First aid for babies: what every parent should know

Why baby first aid is different

A baby is not a small adult, and nowhere does that difference matter more than in first aid. A baby's airway is as narrow as a straw, the skin is thinner and burns faster, and a baby cannot tell you what is wrong; you have to see it. At the same time, the chance that you will ever need to give first aid to your own child is real: choking, a fall and a burn from hot tea are the classics of the first year of life. The good news is that the most important techniques are very learnable, and that calm, prompt action in the first minutes almost always makes the difference. This article lists the situations you want to know about as a parent BEFORE they happen. Read it now, not when you need it, and then seriously consider a hands-on course, because skills like chest compressions are learned with your hands, not with your eyes.

Choking: five back blows, five chest thrusts

If your baby is coughing forcefully and crying, let him cough; that is the most effective mechanism there is. Step in as soon as the coughing becomes silent, your baby can no longer cry, or starts turning blue. Lay your baby face down along your forearm, head lower than the body, supporting the jaw with your hand, and give up to five firm blows with the heel of your hand between the shoulder blades. If that does not help, turn your baby over and give up to five downward thrusts with two fingers on the middle of the breastbone, just below the nipple line. Alternate these two series until the object comes loose. Never give a baby under one year abdominal thrusts as you would an older child; the organs are too vulnerable for that. If your baby loses consciousness or the object does not come loose, call 112, put the phone on speaker and follow the operator's instructions.

Burns: water first, the rest comes later

The most common burn in babies is not an open flame but a knocked-over cup of tea or coffee, often over the lap and arms. The rule of the Dutch Burns Foundation is simple and literally vital: water first, the rest comes later. Cool the burn for ten to twenty minutes under gently running, lukewarm tap water; not ice-cold, because a baby loses body heat quickly. Carefully remove clothing that is not stuck to the wound, but leave stuck clothing in place. Do not apply anything, no ointment, no butter, no toothpaste, and never pierce blisters. After cooling, cover the wound loosely with plastic cling film or a clean, non-fluffy cloth. Go to the GP or emergency department for any burn with blisters, any burn on the face, hands or nappy area, and really with any doubt: in babies, a small area is quickly a large part of the body.

Falls: when is a fall an alarm

Almost every baby falls at some point, off the sofa, the changing table or simply over, and almost always it ends well. The art is recognising the exceptions. If your baby cries hard right after the fall and is then his usual self again, drinks and moves normally, you can be reassured and an extra day of watching is enough. Do call the GP or 112 immediately with these alarm signs: your baby loses consciousness, even briefly, becomes drowsy or inconsolable, vomits repeatedly, stops moving an arm or leg normally, or fluid or blood comes from the nose or ear. A bulging fontanelle or a cry that sounds different from what you know are also reasons to have your baby seen. If in doubt, just call; GPs would rather look at nothing ten times than arrive too late once. After a hard fall on the head, do not let your baby sleep unsupervised for the first hours without occasionally checking that he responds normally.

Fever: under three months, always call

Fever in children is usually harmless, but for young babies there is a separate rule every parent must know: if a baby younger than three months has a temperature of 38 degrees or higher, you always call the GP immediately, even in the middle of the night and even if your baby otherwise seems fine. At that age the immune system is still so immature that a serious infection can hide behind a mild picture. Take a baby's temperature rectally, because at this age that is the only reliable method. Above three months, look mainly at how your child is doing rather than at the number: drowsiness, inconsolable crying, moaning, poor drinking, fewer wet nappies, fast or laboured breathing and skin spots that do not fade under pressure are each reasons to call immediately. Never give medicines to a baby under three months on your own initiative, and dress a feverish child lightly; extra blankets trap the heat.

What belongs in your baby first-aid kit

• •A digital rectal thermometer plus lubricant; the only reliable measurement for a baby
• •Saline solution in ampoules for little noses and for rinsing eyes or small wounds
• •Sterile gauze pads, non-fluffy bandages and skin-friendly plasters in child sizes
• •Plastic cling film to loosely cover a cooled burn
• •Infant paracetamol suppositories, only to be given after consulting your GP or clinic
• •A card with emergency numbers: 112, your GP, the out-of-hours service and your own address for the babysitter

Unconscious or not breathing: call 112 and start

The scenario no parent wants to think about deserves a fixed place in your head for exactly that reason. If your baby does not respond to your voice and gentle stimulation, shout for help and call 112, with the phone on speaker next to you. Look for no more than ten seconds to see whether the chest is moving. If your baby is not breathing normally, start with five gentle rescue breaths, covering your baby's nose and mouth together with your mouth, followed by thirty chest compressions with two fingers in the centre of the chest, then alternate two breaths with thirty compressions. With babies you start with breaths, unlike with adults, because in babies the cause is almost always lack of oxygen. The 112 operator will talk you through it step by step until the ambulance arrives. This is the skill above all others that you want to have practised once physically; on a practice doll it immediately makes sense, from a text it never does.

Take a course, and not just you

Everything in this article becomes many times more effective after one evening of practice on an infant resuscitation doll. The Red Cross and the Oranje Kruis offer short first aid courses for babies and children throughout the Netherlands, often in a few hours or a single evening, and many well-baby clinics and maternity care organisations run them too. There are even compact resuscitation workshops especially for expectant parents, which is an excellent moment because your calendar gets considerably fuller afterwards. Important: do not just send yourself. Your partner, the grandparents who often babysit and the regular babysitter are statistically just as likely to be there as you when something happens. Make it a joint outing if need be. Repeat the course every few years, because guidelines change and skills fade. Think of it as the smoke detector among skills: you hope never to need it, and that is exactly why you want it to work.

Being prepared is not scaremongering

You cannot prevent every accident, and you do not need to; bumps and grazes are part of growing up. What matters is that the serious moments are rare AND that you know what to do in those rare moments. The combination works: a home that is in order via the checklists in this app makes the chance of a serious accident small, and a parent who knows the basic steps makes the consequences small if it happens anyway. Put the list of emergency numbers on the fridge, save the out-of-hours GP service in your favourites, plan that one course evening and reread this article in six months, because the risks shift along with your child's age. After that, you can let it go with an easy mind. Being prepared is not a sign of fear; it is exactly the opposite, because those who know what to do can relax and enjoy everything that simply goes well.