Paediatric emergency nurse Sarah Hunstead is on a mission to build caregivers’ confidence and skills at performing first aid on children, in the vital minutes before an ambulance arrives.
The Sydney-based nurse and mother of two said she had been at the deathbeds of too many children who had choked to death or drowned, and had seen distraught parents who didn't know what to do.
Hunstead is the founder of CPR Kids, a Sydney-based organisation teaching first aid skills to parents at home and through community organisations. She and a team of nurses and midwives have taught thousands of classes.
She is also the author of A Life. A Finger. A Pea Up a Nose: A guide to illness and injury in children, now in its third edition, which covers resuscitation, broken bones, choking, drowning, allergies, breathing problems, and other issues.
Hunstead urged caregivers to learn what to do in an emergency, saying that while young people often learned first aid as part of activity programmes, and adults sometimes learned it in the workplace, there was a gap in the knowledge of many adults around how to perform first aid specifically on children. The time before an ambulance arrived, she said, could have a lasting outcome for the child’s health.
She said in her practice, injuries were the most common malady for children, especially from falls: primarily bumps on the head, broken bones, and lacerations to the skin and head.
"Children don't have that off-switch; they don't understand the consequences of a lot of actions they take," she said.
"We need to let them get out there and take risks. It's how they explore the world and become resilient children. We just need to know how to patch them up afterwards."
What if something gets stuck?
Hunstead’s own toddler daughter once stashed a pea in her nostril, in case she got hungry later. She said it "defied logic" what children would insert into their bodies.
"I've seen everything from popcorn to Lego - you name it; if it's small enough to put into an orifice, they'll put it there."
She cautioned parents that removal of objects could be quite traumatic for children - especially from ears - and they might only have one chance to do it, so a doctor or emergency department should be the first stop. Otherwise, she said, a child might be reluctant to allow a doctor to make a second attempt at removal, and an operation under anaesthetic might be necessary.
Noses could be slightly easier, and if a child was old enough to blow their own nose to dislodge a foreign object, they should be instructed to do so.
Hunstead said lithium ion batteries - small, round button batteries - were corrosive and a medical emergency if ingested, as they could burn through a child's oesophagus.
"It's an ambulance to hospital immediately," she said of that situation.
What if a child is having a seizure?
If the child had a seizure disorder, Hunstead said, they would already have an action plan to follow.
If that wasn't the case, she said, a caregiver should get help, rather than trying to diagnose a seizure as harmful or non-harmful.
"Clear anything away from them that they could harm themselves on and make sure they're safe," she said.
She said a child on a hard surface could have something soft placed under their heads.
"Never, ever, ever put anything in their mouths - especially your fingers," she said. "Not only will you end up with an injury, but their mouth can be damaged as well."
She said you should roll a seizing child on their side, and call for help.
What should I do for a choking child?
First of all, said Hunstead, stay calm, because children take their cues from adults.
"When something happens to the person that you love most in the world, what you want to do is to panic," she said. "But you've got to push that away. You can fall apart later."
If a child has a strong, effective cough while choking, encourage it.
If their cough is silent - "the really scary one," said Hunstead - use back blows and chest thrusts. Up to five back blows could be used - unless the article was dislodged before that - and moving on to chest thrusts.
You should also get help "really, really quickly," she said.
She also recommended you prevent a child from running with an item in their mouth. Putting things in their mouths was fine and an important part of development, she said; just don't let your child run while eating, and ensure food was properly chopped. That included chopping grapes, cherry tomatoes, and other spherical objects for small children.
What does age-appropriate CPR mean?
For a child under the age of 12 months, Hunstead said, how you open a baby's airways is important; the head should be kept in a straight or neutral position, rather than tilted back.
She said mouth-to-mouth was essential for babies as well as chest compressions.
Hunstead said that any CPR was better than none, and assured caregivers not to worry about getting it wrong.
What should I do if a child is burned?
Hunstead said the burn should be cooled for a minimum of 20 minutes with cold, running water - and steer clear of the Vaseline or butter that might have traditionally been used. She said human skin was the same as any meat, and would keep "cooking" after removed from heat if it wasn't cooled.
"Otherwise it will continue to get deeper and bigger," she said, "So you have to stop that process. Even up to three hours after a burn, this will still be effective."
She said the 20-minute time was important, and simply "waving" the burn under the cold tap wasn't enough.
What if a child is bleeding?
Apply firm, direct pressure to whatever's bleeding, Hunstead said. While the advice used to be to elevate the bleeding area, she said, evidence now suggested that this didn't make much difference.
A tea towel or item of a child's clothing could be used to apply firm, direct pressure for up to five minutes.
After that, if the edges are gaping, "or you think, 'Oh my goodness,'" she said, "You need to get medical help."
What should you do if a child has ingested a poison?
First, Hunstead said, take away whatever they have ingested. She said she knew of a parent who had run to the phone to call for help after she found her child drinking medicine - only for the child to drink more while her mother was gone.
Caregivers should call the poisons hotline in the first instance; an ambulance or emergency services should only be called if a child was having trouble breathing or was unconscious.
Hunstead said St. John in Australia and New Zealand ran classes with specific first aid advice for children, but she believed such classes should be established at every maternity hospital.