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    • 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:

    1. 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.
    2. Dante and Claire are chasing one another on the paved path through their play area. Dante trips and skins his knee.
    3. 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.
    4. Luke drops his favorite piece of artwork on the way to his dad’s car. It flutters into the street and he toddles out to catch it. A vehicle cannot stop in time and strikes him.
    5. 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.
    6. 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’ 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. Depending on the severity of the injury, you can:

    • Perform first aid or CPR. Training on first aid and CPR is offered by community agencies, such as the Red Cross. All FCC providers are required to be trained in first aid and CPR, including all back up providers or substitutes.
    • Call emergency medical services (EMS) or its equivalent in international locations. EMS refers to any emergency responders in your area. These may be firefighters, ambulance companies, or the police. EMS services are reached when you dial 911 in the United States.

    For family child care providers, as discussed in Lesson Six on Emergencies, you will also need to consider ahead of time how you will contact your backup provider or family child care coordinator/director, and how quickly he or she can get to your home, in the event you need to ride to the hospital with a severely injured child.     


    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: decrease in level of alertness, confusion, headache, vomiting, irritability, or difficulty walking.
    • 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

    Dealing with Injuries

    Be prepared and know how to differentiate between severe and minor injuries as you care for children in your family child care home.


    Prevent injuries: Follow procedures outlined in other lessons in this course. Make sure dangerous and toxic items are out of children's reach.

    Be prepared: Have a well-stocked first-aid kit. Make sure your first-aid and CPR training are always current.

    Respond quickly: Use what you learned in your first-aid courses.

    • Stay calm.
    • Survey the scene. Look around and find out what is wrong. Decide whether it is safe for you to approach. Tell the child you are there to help. Ask questions and examine the child head-to-toe for injuries.
    • Take action. Decide whether injuries are life threatening: Is the child conscious? Is the child breathing? If the child is not breathing, perform CPR as needed. Use what you learned in your first-aid and CPR training to do the procedure correctly. If the injury is not life threatening, check the child head-to-toe. Look for all injuries. Ask the child questions and continue to check breathing and heart rate. Perform any basic first aid that is needed. Do not move the child unless his or her life is at risk.
    • Make the calls. Decide whether you need to call EMS. Call the child's family.
    • Ride along. Be prepared to ride with the child in the ambulance. Know what documents and contact information you need to bring with you. As discussed in Lesson Six, have these ready to go in an easy location ready to grab.
    • Document: Report the injury using the forms required by your state and program. Make sure the family also signs the incident report.

    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.




    Which of the following is a life-threatening situation?


    Which of the following does not require a call to 911 (or local emergency services)?


    Which of these statements is true?

    References & Resources

    American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. 2011. Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Also available at

    American Red Cross.

    National Association for the Education of Young Children. (2007). NAEYC Early Childhood Program Standards and Accreditation Criteria: The mark of quality in early childhood programs. Washington, DC: National Association for the Education of Young Children.