Choking

Definition
Choking is a condition caused by inhalation of a foreign object that partially or fully blocks the airway.

Description

Choking is a major cause of respiratory emergencies and cardiac arrest in infants and children. Choking occurs when a foreign object, such as food, buttons, coins, or toy parts, are inhaled and partially or completely block the airway, preventing adequate breathing. In many cases of choking, particularly in adults, the individual actively coughs and is able to expel the foreign object with no assistance or medical attention. However, children and infants are at increased risk of choking and foreign body airway obstruction due to immature airway and dental anatomy, distraction and play during eating, and a natural tendency to put objects into their mouths. A 1995 study of the characteristics of objects known to commonly cause choking deaths in children found that round objects are most dangerous. For example, a small ball or marble can completely seal a child's or infant's trachea (windpipe). Round or cylindrical foods, hard candy, chewing gum, and balloons also present choking hazards. In infants, choking usually results from inhalation of small objects (coins, small toys , deflated balloons, buttons) that they place in their mouths.

Demographics
Each year, more than 17,000 infants and children are treated in hospital emergency departments for choking-related incidents, and more than 80 percent of these occur in children aged four years and younger. Airway obstruction death and injury are especially prevalent in children under age four due to anatomy (small airway), natural curiosity and tendency to put objects in their mouths, and incomplete chewing.

According to statistics from the Centers for Disease Control and Prevention, choking rates in 2001 were highest in infants.

Causes and symptoms

Choking is a major cause of death for children under three and is a hazard for older children as well. Young children naturally explore the world with their mouths, and they will readily put in their mouths anything that fits. If a small object slips back into the throat and blocks the trachea, the child may become unable to breathe, and unless the child is helped to eject the object quickly, the child may asphyxiate and die. Food is also a choking hazard, especially for children under three who do not know how to chew food thoroughly. According to statistics from the Centers for Disease Control and Prevention, of the 17,000 or so cases of pediatric choking in 2001, 60 percent were related to food, 31 percent were related to non-food substances, and 9 percent were related to undetermined objects. Of the food-related choking incidents, 19 percent resulted from candy or gum. Of the choking incidents resulting from non-food objects, 13 percent were related to coins. Food-related choking usually occurs because infants and young children do not chew their food well, and larger pieces can become stuck in their throat. The following foods have been identified by the American Academy of Pediatrics as presenting choking hazards:

hot dogs hard candy chewing gum nuts and seeds chunks of meat or cheese whole grapes popcorn chunks of peanut butter raw vegetables

raisins

The following objects have been identified as presenting choking hazards:

coins buttons marbles small balls deflated balloons watch batteries jewelry ball point pen caps and paper clips arts and crafts supplies small toys and toys with small detachable parts

When to call the doctor

All infants, children, and adolescents who have a choking incident should see a doctor, since complications can occur even if the object causing the choking is successfully expelled. Sometimes, pieces can be aspirated into the lungs, and even though breathing returns to normal, wheezing, chest pain , persistent cough , and pneumonia can develop within a few days due to the foreign body in the lung. Foreign bodies may require removal by bronchoscopy or surgery. Vomiting may occur after being treated with the Heimlich maneuver . All infants and children who experience a choking episode severe enough to require the Heimlich maneuver should be taken to the hospital emergency room to be examined for airway injuries.

Diagnosis
Choking is diagnosed by observation of the choking victim. Children able to actively cough should be watched to make sure they expel the object on their own and that their

airways do not become blocked. Indications that a choking victim's airway is blocked include the following:

inability to cough, cry, or speak blue or purple face color from lack of oxygen grabbing at throat weak cough and labored breathing that produces a high-pitched noise all of the above, followed by loss of consciousness

When the actual choking incident is not observed, choking can be diagnosed by observing the above symptoms. For children, infants, and adolescents who are unconscious, choking and foreign body obstruction can be diagnosed by attempting to give rescue breaths. If a breath administered to the victim does not inflate the chest, rescuers should assume that the airway is blocked and take steps to clear the airway.

Treatment
An emergency choking incident is treated using the Heimlich maneuver, usually administered by parents, caregivers and teachers, or bystanders. Children who have a choking incident that requires the Heimlich maneuver should be examined by a physician for potential injuries to their airway and aftereffects of oxygen deprivation. The Heimlich maneuver is used when a child is choking on a foreign object to the extent that he/she cannot breathe. Oxygen deprivation from a foreign body airway obstruction can result in permanent brain damage or death in four minutes or less. Using the Heimlich maneuver can save a choking victim's life. The Heimlich maneuver is not performed on infants under one year of age; rather, a series of back blows and chest thrusts are used to attempt to dislodge the foreign object. If the foreign body cannot be expelled from the child's airway using the Heimlich maneuver, cardiac and/or respiratory arrest may occur, and the child may stop breathing. If this happens, cardiopulmonary resuscitation (CPR) is performed to restore and maintain breathing and circulation and to provide oxygen and blood flow to the heart, brain, and other vital organs. CPR can be performed by trained laypeople or

healthcare professionals on infants, children, adolescents, and adults. CPR should be performed if an infant, child, or adolescent is unconscious and not breathing.

Prognosis
Incorrectly applied, the Heimlich maneuver can break bones or damage internal organs. Following the Heimlich maneuver, dysphagia (swallowing difficulty) and obstructive pulmonary edema (fluid accumulation in the lungs) may occur and require medical treatment. In many cases the foreign material is dislodged from the throat, and the choking victim suffers no permanent effects of the episode. If the foreign material is not removed, the choking victim may suffer permanent brain damage from lack of oxygen or may die.

Prevention
Choking is easily preventable by taking the following steps:

KEY TERMS
Bronchoscopy A procedure in which a hollow tube (bronchoscope) is inserted into the airway to allow visual examination of the larynx, trachea, bronchi, and bronchioles. It is also used to collect specimens for biopsy or culturing, and to remove airway obstructions. Cardiopulmonary resuscitation (CPR) An emergency procedure designed to stimulate breathing and blood flow through a combination of chest compressions and rescue breathing. It is used to restore circulation and prevent brain death to a person who has collapsed, is unconscious, is not breathing, and has no pulse. Diaphragm The thin layer of muscle that separates the chest cavity containing the lungs and heart from the abdominal cavity containing the intestines and digestive organs. This term is also used for a dome-shaped device used to cover the back of a woman's vagina during intercourse in order to prevent pregnancy.

Heimlich maneuver An emergency procedure for removing a foreign object lodged in the airway that is preventing the person from breathing. To perform the Heimlich maneuver on a conscious adult, the rescuer stands behind the victim and encircles his waist. The rescuer makes a fist with one hand and places the other hand on top, positioned below the rib cage and above the waist. The rescuer then applies pressure by a series of upward and inward thrusts to force the foreign object back up the victim's trachea. Trachea The windpipe. A tube composed of cartilage and membrane that extends from below the voice box into the chest where it splits into two branches, the bronchi, that lead to each lung.

supervising infants and children while they eat and play childproofing play areas by removing small objects cutting foods into very small pieces avoiding serving foods listed above as choking hazards to children under age four monitoring older children to make sure they do not give younger children hazardous foods or objects following age and safety guidelines on toys learning CPR and the Heimlich maneuver not letting children and infants play with coins

Parental concerns
Because most choking incidents occur in the home, all parents and infant/child caregivers should be trained in the Heimlich maneuver. Training is available through the American Red Cross and American Heart Association at local schools, YMCAs, and community centers. The likelihood of choking incidents can be reduced by closely supervising infants and children while they eat and play. Most choking incidents are associated with food items, especially hot dogs, candies, grapes, nuts, popcorn, and carrots. Common non-food items that present choking hazards include deflated balloons, buttons, coins, small balls,

small toys, and toy parts. All toys should be examined to make sure they are ageappropriate and do not have loose parts.

Resources
BOOKS
Basic Life Support for Healthcare Providers. Dallas, TX: American Heart Association, 2001.

PERIODICALS
Centers for Disease Control and Prevention. "Nonfatal Choking-Related Episodes among ChildrenUnited States, 2001." Journal of the American Medical Association 288 (November 20, 2002): 240002. Vikle, Gary M., et al. "Airway Obstruction in Children Aged Less than Five Years: The Prehospital Experience." Prehospital Emergency Care 8 (2004): 19699.

ORGANIZATIONS
American Heart Association. 7320 Greenville Ave., Dallas, TX 75231. Web site: http://www.americanheart.org. The Heimlich Institute. 311 Straight St., Cincinnati, OH 452199957. Web site: http://www.heimlichinstitute.org.

WEB SITES
"Choking Episodes among Children." National Center for Injury Prevention and Control. Available online at http://www.cdc.gov/ncipc/duip/spotlite/choking.htm (accessed December 8, 2004). "Heimlich Maneuver." American Heart Association , 2004. Available online at http://www.americanheart.org/presenter.jhtml?identifier=4605 (accessed December 8, 2004).

"Infant First Aid for Choking and CPR: An Illustrated Guide." BabyCenter , 2004. Available online at http://www.babycenter.com/general/9298.html (accessed December 8, 2004). National Safe Kids Campaign . Available online at http://www.safekids.org (accessed December 8, 2004). Jennifer E. Sisk, M.A.

Read more: http://www.healthofchildren.com/C/Choking.html#b#ixzz2JXgcERKd

First Aid for a Choking Child

The best way to help a choking child is to be preparedand that means enrolling in a CPR class (or a refresher course) so you'll know what to do in case of an accident. But there are other steps you can learn so that you know what to doand how to act immediately if see your child choking.

In This Article
1. 2. 3. 4. 5. 1. Mouth Injuries in Children 2. Head Injuries in Children 3. Treating Burns in Children 4. Childhood Poisoning 5. First Aid for a Choking Child

6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.

6. Infant CPR 7. CPR for Children 8. Prevent Burns in Children 9. Treating Bee Stings in Children 10. Treating Skin Wounds in Children 11. How to Remove Splinters in Children 12. Treating Dog Bites in Children 13. Treating Mosquito Bites in Children 14. Treating Spider Bites in Children 15. Treating Tick Bites in Children 16. Sprains in Children 17. Broken Bones in Children

How choking happens: It goes without saying that its a scary thing to see a choking child. Usually, it happens when a baby or young child tries to swallow a piece of food or small object (like a coin or a little toy) and instead of going smoothly down the esophagus, the object gets lodged in the windpipe and blocks air from flowing in and out of the lungs. Children younger than four are particularly at risk for these types of injuries. Thats because they explore by putting practically everything (even objects that are off-limits) in their mouths; they arent adept at chewing (after all, it can be tough without a full set of teeth); and their airways are still quite small (which means that some foods that adults and older kids can safely swallow pose a risk to little kids). Signs of a child choking include:

Gasping, wheezing, or inability to breathe Inability to talk, cry, or make noise Bluish color to the skin Panicked look Grabbing at the throat (in toddlers) What to do when your child is choking: If you see your child choking, but he can still cough or cry, that means his trachea is probably only partially blocked. In that case, its best that you wait to see if your child can cough the object out on his own. Interfering could make matters worse, and most likely, your little one will be able to get the object out after a brief coughing spell. If you see your child choking and hes unable to cough or breathe, and you dont know how to do the Heimlich maneuver on a baby under one or on a child or have forgotten how to do it, call 911 immediately. Dont reach into your childs mouth to search for the object since this can lodge the object more deeply and cause more damage.

If you do know how to do the Heimlich maneuver, start doing it immediately and get someone to call 911. If your little one loses consciousness, carefully look in his mouth to check for the object. If you see the object and can safely take it out with a sweep of your finger, do so and start infant CPR (cardiopulmonary resuscitation) or CPR for children over one. Then wait for medical help to arrive. If you dont see the object, start CPR, and wait for help. When to call the doctor: Call 911 whenever you suspect a child is choking or having trouble breathing. Even after youve resolved a choking episode your child has coughed up the object on his own or youve done Heimlich or CPR call your doctor to help to make sure your child is really okay. How to prevent choking in children: To safeguard against your child choking, take the following precautions.

Take a first-aid course, which should include learning the Heimlich maneuver and CPR. To find one in your area, contact your local hospital or ask your pediatrician.

Babyproof your home to minimize the chances that your baby gets his hands on choking hazards. Do another round of childproofing before your baby starts walking.

Make sure your child eats at the table, or at least while sitting down, since moving around while eating can lead to choking.

Cut food into pieces no larger than a quarter inch. Stay close by whenever your child eats. Avoid toys with small or broken parts, and keep jewelry and small household items (such as coins, marbles, pen caps, and button batteries) out of the reach of infants and young children.

Use a toilet-paper tube as a guide: Make sure that teething toys and pacifier shields are too large to fit through it (if theyre smaller, they could get stuck in your childs windpipe).

Do a weekly check under furniture and between cushions for coins and other small items that children might find and put in their mouths.

Keep pieces of latex balloons away from your child since they pose a choking risk to kids as old as eight.

The following foods are choking hazards to babies and little kids: hot dogs (unless you slice them into small, quarter-sized pieces); nuts and seeds; chunks of meat or cheese (unless you slice them into quarter-sized pieces); whole grapes (halve or quarter them to reduce the

risk of choking); hard, gooey, or sticky candy; popcorn; chunks of peanut butter; raw vegetables and chunks of hard fruit (like apples serve them in thin slices to your toddler); chewing gum; and dried-out raisins.

Infant CPR: Emergency Choking Relief for Babies Under One Year Old
The best way to handle a choking baby is to use what you've learned in a CPR course. If you review and practice these steps for the Heimlich maneuver and CPR, they'll become second nature which is exactly what you want when faced with an emergency.
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In This Article
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 1. Mouth Injuries in Children 2. Head Injuries in Children 3. Treating Burns in Children 4. Childhood Poisoning 5. First Aid for a Choking Child 6. Infant CPR 7. CPR for Children 8. Prevent Burns in Children 9. Treating Bee Stings in Children 10. Treating Skin Wounds in Children 11. How to Remove Splinters in Children 12. Treating Dog Bites in Children 13. Treating Mosquito Bites in Children 14. Treating Spider Bites in Children 15. Treating Tick Bites in Children

16. 16. Sprains in Children 17. 17. Broken Bones in Children

In the best of all possible worlds, youd never need to save your babys life. But emergencies can happen, even when youre vigilant babies can choke on a piece of food or on something theyve picked up from the floor or playground or get tangled up in a curtain cord. Luckily, with a little preparation, you can handle many emergency situations yourself. The best way and the best way to safeguard your baby is to take a class that teaches lifesaving techniques: the Heimlich maneuver and infant CPR (short for cardiopulmonary resuscitation, or chest compressions a way to get the heart and lungs to work after a lifethreatening trauma or injury). In a class, youll learn the proper techniques for breathing, chest thrusts, back blows, and more. The other advantage of taking a class? Youll get experience practicing these emergency techniques and studies have shown that the more people practice, the more confident they are in a true emergency. To find an infant CPR class near you, visit the American Heart Association class locator or the American Red Cross class locator. You can also find a class through your local hospital or log on to cpranytime.org to order a home-based infant CPR course that comes with a DVD and practice mannequin and includes instructions on choking relief. (And then make time to watch it and practice the techniques.) After your babys first birthday, it would be a good idea to take a CPR class for children who are older than one. But for now, review these steps for performing the Heimlich maneuver and CPR for infants younger than a year old and reread them from time to time so youll always know what to do. Review Steps Heimlich in a Baby Under One Year Old If you see signs that your baby is choking, and shes unable to cough or breathe, start taking these steps immediately:

Hold your infant facedown on your forearm so that her head is lower than the rest of her body (sit or kneel and rest your arm on your lap or thigh for support). Support your babys head and jaw with your hand. Dont cover her mouth or twist her neck.

Give up to five quick back slaps between your babys shoulder blades with the heel of your free hand.

If the object doesnt pop out after five blows, turn your baby onto her back along your forearm (still using your lap for support). Remove or open her clothes (if you can do that

quickly), support the back of her head with your hand, and keep her head lower than the rest of her body.

Place your index and ring fingers just below an imaginary horizontal line running between your babys nipples, and give up to five quick chest thrusts with those fingers.

If the object still doesnt come out, alternate giving your baby five back blows (turning her over) and five chest thrusts. Do this until the object comes out and your baby can breathe, cough, or cry, or until help arrives.

If your baby loses consciousness, start infant CPR (below). Review Steps CPR for Infants Under One Year Old

1. Check to see if your baby is responding. Call her name or tap the soles of her feet. If your baby does respond, dont start CPR. But if shes stopped breathing or is struggling to breathe and turning blue (check her lips and fingertips) start CPR after carefully looking in her mouth to check for an object. If you see an object and can safely take it out with a sweep of your finger, do so and start CPR. If you dont see an object, start CPR. 2. Have someone call 911 if youre with another adult (or a school-aged child). 3. Place your baby on her back on a firm, flat surface (not on a bed). 4. Gently tilt your babys head back. Push back on her forehead, and lift her chin up with one finger by pressing underneath the bony part of the chin. 5. Double-check her breathing. Take about five seconds to put your ear next to her mouth and nose to feel and listen for breathing. See if her chest rises and falls. 6. Give her two short, gentle breaths. If your baby isnt breathing, put your mouth over her mouth and nose, and give two breaths lasting one second each. Watch for her chest to rise as you give each breath. 7. Give her 30 chest compressions. Quickly remove (or open) clothes from your babys upper body, and put your index and ring fingers just below an imaginary horizontal line running between your babys nipples (Make sure not to press down at the very end of the breastbone.) Give 30 chest compressions with those two fingers very quickly at a rate of 30 compressions in about 15 seconds (two compressions per second). Press your babys chest straight down, about one-third to one-half the depth of her chest. After each chest compression, release pressure on the chest to let it come back to its normal position. 8. Repeat compressions and breaths. Repeat the cycle of two breaths and 30 chest compressions (two breaths and 30 chest compressions equals one CPR cycle). Every time you stop to give breaths, open the babys mouth wide and look for the object, which might have dislodged. If you see an object, remove it with a sweep of your finger. If you do not see

an object, keep giving sets of two breaths and 30 chest compressions. If youre alone and no one has called 911, after five cycles of CPR, call 911 yourself. 9. Keep giving two breaths and 30 chest compressions until the baby starts to move and breathe on her own or help arrives.

CPR for Children: Emergency Choking Relief for Kids One Year and Older

The best way to be prepared for an emergency is to take a CPR course. Practicing and reviewing these steps for the Heimlich maneuver and CPR will make them second nature which is exactly what you want when faced with an emergency.
In This Article
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 1. Mouth Injuries in Children 2. Head Injuries in Children 3. Treating Burns in Children 4. Childhood Poisoning 5. First Aid for a Choking Child 6. Infant CPR 7. CPR for Children 8. Prevent Burns in Children 9. Treating Bee Stings in Children 10. Treating Skin Wounds in Children 11. How to Remove Splinters in Children 12. Treating Dog Bites in Children 13. Treating Mosquito Bites in Children 14. Treating Spider Bites in Children 15. Treating Tick Bites in Children 16. Sprains in Children 17. Broken Bones in Children

In a perfect world, youd never need to save your childs life. But accidents and emergencies happen, even with the most-vigilant parent a toddler or preschooler can choke on a piece of food or a small toy, or get caught in a curtain cord or (in a young toddlers case) even the string from a pull-toy. Luckily, by taking a childrens CPR class, youll learn to handle many emergency situations yourself. If youve already taken an infant CPR class, its probably time for a refresher course now if your baby turned one: The steps for both the Heimlich maneuver and CPR (short for cardiopulmonary resuscitation, or chest compressions a way to get the heart and lungs to work after a life-threatening trauma or injury) change for kids who are over a year old. In a class, you get experience practicing these life-saving techniques, like the Heimlich, chest thrusts, and more and studies have shown that the more people practice, the more confident they are in a true emergency. To find a childrens

CPR class near you, go to the American Heart Association class locator or the American Red Cross class locator. You can also find a class through your local hospital or log on to cpranytime.org to order a home-based CPR course that comes with a DVD and practice mannequin and includes instructions on choking relief. You can also practice by reviewing these CPR steps. Review Steps Choking Relief in a Child Over One Year Old If you see signs that your toddler is choking, and hes unable to cough or breathe, start taking these steps immediately: 1. First, deliver five quick slaps between your toddlers shoulder blades with the heel of your hand. 2. Then, do five abdominal thrusts (also known as the Heimlich). To do the Heimlich maneuver on any child over the age of one:
o

Kneel or stand behind your toddler and wrap your arms around him so that your hands are in front of his chest.

Make a fist with one hand put the thumb side of your fist slightly above the toddlers belly button and well below the breastbone.

Grasp your fist with your other hand and give quick inward and upward thrusts into his belly until the object is forced out (use less force than you would on an adult or older child).

3. Keep alternating back slaps and thrusts until the object comes out and your toddler can breathe, cough, or talk. 4. If your child loses consciousness, start CPR for children (below). Review Steps CPR for Children Over One Year Old 1. Check to see if your child is responding. Call his name, tap the soles of his feet, or gently shake his shoulder. If he responds, dont start CPR. If he doesnt, you can start CPR after carefully looking in his mouth to check for an object. If you see an object and can safely take it out with a sweep of your finger, do so and start CPR. If you dont see an object, start CPR. 2. Have someone call 911 if youre with another adult (or a school-aged child). 3. Place your child face up on a firm, flat surface (not a bed) and stand or kneel at the childs feet.

4. Gently tilt your toddlers head back. Push back on his forehead, and lift the childs chin up by putting your fingers underneath the bony part of the chin. 5. Check to see if your child is breathing. Take about five seconds to put your ear next to your toddlers mouth and nose to feel and listen for breathing. See if his chest rises and falls. 6. Give your child two breaths. If your toddler isnt breathing, pinch his nose closed, cover his mouth with your mouth, and gently give two breaths lasting one second each. Watch for his chest to rise as you give each breath. 7. Start chest compressions. Quickly remove clothes from the chest, and put the heel of one hand on the center of your toddlers chest between the nipples. If the child is older (or larger), you may need to put the heel of your other hand on top of the first hand. Give 30 chest compressions for about 15 seconds (a rate of two compressions per second). Push straight down one-third to one-half the depth of his chest. After each chest compression, release pressure on the chest to let it come back to its normal position. 8. Repeat compressions and breaths. Repeat the cycle of two breaths and 30 chest compressions (two breaths and 30 chest compressions equals one CPR cycle). Every time you open the airway to give breaths, open the childs mouth wide and look for the object, which might have dislodged. If you see an object, remove it with a sweep of your finger. If you do not see an object, keep giving sets of two breaths and 30 chest compressions. If youre alone and someone else has not called 911, after five cycles of CPR, call 911 yourself. 9. Keep giving two breaths and 30 chest compressions until the child starts to breathe on his own and move or help arrives.

Treating Skin Wounds in Children

From split lips to skinned knees, scrapes and cuts are rites of passage for kids. No matter how vigilant you are, boo-boos will happen. But if you know the basics for treating simple skin wounds, you and your tot can make it through an episode with a minimum of tears.

In This Article
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 1. Mouth Injuries in Children 2. Head Injuries in Children 3. Treating Burns in Children 4. Childhood Poisoning 5. First Aid for a Choking Child 6. Infant CPR 7. CPR for Children 8. Prevent Burns in Children 9. Treating Bee Stings in Children 10. Treating Skin Wounds in Children 11. How to Remove Splinters in Children 12. Treating Dog Bites in Children 13. Treating Mosquito Bites in Children 14. Treating Spider Bites in Children 15. Treating Tick Bites in Children 16. Sprains in Children 17. Broken Bones in Children

When you think about it, a young childs job exploring every nook and cranny of her world is fraught with the potential for a childhood injury. The sharp corner of the coffee table = a forehead gash just waiting to happen. Those pointy pebbles in the driveway = a cut on her knee. The best you can do to protect your little one from the inevitable hazards of her workplace is to childproof your homewhen you can (That coffee table that's just inviting a head injury? Theres a pad for that), watch her carefully when you cant, and be prepared to treat any cuts, scrapes, scratches, or other skin wounds she suffers along the way. How to treat skin wounds:

Stop any bleeding. A minor scrape will stop bleeding on its own, but a cut or gash may not. Using a clean washcloth or towel, apply gentle but direct pressure to the wound until the bleeding stops. (If you use a dark-colored cloth, the blood wont look as scary to your child or to you.)

Double up. If the blood soaks through the cloth, place another one over it and continue to apply pressure. Elevating the injured body part can help to slow the bleeding as well. If the skin wound is on your childs leg, for example, have her lie on the sofa with her foot propped up on your lap. Distract your child with a story or song or DVD. It will calm you both down.

Rinse it off. Hold the injured body part under warm running water to wash away dirt, broken glass, or any other foreign matter. You might find it easier to use the tap in the tub than the faucet in the sink, since its at kid-level. Remove any bits of debris that may still be stuck to the wound using tweezers (disinfect them first).

Clean it up. If the skin around the cut is dirty, gently wash it with a mild soap but try not to get soap in the actual wound. Break out the bandages. Once the bleeding has stopped and the wound is clean, dab on a thin layer of antibiotic ointment and apply a fresh bandage. Little kids usually like this part: So make sure you have a selection of cute and colorful bandages on hand, and let your little patient choose which one she wants.

Keep it clean. Change the bandage at least once a day or if it gets dirty. When a scab forms, you can remove the bandage but teach (and remind) your child not to pick at it. When to call the doctor for cuts and scrapes: You should seek medical care (by calling your pediatrician or heading to the emergency room) if:

The cut or gash is very deep or the edges are widely separated; sutures may be in order. The skin wound wont stop bleeding, even after youve applied direct pressure for ten or 15 minutes.

Blood is spurting (an artery may have been severed). After a day or two, the cut shows visible signs of infection, such as redness, swelling, or pus, or it feels warm to the touch. Preventing skin wounds:

Accidents will happen, but theyre less likely if you take some simple children's safetyprecautions. Once your child starts walking, shell be able to reach things that she couldnt before, so:

Put a safety latch on any drawers that contain sharp objects (knives, forks, scissors, foodprocessor blades).

Place anything that can shatter high up, including drinking glasses, coffee mugs, and hand mirrors.

Keep paper shredders out of reach and unplugged when not in use. Make sure your toddler is a safe distance away when youre loading or emptying the dishwasher.

Store tools in locked containers. Keep bins for recycling glass out of reach. Scan your yard for sharp objects that could cause scrapes and cuts, such as pointy rocks (find a place to toss them) or gardening tools (store them in a safe, out-of-reach place). Of course you wont be able to prevent your child from every boo-boo skin wounds come with the toddler territory but a little bit of vigilance can go a long way toward making her world as safe as possible.

How to Remove Splinters in Children

A close encounter with a tiny sliver of wood may not be the most dramatic injury a little child endures, but it can still hurt. Here's what you need to know about treating splinters in children.
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In This Article
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 1. Mouth Injuries in Children 2. Head Injuries in Children 3. Treating Burns in Children 4. Childhood Poisoning 5. First Aid for a Choking Child 6. Infant CPR 7. CPR for Children 8. Prevent Burns in Children 9. Treating Bee Stings in Children 10. Treating Skin Wounds in Children 11. How to Remove Splinters in Children 12. Treating Dog Bites in Children 13. Treating Mosquito Bites in Children 14. Treating Spider Bites in Children 15. Treating Tick Bites in Children 16. Sprains in Children 17. Broken Bones in Children

Given your childs touchy-feely nature (what little munchkin can keep his mitts to himself?), its bound to happen: He gets hold of a rough-textured stick or encounters an unfinished two-by-four on your trip to the home improvement store and bingo! A sliver of wood wriggles its way under his skin. That can hurt and even cause an infection. Fortunately, removing splinters in children is almost always a quick and mostly painless process. How to remove a splinter:

Keep it clean. Wash your hands thoroughly with soap and warm water. The splinter has created an opening in the skin, so you dont want to introduce any infection-causing bacteria in the tiny wound.

Stick it to the splinter. There are several ways to remove splinters in children. If the tip of the splinter is sticking out, one of the gentlest (and least scary to a small child) options is plain old cellophane tape. Simply tear off a small piece, press it gently over the splinter tip, and then pull off the tape in the direction that the splinter entered the skin. If the splinter isnt lodged too deeply, it should stick to the tape and slide right out. You can also try smearing a bit of white glue on the splinter, letting it dry, and then peeling it off.

Get a grip. If the splinter is embedded too deeply in the skin to slip out with the aid of an adhesive, youll need to bring out the big guns: tweezers. Sterilize a pair with rubbing alcohol, and then use it to grasp the part of the splinter thats sticking out. Pull gently, in the direction the splinter went in.

Dig for it. Sometimes a splinter will become completely embedded under the skin. In that case, sterilize a needle with alcohol and make a small hole in the skin where the tip of the splinter is. A magnifying glass can come in handy here. You might also flip on a video to distract your tot from the minor surgery youre performing. Lodge the needle under the tip of the splinter to lift it up and make it accessible so that you can use tweezers to pull it out. (Teamwork makes this procedure even easier, so enlist Dad to handle the needle or the tweezers if possible.)

Treat the boo-boo. Once the splinter is out, dab on a bit of antibiotic ointment and cover with a bandage. Just like any skin wound, keep an eye on the area for signs of infection (swelling, redness, pus). When to see a doctor: Most splinters in children are easily removed, but in some cases you might want to let a professional take care of this childhood injury. Seek medical attention if:

The splinter is very large. You cant get it out. It breaks off. Its in or near your toddlers eye: Those baby blues (or browns) are especially delicate. How to prevent splinters in children: The best way to protect your tot from getting a splinter is to be vigilant about what he handles. It would be impossible to keep him from touching everything that might leave a little shard behind and besides, how else would he discover that, say, the bark of a tree has a rough texture? What you can do is keep potential sources of splinters out of reach by sanding down any rough surfaces in your home (the edge of a door, a banister, a porch

railing, a wooden toy), and, if you do any sort of woodworking, steer your child clear of it. Also, if youve got a deck out back, a good children's safety rule of thumb is to keep shoes on your sweetie when hes outside.