Injuries and emergencies can happen in childcare programs. Most injuries are minor, such as cuts, scrapes, bruises, and splinters. Less commonly, children may sustain serious injuries involving head injuries, broken bones, knocked-out teeth, poisoning, burns, choking, and drowning. Children also can experience medical emergencies such as severe allergic reactions to insect bites or food, and asthma attacks. While most injuries in a childcare setting involve children, caregivers and other adults present are at risk as well.

Most injuries in childcare are caused by falls, usually from play equipment and running in the play area. Other injuries result from children colliding with furniture or moving playground equipment, fighting and biting incidents between children, insect stings and animal bites, ingestion of plants or other toxic substances, and incidents involving motor vehicles.

Most injuries can be prevented by creating and maintaining safer play areas, establishing safety rules, following individual children's health care plans, and supervising children properly. Being prepared to respond appropriately to those injuries that do occur can help caregivers and children stay calm and can aid in care of the child.

For potentially serious injuries or emergencies, one of the first steps will be calling for emergency help. In most urban childcare settings, qualified personnel can arrive in a matter of minutes. In rural areas, help may take longer. It is important that at least one caregiver have training (and be available) for life-threatening emergencies such as severe bleeding, breathing difficulties, poisoning, or head injury. Immediate, intensive first aid is required in these situations while waiting for paramedics or other trained emergency help to arrive.

Basic first aid and TLC (tender loving care) are necessary ingredients for minor injuries and those times when the injured child must wait for the parent to arrive. To provide the appropriate first aid, your childcare program should have available:

• Caregivers trained in emergency procedures and pediatric first aid, including first aid for choking and rescue breathing.
• A written emergency care plan.
• A well-stocked, accessible first aid kit.
• Emergency medications or supplies prescribed for each child with special health needs.

First Aid Kit

Here are some appropriate supplies for a basic first aid kit.

• Disposable non-porous, latex-free gloves to protect hands from contact with blood or body fluids.
• Tweezers to remove splinters.
• Adhesive bandages; colorful ones are the most fun!
• Scissors to cut tape or dressings.
• Bandage tape to hold gauze pads in place.
• Sterile gauze pads to clean the injured area and cover wounds. (Individually wrapped sanitary napkins can be used as a dressing to stop bleeding from a wound.)
• Flexible rolled gauze to hold a gauze pad or eye pad in place.
• Eye dressings to cover both eyes if a foreign body is present.
• Insect sting preparation such as a baking soda and water paste.
• Non-glass thermometer.
• Pen/pencil and notepad to write down information and instructions.
• Coins to use in a pay phone as the injury may occur on a field trip.
• Telephone numbers of poison control center, paramedics, and other emergency numbers.
• First aid guides such as those from the American Academy of Pediatrics (AAP) or American Red Cross.
• Plastic zipper bags to transport knocked-out teeth or tissue.
• Plastic trash bags to dispose of contaminated supplies.

Health care providers differ in their opinions about using antiseptics such as alcohol, hydrogen peroxide, or an iodine-containing solution to clean wounds. The most important treatment is to wash the wound thoroughly with soap and running water. This avoids the risk of allergic reaction or poisoning resulting from the antiseptic.

Childcare programs should have a first aid kit readily accessible at all times. A single kit may be sufficient for home-based or small childcare programs. Large centers with multiple nurseries and/or classrooms might need additional kits, such as one located in each area of the facility. If you transport children to/from the program or for field trips, you should have a first aid kit in every vehicle. You may want to include these additional items in the vehicle kit:

• Instant cold pack to reduce swelling of bumps and bruises when ice is not available.
• Soap and bottled water to clean wounds and wash hands. Pre-moistened towelettes and/or bottled hand sanitizer can be used, but wounds should be cleaned thoroughly with soap and running water as soon as possible.
• Triangular bandage and safety pins to support an injured arm.
• Eye dressings to cover both eyes if a foreign body is present.
• Finger splints to support an injured finger.
• Medical information about each child, including allergies and emergency contact information.
• A cellular phone may seem like a luxury but it can be used to ensure a rapid response from emergency services, if necessary.

It also is practical to have either a complete first aid kit or a "mini-kit" available when children are using outside play areas. While children with wound injuries should be taken inside to wash the wound with soap and water, this kit can help caregivers promptly tend to children's injuries, such as bleeding. Remember that the first aid kit must be kept out of children's reach. The kit can be kept in a portable, locked box, or mini-kits can be transported in a pocket or a fanny pack. Make sure the kit is easy to transport; if it is bulky, you may be tempted to put it down where a child may access it.

For Children With Special Health Needs

Increasingly, childcare programs may enroll children who have allergies, asthma, or other chronic medical conditions. Caregivers should be prepared to care for the unique routines and emergency medical needs of these children.

Every child with chronic medical conditions should have a written care plan detailing the child's diagnoses, routine measures to maintain health and prevent complications, signs of emergency, and emergency procedures including medications and who to contact when.

Keep a copy of the care plan in the emergency/first aid kit as well as in the childcare setting.

Keep a labeled supply of emergency medication in a separate first aid kit (such as injectable epinephrine for severe allergies or metered dose inhaler for asthma) and be sure that the kit is always available. Check medications regularly for expiration dates.

In childcare programs with multiple caregivers, make sure that the caregivers working with this child know how to access the first aid kit and are trained in the child's special care plan.

Karen Sokal-Gutierrez, MD, MPH

Safety Tips

• First aid kits should be accessible to caregivers but not to children. Since kits may contain potentially hazardous items, they should be stored in a locked cabinet or closet. Even if the kit is stored in a room inaccessible to children, it should be located on a high shelf.
• If you transport children, there should be a first aid kit in every vehicle. These kits should be inaccessible to children and be in a locked container. Check the kit to make sure it does not contain supplies that can be damaged by extreme heat or cold while the vehicle is parked.

Resources

American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove, IL 60007; 888-227-5409; www.aap.org

American Red Cross, 1621 N. Kent St., 11th Floor, Arlington, VA 22209; 703-248-4222; www.redcross.org

Internet Resources

Healthy Kids, www.healthykids.us/chapters/firstaid_main.htm