Parenthood can be the greatest joy, and with it comes great responsibility of keeping your child safe and healthy. Even with the most careful and best-prepared parents, childhood injuries can happen. When they do, you, as the main caregiver, are by default, the first responder.
In the event of a serious injury, it is important for you to stay calm so that you can take the necessary steps to stabilise your child’s condition before seeking emergency medical care.
Dr Lee Khai Pin offers a quick rundown on common situations that can occur and immediate steps parents should take.
1. Contusions (bruises)
Bruises are usually marked by pain, swelling and discolouration of the skin, commonly seen after blunt trauma or a fall. It is important to ensure that your child is well, alert and conscious, with no other significant injuries (e.g. head injury) to other parts of their body.
What to do:
- To reduce the swelling, place an ice pack (or ice wrapped in a towel) on the affected area for up to 15 minutes. Avoid placing ice directly on the skin as it can be extremely uncomfortable or painful for your child.
- Where possible, elevate the bruised region (e.g. the lower leg) as this will help prevent blood pooling in the bruised tissue and reduce the associated swelling.
While most bruises will heal and resolve within a week, any bruise caused by extreme force, especially if accompanied by severe pain, should be medically examined early to exclude internal injuries (e.g., a fracture). Additionally, unexplained bruising, in the absence of any known trauma or fall, may be a sign of a bleeding disorder. In such circumstances, it is best to seek medical advice.
2. Eye injury
Eye injuries are generally caused by exposure to chemicals, foreign substances or objects in the eye, or a blow to the eye.
What to do:
- For chemical burns, which can be caused by household items such as hand sanitiser and cleaning agents, gently but firmly open the affected eye and irrigate the eye copiously with water for 15 – 20 minutes.
- For suspected small foreign objects caught in the eye, do try to stop your child from rubbing their eyes as this may further scratch and damage the cornea. Attempt to remove the foreign body by flushing the affected eye repeatedly with water until the “foreign body” sensation has resolved. In the event of a persistent foreign body, place a soft dressing or eye pad over the closed eye and seek emergency medical attention.
- For a blow to the eye, gently place an ice pack (or cloth-wrapped ice) over the affected eye for 10 – 15 minutes and seek medical attention. It is important to exclude external injuries (e.g. cornea) as well as internal injuries (e.g. retina). Do not place ice directly on the eye.
“They are likely to be upset and in pain, and it may be easier to flush the eye by laying them down in a bathtub or have them lean over a sink. It is important to ensure that the affected eye is positioned lower than the uninjured eye. For example, if there is a suspected foreign body in the right eye, have the child lie on the right side of their face before irrigating the right eye. This will help avoid contaminating the unaffected eye and prevent water from getting up their nose or in the mouth
“Even after taking the first aid steps above, eye injuries, especially in the very young, should be examined by a medical professional to look for serious injuries and help prevent infection and loss of vision.”
3. Head injury
Head injuries may include obvious injuries such as bleeding or bruising, or less apparent symptoms such as headache, loss of balance and drowsiness, amongst others. In infants and young children, non-specific signs may include persistent inconsolable crying, poor feeding, and repeated vomiting.
What to do:
- For severe head injuries (e.g., fall from a great height or road traffic accident), please call for an ambulance.
- While waiting, try not to move your child and keep them still. Avoid moving their head and neck, and if they are wearing a helmet, do not remove it to avoid causing further injury.
- If there is bleeding, apply firm pressure using a piece of clean cloth or gauze.
For less severe head injuries that appear stable with no apparent symptoms, you may still consider bringing your child to a doctor for a thorough evaluation, especially for infants.
4. Lacerations (cuts)
Deep cuts and punctures, animal bites, and cuts that continue to bleed even after applying pressure require medical attention. This may include a thorough inspection and exploration of the wound, suturing of the laceration, antibiotics, and anti-tetanus vaccination.
What to do:
- Rinse the wound with clean water and apply firm pressure using sterile gauze, a bandage or a clean towel. If blood soaks through the bandage, place another bandage on top of the first and continue to apply pressure.
- If possible, raise the injured body part above the level of the heart to slow the bleeding.
- Do not use a tourniquet or any other method to reduce blood flow.
- When the bleeding has stopped, a fresh bandage may be used to cover the wound.
Accidental inhalation or consumption of common household cleaners and chemicals, as well as overdose of medications, can be very dangerous for young children and requires immediate medical assessment. Signs of poisoning can be non-specific and may include difficulty breathing, vomiting, nausea, abdominal pain or cramps, and fits or convulsions.
What to do:
- Call an ambulance for emergency assistance, especially if your child is having seizures or looks ill.
- If your child has unfortunately stopped breathing, please perform cardiopulmonary resuscitation (CPR) if you have been previously trained.
- If your child is conscious, keep them calm while seeking medical attention.
- Ask them to spit out any residue of the poison in their mouth but do not force your child to vomit as this may do more harm than good.
- Try to find out the possible substance consumed so you can inform the doctor – look for nearby medicine containers or open bottles of chemicals and cleaners.
“Preventive measures are crucial. Always store household items (e.g., detergents, cleaners, etc.) and medicines out of sight and reach of children in containers with child-resistant packaging. Never store these products in food or drink containers within easy reach of unsuspecting children,” says Dr Lee.
6. Scalds & burns
Scalds, caused by steam or hot water, and burns, caused by an iron or fire, can be extremely painful and cause the skin to turn red, peel or blister. Severe burn injuries may require specialised procedures and dressing under sedation, antibiotics, and anti-tetanus vaccinations.
What to do:
- Remove your child from the source of the burn or scald.
- Remove any clothing or accessories over the burn or scald injury if they are not stuck to the skin.
- Do not break any blisters that may form.
- Hold the burn (or scald) under cool running water for 20 minutes. Do not use ice or iced water.
- Cover the burn loosely with a clean towel and seek medical attention.
- Do not apply any ointment cream or powder over the affected area prior to the medical assessment.
Even if the burn or scald does not seem to hurt much, it could still be potentially serious. Immediate medical care is required for burns involving a large body surface area, severe deep burns, electrical or chemical burns, as well as burns involving sensitive areas such as the face or genitals.
7. Sprains & fractures
Sprains involve injury to ligaments, while fractures are broken bones which may or may not break through the skin. In either case, the usual symptom is pain in the affected area that worsens with movement or when trying to bear weight on the affected limb.
What to do:
- Avoid moving or using the affected joint or limb, to prevent further injury.
- If there is an open fracture (i.e., broken bone breaking through the skin), avoid further movement to the limb and do call for an am balance.
For sprains, it will be useful to rest the injured limb, apply an ice pack (as tolerated) to the affected area, compress the swollen injured area with a bandage, and keep it elevated (this management is sometime better known as the acronym RICE – rest, ice, compression, elevation). Should the presumed sprain continue to cause persistent pain and swelling despite the above measures, it will be important to seek medical attention to exclude a possible fracture, which may require an X-ray. Note that children younger than 5 years old are more prone to fractures rather than sprains.
In summary, Dr Lee adds, “It is important for parents and caregivers to remain calm and attend to their child’s immediate needs by first removing them from danger and keeping them stable prior to medical care or arrival of emergency services. With infants and young children, especially in pre-verbal toddlers, it can be challenging trying to establish the severity of the injury. As such, when in doubt and for situations with an uncertain mechanism of injury, it may be prudent to seek medical attention and have the injury thoroughly assessed by a doctor.”