefore important to weigh things up carefully and keep the monitoring phase as short as possible.

What general advice can you give to worried parents?

There can never be absolute safety with children. This makes it all the more important that parents recognise potential dangers in their children's lives and know how to react correctly in an emergency. The best way to acquire this knowledge is to attend a practical first aid course. Most parents will then realise that first aid for children is usually not as complicated as they think.

¹ Siebert, J. N., Salomon, C., Taddeo, I., Gervaix, A., Combescure, C., Lacroix, L. (2023). Outdoor cold air versus room temperature exposure for croup symptoms: a randomised controlled trial. Pediatrics, 152(3), e2023061365.