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Dr Cathy Stephenson: Basic life support - 31 August

What To Do When Your Child Gets Sick - Basic Life Support

Successful Basic Life Support (BLS) can save the life of a child in an emergency situation. It can be performed by anyone who has the training. Sadly the number of New Zealanders trained in BLS is low compared to other developed nations.

Your first reaction in an emergency situation involving a child will be to rush in and help. However, it is essential that your first priority should actually be your own safety. Be aware of your surroundings, and any potential hazards before rushing in - if you are injured too, you will be unable to help your child at all.

To avoid danger to yourself, use the SAFE approach:
S - shout for help (you can't deal with a seriously unwell child alone, so call/telephone/shout for help immediately)
A - approach with care (evaluate any potential hazards before approaching the child)
F - free from danger (once you have assessed the dangers, try to minimise them eg turn off the electricity at the mains if the child has been electrocuted, or turn off the car ignition if they have been involved in a motor vehicle accident - it will reduce the likelihood of the car catching fire)
E - evaluate Airways, Breathing and Circulation.

Evaulate ABC

This systematic way of checking a child ensures that nothing is missed, and that the most likely life-threatening problems are looked at first.

When approaching a seriously ill or injured child, first assess their reponsiveness - eg say "Hello, are you all right?"to a child, or pick up a baby. If the child is able to respond, they must have an open airway (allowing air to come out from the lungs), they must be breathing (as they can speak) and they must have a functioning circulation (as the brain is getting enough oxygen to allow the child to speak).

If trauma has occurred (eg the child has been knocked down by a car), it is important to keep their neck still and supported throughout the resuscitation as far as possible.

If you are alone and the child has stopped breathing, it is recommended that 2 minutes of BLS (also known as cardiopulmonary resuscitation - CPR) is administered before calling for help. If the child is small enough, you may be able to carry them with you, and continue doing BLS, whilst you go to telephone for help.

AIRWAY - if the airway is blocked (eg with the tongue over the back of the throat), fixing this problem may be all that is needed to save the child's life. A simple manoeuvre called "head-tilt/chin-lift" will lift the tongue away from the back of the throat, allowing them to breathe again. This involves gently tilting the head backwards (looking directly upwards for infants, but slightly further back in older children), and lifting the chin upwards and outwards - as on the picture below..

If there is significant trauma, and a possible neck injury, use a manoeuvre called the "jaw-thrust" instead - this involves holding the head and neck in a straight line, and opening the airway by pushing the jaw forward with the fingers.

If there is anything visible in the child's mouth (eg any vomit) you can gently scoop it out with a sideways movement of your finger, as long as you can see the end of your finger at all times.

BREATHING - once the airway is open, assess the child's breathing by watching the rise and fall of the chest, listening for breath sounds and feeling exhaled breath on your cheek. If there are no breaths after 10 seconds, you will need to start mouth-to-mouth resuscitation:

1. Ensure the child's airway is open at all times (using the manoeuvres above)
2. Breathe in and place your mouth over the child's mouth (or mouth and nose if it is an infant or small child). Make a seal.
3. Slowly exhale for 1 second until their chest rises.
Your lung capacity is bigger than a child's, so only gently breathe out until you see the chest rise Try to give 5 successful breaths initially, maximum of 5 attempts. If the chest doesn't rise, then ventilation is not effective and it is likely that the airway is blocked.

Check and open the airway again, but if this fails then treat as though the child is choking (and has a foreign body in their airway) - see below.

If the child starts breathing spontaneously during these breaths, cease doing mouth-to-mouth, place them in the recovery position and call for help.

CIRCULATION - once the airway has been opened, and 5 effective rescue breaths have been given, start chest compressions to restore circulation and pump oxygen rich blood around the body.

Call for help after 2 minutes of mouth-to-mouth if you have not already done so.

Chest compressions should be performed on a hard surface. Compress the lower � of the sternum or breastbone - and aim to compress down to about 1/3 of the depth of the child's chest. For a baby, only 2 fingers or 2 thumbs will need to be used; compared with 1 hand for an older child. Try to make the compressions smooth and rhythmical.

Give 30 compressions, followed by 2 breaths, and repeat this continuously until help arrives. Aim for about 100 compressions per minute.

The Recovery Position

If at any stage, the child is breathing effectively and there is no sign of trauma, place the child in the recovery position - lying on their side, stabilised by the leg farthest from the ground. This protects the airway and allows any fluid to drain out of the mouth. 

The Choking Child

This is a major cause of death in pre-schoolers. If a child suddenly becomes distressed, has breathing difficulties, starts coughing or gagging, you should assume they are choking.

If you think the child is choking, first ask them "Are you choking?" and encourage them to cough if they can.

If the airway is completely obstructed, and they don't respond, use a combination of back blows and either chest thrusts (baby) or Heimlich manoeuvres (child) to try and dislodge the foreign body and open the airway again.

Back blows are given with the child placed over your knee, or bending forward, head hanging down. Hit the child between the shoulder blades 5 times, quite forcefully.

If this fails, in babies turn them over and give 5 sharp chest thrusts, pressing down on the breast bone. In over 1 year olds, replace this with 5 Heimlich manoeuvres (see picture below).

Recheck the mouth, remove any obvious obstruction, and repeat this cycle - 5 back blows followed by 5 chest thrusts/Heimlichs - until the obstruction is relieved. If at any time, the child stops breathing or becomes unconscious, open the airway, give 5 breaths via mouth-to-mouth, and start BLS as above.

Do a basic life support course:

Wellington Free Ambulance Service
St John -  or 0800 347 782
Red Cross -  or 0800 733 276
Read the relevant chapters in "What to do you're your child gets sick" or visit their website for information on courses in New Zealand (available in 2011) .

In an emergency situation, dial 111.