- Recognize minor injuries, serious injuries, and life-threatening injuries.
- Identify signs and symptoms that indicate that EMS (emergency medical services) should be contacted.
- Assess how to respond to an injury.
It is very important that you take courses in first aid and cardiopulmonary resuscitation (CPR). Such courses are required to open and maintain your family child care program. This lesson does not replace these courses. This lesson only provides a brief introduction to keeping children safe when they are injured
Children are natural explorers. Have you ever thought, “That child has no fear!”? You were probably right: young children do not always recognize the danger in situations. They challenge their developing bodies and minds. In family child care programs, we have to be prepared to respond to a range of injuries. Some injuries will only require cleaning and bandaging. Other injuries require immediate medical attention. You must be able to tell the difference between the two and be prepared to respond to any situation. Consider these examples:
- As Simone climbs the ladder on the slide, she twists her ankle and falls backward onto the ground. Her left foot is turned at an awkward angle.
- Dante and Claire are chasing one another on the paved path through their play area. Dante trips and skins his knee.
- Madison and Tristan are riding trikes down a path that goes down a slight hill. Madison stops his trike at the bottom of the hill. Tristan can’t stop in time and runs into Madison. Both trikes fall over on top of the children. Madison hits his mouth on the bar of his trike and loses a tooth.
- Luke drops his favorite ball on the way to his dad’s car. It rolls into the street and he toddles out to catch it. A vehicle cannot stop in time and strikes him.
- Luis brings you a handful of “candy” that he found on the floor. You see they are actually pills that must have fallen out of an adult’s purse. Luis has swallowed some of the pills, but you cannot determine how many.
- Millie is giggling with her friends during lunch. Suddenly her face turns red, her eyes get wide, and she stops making any sounds. It appears she is choking.
Your program should be designed to minimize risks when accidents occur. For example, properly inspected playground equipment and cushioned fall zones make it unlikely Simone would be seriously injured in a fall from the slide. The safety rules you teach make it less likely children will collide with one another at high speeds. Even in the best situations, though, accidents happen. You must be prepared to act on injuries big and small.
Some injuries only require minor first aid. For example, when Dante skins his knee, his caregiver will likely respond by cleaning the wound, applying a bandage, and completing an incident report. Dante is able to continue playing.
Other injuries are serious, but not life threatening. For example, Madison and Simone may need medical treatment for their injuries, but they are not likely to face permanent disability or death.
Some injuries are life threatening and require immediate medical attention. For example, Luke’s accident with a moving vehicle, Luis’s ingestion of unidentified pills, and Millie’s choking could all result in serious injury or death. As a family child care provider, you must be able to recognize these situations and respond appropriately.
You must know what resources are available to help an injured child. Your options will depend on the severity of the injury and the urgency of the situation. If the injury is minor, like a cracked lip, a caregiver trained in first aid can offer immediate care. If a child is choking or not breathing, a caregiver trained in first aid or CPR should also respond immediately. Training on first aid and CPR is offered by your employer and community agencies, such as the Red Cross.
For family child care providers, as discussed in Lesson Six on Preparing for Emergencies, you will also need to consider ahead of time how you will contact your backup provider or family child care coordinator/director. You will also have to consider how quickly they can get to your home in the event you need to ride to the hospital with a severely injured child.
Identifying and Responding to Concussions in Child and Youth Settings
As children are growing and learning, accidents are bound to occur. But what happens when a child suffers a significant head injury? What if they are too young to communicate how they feel as a result? With increasing research about the long-term effects of traumatic brain injuries, it is important for caregivers to understand how to properly identify and respond to head injuries in young children.
Childhood concussions are common. They can affect a child’s ability to think, learn, and interact with the world around them. According to Dr. Sam Torbati of Cedars-Sinai Hospital (2021), a concussion is “a mild, temporary form of brain injury that can result after a forceful blow to the head or jolt to the body which causes the brain to bounce against the skull.” Concussions are often thought to be the result of sports injuries, however, the most common reasons for a concussion in younger children are falls or collisions with objects such a ball, peer, table, or wall. The following are a few scenarios in which a concussion could occur:
Symptoms of a concussion can appear immediately following the injury or up to a few days afterwards. For this reason, it is important for caregivers to carefully observe the child and track their symptoms over the course of several days. Below are common symptoms you may notice in different ages.
Common Symptoms of Concussion by Age
Infants & Toddlers
- Frequent vomiting
- Excessive crying (especially when moving head)
- Significant changes in sleep patterns
- Changes in appetite
- Decreased interaction
Preschoolers & School Age
- Dizziness/ balance problems
- Changes in vision
- Sensitivity to light or sound
- Difficulty concentrating
- Memory loss/ slowed response time
- Changes in mood
- Significant changes in sleep patterns
- Changes in appetite
Regardless of the perceived severity of the head injury, caregivers should take the following actions after a blow to the head occurs:
- Stay calm: We know that young children’s actions and feelings are affected by their caregivers’ responses. When you remain calm, the child can focus on calming themselves if they are upset.
- Take action: Use your knowledge of the typical appearance and behavior of the child. If anything seems out of the ordinary, or you observe any of the symptoms listed in the table above, seek appropriate medical care. Once the situation has been evaluated, provide appropriate first aid (stop any bleeding, clean any cuts or scrapes, apply bandages or cold compress).
- Notify: Whenever a child suffers a head injury, providers should contact the child’s family to notify them of what occurred and the status of the child. If immediate medical attention is needed, contact the family after Emergency Medical Services (911) has been called.
- Document: Be sure to complete the incident reporting form used by your program or Service. One copy will be provided to the child’s family, and one will go in the child’s program records. This is an important step as symptoms of a concussion may not appear for a few days. Refer to your program or Service specific guidelines for additional required documentation.
Concussion symptoms in infants and younger toddlers are especially important to note as children under 2 years of age are at a higher risk for more serious brain injuries. If you notice excessive vomiting in younger children, you should seek medical attention right away. Additional symptoms that warrant an emergency visit to a doctor or hospital (in all ages) include worsened headache, increased confusion, inability to stay awake, slurred speech, weakness, seizures, and loss of consciousness.
As evident in the information above, symptoms of a concussion will look different for every child. The recovery time will look different as well. Regardless of how the injury occurred or presented in a child, monitoring and rest is important for all ages to properly recover from a concussion. For older children, modifications to their learning environment and school workload may be necessary. If mild symptoms persist for longer than a week or you observe signs of a regression in the child’s development, talk with their family about contacting their pediatrician for follow-up care.
You must know what to look for when you are deciding how to respond to an injury.
If a child has any of the following symptoms, call emergency medical services (EMS) right away:
- You believe the child’s life is at risk or there is a risk of permanent injury.
- The child has difficulty breathing, is having an asthma exacerbation, or is unable to speak.
- The child’s skin or lips look blue, purple, or gray.
- The child has rhythmic jerking of arms and legs and a loss of consciousness (seizure).
- The child is unconscious.
- The child is less and less responsive.
- The child has any of the following after a head injury: vomiting, headache, balance problems, difficulty concentrating, slowed response time, or changes in vision, mood, sleep patterns, or appetite.
- The child has increasing or severe pain anywhere.
- The child has a cut or burn that is large, deep, or won’t stop bleeding.
- The child is vomiting blood.
- The child has a severely stiff neck, headache, and fever.
- The child is significantly dehydrated: sunken eyes, lethargic, not making tears, not urinating.
- Multiple children are affected by injury or serious illness at the same time.
When in doubt, call EMS. After you have called EMS, remember to contact the child’s legal guardian.
If a child has any of the following symptoms, get medical attention within one hour:
- Fever in any age child who looks more than mildly ill
- Fever in a child less than 2 months (8 weeks) of age
- A quickly spreading purple or red rash
- A large volume of blood in the stools
- A cut that may require stitches
- Any medical condition specifically outlined in a child’s care plan requiring parental notification
When it comes to responding to injuries, make sure you always do the following:
- Have a fully stocked first aid kit in your child care program.
- Have a fully stocked first aid kit that can be taken along to outdoor play spaces or field trips.
- Know how to stop bleeding.
- Know what to do if a child is not breathing.
- Know how and when to call 911.
- Know where your accident or injury report forms are located and the procedure for completing one.
It is important to think about what you would do during stressful situations. Review the Responding to Injuries Activity. Complete the answers and share with your coach, trainer, or family child care administrator. Then compare your answers to the suggested responses.
Make sure you are prepared for injuries and other emergencies. Use the First Aid Kit Checklist and use it to make sure your first aid kit is well-stocked.
American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2019). Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. (4th ed.). American Academy of Pediatrics. https://nrckids.org/CFOC
American Red Cross. (2012). American Red Cross homepage. https://www.redcross.org/
Cedars-Sinai Staff. (2021, July 29). Concussion symptoms in children: What to know. Cedars-Sinai Hospital.https://www.cedars-sinai.org/blog/concussions-children.html
Centers for Disease Control and Prevention. Caring for your child’s concussion. (2018). https://www.cdc.gov/traumaticbraininjury/pdf/pediatricmtbiguidelineeducationaltools/2018-CDC_mTBI_Discharge-Instructions-508.pdf
Cleveland Clinic. (2020, May 5). 10 things parents should know about children and concussions.https://health.clevelandclinic.org/10-things-parents-should-know-children-and-concussions/
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Kids Health. Concussions. (2019, February). https://kidshealth.org/en/parents/concussions.html
National Association for the Education of Young Children. (2018). NAEYC early learning program accreditation standard and assessment items. National Association for the Education of Young Children. https://www.naeyc.org/accreditation/early-learning/standards
Podolak, O. (2020, June 18). The natural history of concussion in infants and children under age 5. Children’s Hospital of Philadelphia.https://injury.research.chop.edu/blog/posts/natural-history-concussion-infants-and-children-under-age-5
Podolak, O.E., Chaudhary, S., Haarbauer-Krupa, J., Metzger, K.B., Curry, A.E., Kessler, R.S., Pfeiffer, M.R., Breiding, M.J., Master, C.L., & Arbogast, K.B. (2021). Characteristics of diagnosed concussions in children aged 0 to 4 years presenting to a large pediatric healthcare network. Retrieved March 10, 2022, from https://journals.lww.com/pec-online/Fulltext/2021/12000/Characteristics_of_Diagnosed_Concussions_in.174.aspx
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