The emergencies worth recognising

Most childhood illness is self-limiting, and a small number of presentations require immediate action — which are worth knowing before you need them.

Sepsis

The one where recognition saves lives and delay costs them.

In a baby or young child, the features to act on: breathing very fast, difficulty breathing, or grunting; a fit or convulsion; mottled, bluish or very pale skin; a rash that does not fade when pressed with a glass; being very lethargic or difficult to wake; feeling abnormally cold to touch; not feeding, repeated vomiting, or no wet nappy for twelve hours.

Sepsis can occur without a rash and without a fever, and in infants a low temperature is as concerning as a high one.

If you are worried a child may have sepsis, say so explicitly when seeking help — the phrase prompts a specific assessment pathway in many systems.

Choking

Where seconds matter.

A child who is coughing effectively should be encouraged to cough and should not be interfered with.

A child who cannot cough, cry or breathe needs immediate action.

For an infant: five back blows with the head down, supported on your forearm, then five chest thrusts, repeating and calling for emergency help.

For a child over one: five back blows then five abdominal thrusts, repeating.

If the child becomes unresponsive, start resuscitation and continue until help arrives.

Anyone who has needed thrusts should be assessed afterwards.

This is a procedure worth learning practically on a first aid course rather than from a description.

Difficulty breathing

Signs requiring emergency assessment.

Rapid breathing, grunting with each breath, nostril flaring, drawing in below the ribs, between the ribs or at the base of the neck, head bobbing in an infant, or an inability to complete a feed or a sentence.

Noisy breathing in, stridor at rest, particularly with drooling or an inability to swallow.

Blue lips or tongue.

Pauses in breathing.

Keep the child calm and upright and call emergency services.

Seizures

What to do.

Place the child on their side on a safe surface, away from anything hard.

Do not restrain them or put anything in their mouth.

Note the time and what the seizure looks like.

Call emergency services for a first seizure, a seizure lasting more than five minutes, repeated seizures, difficulty breathing, or a child who does not recover afterwards.

Most febrile seizures are brief and benign, and a first one should always be assessed.

Head injury

Most are minor; the features that are not.

Loss of consciousness at any point.

Repeated vomiting.

Increasing drowsiness, or difficulty waking.

A seizure.

Clear fluid or blood from the nose or ears.

Unequal pupils, weakness, or unsteadiness.

A significant mechanism — a fall from height, a road incident, or a high-speed impact.

Any head injury in a baby under one, particularly a fall from a height, warrants a low threshold for assessment.

Burns and scalds

Immediate action changes the outcome.

Cool the burn under cool running water for twenty minutes, which is the single most effective thing and which is effective up to three hours after the injury.

Remove clothing and jewellery unless stuck.

Do not use ice, butter, creams or any traditional remedy.

Cover loosely with cling film or a clean non-fluffy cloth.

Keep the child warm otherwise, since cooling a small child can cause hypothermia.

Seek medical assessment for anything more than a very small superficial burn, and for any burn to the face, hands, feet, genitals or across a joint, and for any chemical or electrical burn.

Poisoning and swallowed objects

Where specific items are far more dangerous than others.

Button batteries: any suspected ingestion is an emergency requiring immediate hospital attendance, because they cause severe internal burns within hours.

Do not wait for symptoms.

Magnets, particularly more than one, which can trap bowel between them.

Laundry capsules, which cause airway and eye injuries.

Medication, alcohol, e-cigarette liquid and cleaning products.

Do not induce vomiting.

Take the container or a photograph with you.

And call your national poisons service or emergency line for advice immediately.

The things worth having in place

Before anything happens.

A paediatric first aid course, which is short and is the single best preparation available.

Emergency numbers accessible, including out-of-hours services.

Knowing where your nearest emergency department is.

A stocked first aid kit and correct-dose medicines.

And a low threshold for seeking help, since clinicians would far rather assess a well child than miss an unwell one, and parental instinct is a recognised part of the clinical picture.

General information only, not medical advice. In an emergency call your local emergency number. Consider a paediatric first aid course — these procedures are best learned in practice.