What to Expect the First Year (128 page)

53. Massive bleeding.
Get immediate emergency medical attention by calling 911 or rushing to the nearest ER if a limb is severed (
#47
) and/or blood is gushing or pumping out of a wound. In the meantime, apply pressure to the wound with gauze pads, a fresh diaper or maxi pad, or a clean washcloth or towel. Increase the packing and pressure if bleeding doesn't stop. Do not use a tourniquet without medical advice, as it can sometimes do more harm than good. Maintain pressure until help arrives.

54. Puncture wounds.
Soak a small puncture wound (one caused by a thumbtack, needle, pen, pencil, or nail) in comfortably warm, soapy water for 15 minutes. Then consult the doctor about what to do next. For deeper,
larger punctures—from a knife or a stick, for example—take your baby to the doctor or the ER immediately. (If there is extensive bleeding, see
#53
.) If the object still protrudes from the wound, do not remove it, as this could lead to increased bleeding or other damage. Pad or otherwise stabilize the object, if necessary, to keep it from moving around while on route to medical care. Keep baby as calm and still as possible to prevent thrashing that might make the injury worse.

55. Splinters or slivers.
Wash the area with clean water and soap, then numb it with an ice pack or ice cube. If the sliver is completely embedded, try to work it loose with a sewing needle that has been sterilized with alcohol or the flame of a match. If one end of the sliver is clearly visible, try to remove it with tweezers (also sterilized by alcohol or flame). Don't try to remove it with your fingernails or your teeth. Wash the site again after you have removed the splinter. If the splinter is not easily removed, and if baby will cooperate, try soaking the area in warm, soapy water for 15 minutes, 3 times a day for a couple of days, which may help it work its way out or make it easier to remove. Consult the doctor if the splinter remains embedded or if the area becomes infected (indicated by redness, heat, swelling). Also call the doctor if the splinter is deeply embedded or very large and your baby's tetanus shots (part of the DTaP vaccine) are not up-to-date, or if the splinter is metal or glass. Some wood splinters that are embedded just end up being absorbed into the skin, and that's fine. In that case, trying to remove the splinter can do more harm than good.

see
#6

see
#5

see
#55

see
#15

56. Coins, marbles, and other small objects.
If a baby has swallowed such an object and doesn't seem to be in any discomfort, check with the doctor for advice. If, however, your baby has difficulty swallowing, or if wheezing, drooling, gagging, vomiting, or difficulty swallowing develop immediately or later, the object may have lodged in the esophagus. Immediately call the doctor or take your child to the ER. If baby is coughing or seems to have difficulty breathing, the object may have been inhaled rather than swallowed. Treat this as a choking incident (
click here
).

57. Button batteries.
If your child swallows a button battery of any kind, call the doctor and head to the ER immediately. The danger: The battery can become lodged in the digestive tract—anywhere from the esophagus to the intestines—and once there can start to burn through the organs, leading to serious injury and even death. Prompt medical attention (within hours) is necessary.

58. Sharp objects.
Get prompt medical attention if a swallowed object is sharp (a pin or needle, a fish bone, a toy with sharp edges). It may have to be removed in the ER.

see
#38
,
#39

see
#5

see
#27
,
#28
,
#29
,
#30

see
#37

The instructions that follow should serve only to reinforce what you learn in a baby first-aid and CPR course. (The training you receive may vary somewhat from the protocol described here, and should be the basis for your actions.) Participating in a formal course is the best way to ensure you'll be able to carry out these life support procedures correctly. Periodically review the guidelines below and/or the materials you receive from course instructors.

Coughing is nature's way of trying to clear the airways or dislodge an obstruction. A baby (or anyone else) who is choking on food or some foreign object and who can breathe, cry, and cough forcefully should be encouraged to keep coughing. But if the baby who is choking continues to cough for more than 2 to 3 minutes, call 911 for emergency medical assistance. If the cough becomes ineffective (baby tries to cough, but no sound comes out) or baby is struggling for breath, making high-pitched crowing sounds, unable to cry, and/or starting to turn blue (usually starting around the lips and fingernails), begin the following rescue procedures:

IMPORTANT. An airway obstruction may also occur when a baby has croup or epiglottitis (an inflammation of the epiglottis, the tissue that covers the windpipe). A baby who is struggling to breathe and seems ill—has fever and possibly congestion, hoarseness, drooling, lethargy, or limpness—needs immediate medical attention at an ER. Do not waste time trying to treat your baby by yourself—that could be dangerous. Call 911.

1. Get help.
Have someone call emergency medical assistance (911) immediately. If you're alone, call 911 yourself, even if you're familiar with rescue procedures (though do provide about 2 minutes of care before calling, if you can). This will ensure that help will be on the way in case the situation worsens. If you're unfamiliar with rescue procedures—or if you panic and forget them—bring a phone to your baby's side (or take baby with you to a phone if there is no cordless or cell phone available) and the 911 operators can help walk you through rescue procedures as you wait for emergency medical assistance to arrive (put your phone on speaker or hands-free mode if possible).

If baby is unconscious, skip to Step 5 below. If baby is conscious:

2. Position baby.
Position baby faceup on your forearm, with baby's head on your hand. Place your other hand on top of baby, using your thumb and fingers to hold baby's jaw while sandwiching him or her between your arms. Turn baby over so that he or she is facedown on your forearm. Lower your arm onto your thigh so that baby's head is lower than his or her chest (see
illustration
). If baby is too big for you to comfortably support on your forearm, sit in a chair or on your knees on the floor and place baby facedown across your lap in the same head-lower-than-body position. You can give back blows effectively whether you stand or sit, as long as the baby is supported on your thigh.

3. Administer back blows.
Give 5 consecutive forceful slaps between baby's shoulder blades with the heel of your free hand while keeping the arm that is holding the baby supported on your thigh (see
illustration
). Deliver each slap with enough force to attempt to dislodge the foreign body. After 5 back blows, continue to Step 4.

BACK BLOWS. With your arm resting on your thigh and baby's head lower than the chest, give 5 forceful back blows to help dislodge what baby is choking on.

4. Administer chest thrusts.
Turn baby from a facedown position to a faceup position by sandwiching him or her between your two hands and forearms, supporting baby's head between your thumb and fingers from the front while you cradle the back of the head with your other hand (see
illustration
). Lower the arm that is supporting baby's back onto your opposite thigh. The baby's head should be lower than his or her chest, which will assist in dislodging the object. (A baby who is too large to hold in this position can be placed faceup on your lap or on a firm surface.)

Locate the correct place to give chest thrusts by imagining a line running across baby's chest between the nipples. Place the pads of 2 or 3 fingers in the center of baby's chest. Use the pads of these fingers to compress the breastbone to a depth of 1½ inches (about one-third of the depth of the chest) and then let the chest return to its normal position. Keep your fingers in contact with baby's breastbone and give a total of 5 chest thrusts.

If baby is conscious, keep repeating the back blows and chest thrusts until the airway is cleared and the baby can cough forcefully, cry, or breathe—or the baby becomes unconscious. If baby becomes unconscious, call 911 if this has not already been done, and continue below.

CHEST THRUSTS. With baby in a faceup position, head lower than the chest, give 5 chest thrusts with the pads of your fingers.

5. Do a foreign-body check.
Look in the mouth for a foreign object. If you can see the object and can easily remove it, do so with a finger sweep (see description and illustration).

FINGER SWEEP. If you can see an easily removable object in your baby's mouth, hook your finger to sweep it out. Do not do a blind finger sweep (aka if you don't see anything in the mouth) because doing so risks pushing an unseen object further into the airway, causing more choking.

6. Give two rescue breaths.
Open baby's airway by gently tilting baby's head back slightly while lifting the chin (see
description
;
illustration
). Give two rescue breaths with your mouth sealed over baby's nose and mouth (see
illustration
). If baby's chest does not rise and fall with each breath, reposition baby's airway by re-tilting the head and try to give rescue breaths again. If the breaths still do not make baby's chest rise, locate the correct hand position for chest compressions (imagine a line between the nipples and place two fingers just below that line in the center of the chest). Give 30 chest compressions in about 18 seconds (a rate of 100 per minute). Each compression should be about 1½ inches deep, or one-third the depth of the chest (see
illustration
).

7. Repeat sequence.
If the breaths do not go in, repeat the cycle of chest compressions, rescue breaths, and foreign-object check until the airway is clear and the baby is conscious and breathing normally, or until emergency medical assistance arrives.

IMPORTANT: Even if your child recovers quickly from a choking incident, medical attention will be required. Call the doctor or go to the ER immediately.