Emergency procedures have changed over the years. Use this guide to check that your skills are up-to-date.
old think: Apply ice on a bruise until it heals.
new think: Ice or a cold compress is useful in the first 24 hours, then switch to warm compresses
why: A bruise is a broken blood vessel under the skin, and applying ice to the area early on will help stop the internal bleeding and inflammation. A day after the injury, put warm compresses or a hot water bottle on the bruise to increase blood flow to the area, which will help break up the blood clot. A heating pad on a low setting will also work -- just be sure to place a cloth or towel between it and your child´s skin. (None of this will produce magical healing, though: You´ll probably see a kaleidoscope of colors for about 10 days.)
Bumps On The Head
old think: Don't let a child go to sleep after a head injury.
new think: As long as she's acting normally, let her go to sleep at her usual bedtime. Wake her after an hour to be sure she recognizes you and responds appropriately. Do it again at the four–hour mark; if she's fine, you can let her sleep through the rest of the night.
why: If a child has hit her head hard enough to cause internal bleeding, your keeping her awake won't change anything. If she's acting normally but you're concerned about the force with which she banged her head, call your doctor. If she seems disoriented or off balance, loses consciousness, vomits repeatedly, or cries inconsolably after a head injury, bring her straight to the emergency room.
For an infant under age 1:
old think: If a baby appears to be choking on a piece of food or other item, you should pat him strongly on the back.
new think: If he can cough it up, first let him try to dislodge the item himself.
why: If you start by hitting him on the back, you may cause the item to lodge more firmly where it's stuck. However, if your child is having trouble breathing, call an ambulance. Then, flip him upside down against your forearm, his head toward your hand, and deliver five firm-but-gentle back blows between his shoulder blades, using the heel of your hand. Turn him over and deliver five thrusts to the center of his breastbone, using your middle and index fingers. Repeat this action until he coughs up the item and resumes breathing normally (or until help arrives).
For a child over age 1:
old think: If a child appears to be choking on a piece of food or other item, pat him strongly on the back.
new think: If he can speak or cough, let him try to dislodge the item himself.
why: He'll probably cough it up on his own, but if you hit him on the back, you may cause the item to lodge more firmly where it's stuck. If your child is having trouble breathing, however, call an ambulance. If your child's airway seems to be completely blocked, your best bet is to administer the Heimlich maneuver: Wrap one hand over your other fist and place both hands with the thumb side of the inside fist just above the belly button under the child´s diaphragm and give quick, upward thrusts. If the item is sealing the airway, it should pop out like a cork.
old think: Clean the wound thoroughly using hydrogen peroxide, then leave the cut uncovered and just let it heal in the open air.
new think: Wash the wound with soap and water.
why: Foaming peroxide won't wash the dirt out; in fact, it kills white blood cells along with bacteria, which may increase the risk of infection. Once they´re clean, superficial abrasions like skinned knees can be left open, but cover anything deeper with an antibiotic ointment (such as Neosporin or Bacitracin) and a bandage. Remove the bandage at night (because kids will be less likely to pick at the cut in their sleep) to allow the wound to dry.
old think: If your child suffers from vomiting, lethargy, muscle cramps, or other early signs of a heat illness, give him lots of cool water to drink.
new think: He should drink an electrolyte solution instead.
why: Giving your child only water can lower the body's sodium level even more, which can lead to seizures. Instead, if he´s between 6 months and 2 years old, give plenty of an electrolyte solution such as Pedialyte. For kids older than 2, offer a drink like Gatorade. It's not possible for him to drink too much; the more he urinates, the better off he´ll be. In the meantime, loosen any tight clothing and have him rest in a cool environment. If he does not bounce back within an hour, if his temperature seems elevated and he's not sweating, or if he exhibits changes in his mental status, seek prompt medical attention.
old think: When a young child loses a tooth, wash it off and wrap it in gauze until you can get prompt medical attention.
new think: Place the errant tooth in a container of cold milk and get to the dentist or emergency room immediately.
why: If her tooth is shattered, or if it's a baby tooth, doctors or dentists won't bother to reattach it. But if there's a big piece of a permanent tooth intact, save it. Doctors will be able to reimplant the tooth and bond around it to make it look normal. While it's fine to gently rinse any dirt off, don't wash the tooth thoroughly or you could lose the roots. Ideally, stick the tooth right back in its socket until you get medical attention; saliva is good for the tooth and keeps the roots from dying. To stop her gums from bleeding, it's best to roll up a piece of gauze and have her bite down on it.
old think: Have your child lie down and pinch the bridge of her nose with your fingers to stop the bleeding.
new think: While she's sitting, tilt her head slightly forward and pinch the sides of her nose tightly with your fingers.
why: If a child lies down, blood goes down the back of the throat into the stomach, and her natural reaction is to vomit. But vomiting increases the pressure in the head, which causes the nose to bleed again. On the other hand, if she sits up and you squeeze her nostrils against the nose's septum, you'll put pressure on the bleeding vessels, which will prevent the blood from dripping. Placing a cold washcloth on her nose will also encourage the blood to clot. The key is to pinch the nose for a minimum of 10 minutes, and preferably up to a half hour.
old think: If your child ingests a toxic substance, you should administer syrup of ipecac to make him vomit.
new think: Don't do anything until you call your local Poison Control Center.
why: If you don't give ipecac within 30 minutes of ingestion, it does no good. Besides, if a child has swallowed a caustic agent like Liquid Drano or lighter fluid, vomiting will cause further harm because the liquid can burn the esophagus on the way back up. So call the Poison Control Center and report what your child has swallowed and how long ago it happened. If the substance is toxic, you'll probably be advised to bring him to the nearest ER, where he´ll be given activated charcoal to prevent absorption of the poison. In some cases ipecac may be useful -- but only if the Poison Control Center or your doctor recommends it.
old think: Force a spoon or your hand into your child?s mouth to prevent him from swallowing his tongue.
new think: Lie him down on the ground, support his head with a pillow or a folded jacket, and turn his head to the side.
why: A child is not in danger of swallowing his tongue during a seizure. In fact, forcing anything into a child's mouth could result in broken teeth or choking (if the object goes farther than you intended). You can't stop a seizure, so don't try to restrain your child; the upsetting event will have to run its course (in all likelihood within a few minutes). But do move any furniture or objects he could hit. Turn his head to the side; if you then place your fingers behind his jaw and slide it forward, you'll help keep his airway open. Follow up with your doctor afterward.
Bleeding that lasts for more than 20 minutes:
old think: Apply a tourniquet tightly above the gash to stop the bleeding.
new think: Apply firm, direct pressure and be sure to keep the wound elevated.
why: Cutting off blood flow to an appendage with a tourniquet could destroy vital tissue around the wound, which could lead to partial amputation. A safer but no less effective approach: Apply firm, direct pressure to the gash with a clean, cool, wet washcloth and elevate the affected part of the body. Then, get to the nearest emergency room for treatment. (Don't assume your child will be given stitches, though. Today, ER doctors have other, quicker options -- like special glues, tapes, and staples -- for repairing wounds, and these often require less follow–up care than stitches.)
Wendy Lucid, M.D., F.A.C.E.P., director of pediatric emergency medicine at Phoenix Children?s Hospital in Arizona
Alfred Sacchetti, M.D., F.A.C.E.P., emergency physician with the American College of Emergency Physicians and associate director of emergency medicine at Our Lady of Lourdes Medical Center in Camden, New Jersey
Pamela Ross, M.D., F.A.C.E.P., assistant professor of emergency medicine and pediatrics at the University of Virginia in Charlottesville.