CPR & Choking Emergencies

One of my worst fears is having to perform CPR on a child, or a child having a choking emergency, something that could have been prevented. Children are curious by nature and can easily place items, toys, bugs and more into their mouths just to see what it taste like. Most of these objects, including food, are common objects that children choke on every day, and without the proper reaction to the child’s emergency, the child could die. Knowing how to respond to such an emergency is extremely important in the Early Childhood field.

            To explain the proper way to react to a choking situation, let me create a scenario. A 2 year old child in a daycare setting has found a lid to a glue stick that had rolled away from the craft table; she curiously puts it in her mouth and after a few seconds begins to choke on it. The Teacher notices right away. How should she react?

            The teacher should remain calm, and act immediately to the choking child. If the cap is in fact lodged into her throat, the teacher should perform the Heimlich maneuver, to get the cap out of the child’s throat.  Once the child has the cap removed, take them to an area where they can calm down, and contact the child’s parents about the emergency. How do you perform the Heimlich maneuver? According to the Children’s Hospital of Pittsburg’s Website;

To perform the Heimlich maneuver on children over 1 year old:

1. Remain calm.
2. Stand or kneel behind a child who is conscious.
3. Make a fist with one hand.
4. Place the thumb side of the fist right above the belly button, and well below the bottom of the breastbone.
5. Cover the fist with your other hand.
6. Deliver five upward and inward thrusts into the child’s abdomen. The thrusts should quickly squeeze in the abdomen to help the child “cough out” the obstruction.
7. Check the child after every five thrusts.
8. Continue the abdominal thrusts until the object comes out or the child becomes unconscious.
9. If the child becomes unconscious, call for emergency medical services.

See website here: http://www.chp.edu/CHP/Heimlich+Maneuver 

The best way to prevent a child from choking is to make sure there is nothing in their reach that they can choke on. A rule of thumb is, if it can fit through a toilet paper roll a child can choke on it. Object this small should be removed from the area in which small children are playing, or will be in for periods of time. Food should be cut into small pieces that can be swallowed without blocking the wind pipe. Hotdogs are a food that should be cut and children should be supervised when eating, this is the most common food that children can and have choked on. 

In our next situation we will talk about a situation where a child has stopped breathing. A 4 year old boy is found by his teacher, in a preschool setting unconscious and not breathing. What should you do? The Teacher needs to stay calm and not panic, Inform another teacher or assistant in the classroom to call 911. Check the child for a pulse and then check the child’s airway to see if anything is blocking the airway. If there is nothing in the way the teacher needs to perform CPR on the Child until an Ambulance and Paramedics arrive or the child starts breathing. If there is something in the airway the teacher needs to try and remove the object and continue CPR. (WebMD.com, 2011)  

Check for responsiveness. Shake or tap the child gently. See if the child moves or makes a noise. Shout, "Are you OK?"

If there is no response, shout for help. Send someone to call 911 and retrieve an AED (if available). Do not leave the child alone to call 911 and retrieve an AED until you have performed CPR for about 2 minutes.

Carefully place the child on his or her back. If there is a chance the child has a spinal injury, two people should move the child to prevent the head and neck from twisting.

Open the airway. Lift up the chin with one hand. At the same time, tilt the head by pushing down on the forehead with the other hand.

Look, listen, and feel for breathing. Place your ear close to the child's mouth and nose. Watch for chest movement. Feel for breath on your cheek.

If the child is not breathing:

• Cover the child's mouth tightly with your mouth.
• Pinch the nose closed.
• Keep the chin lifted and head tilted.
• Give 2 rescue breaths. Each breath should take about a second and make the chest rise.

Perform chest compressions:

• Place the heel of one hand on the breastbone -- just below the nipples. Make sure your heel is not at the very end of the breastbone.
• Keep your other hand on the child's forehead, keeping the head tilted back.
• Press down on the child's chest so that it compresses about 1/3 to 1/2 the depth of the chest.
• Give 30 chest compressions. Each time, let the chest rise completely. These compressions should be FAST and hard with no pausing. Count the 30 compressions quickly: "1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30, off."

Read more: http://www.righthealth.com/topic/CPR_-_child_(1-8_years)/overview/adam20_s#ixzz1Rkftvn5u

Once the situation is handled the Teacher or School Director should immediately contact the child’s parents and let them know what happened and where they need to go in order to be with their child. Most of the time in either situation the school will complete an incident report. The incident reports are good for looking back over the situation and ways that the situation can be avoided or the responses to the situation could differ. 

Any person that is in the Early Childhood field should take preparedness courses for these situations, these classes can save lives. “Every Teacher should be able to recognize the symptoms and be able to perform rescue breathing” (Robertson, 2010. P. 180). Most hospitals, some health departments and Red Crosses offer classes in CPR and First Aid. It should be required of every person employed by a facility in the early childhood field to be certified and up to date in these courses. If there ever is an emergency that requires CPR, Heimlich maneuver or breathing emergency the teachers and staff know just how to handle the situation and have a positive outcome. However, being prepared and knowing how to avoid the situation with proper planning and constant observation a teacher may never have to use her certification!

References:

Children's Hospital of Pittsburg. (2008, Feburary 10). The Heimlich maneuver. Retrieved from http://www.chp.edu/CHP/Heimlich+Maneuver

Right Health. (2009, July 8). Cpr guide. Retrieved from http://www.righthealth.com/topic/CPR_-_child_%281-8_years%29/overview/adam20_s#ixzz1Rkftvn5u

Robertson, C. (2010). Safety, nutrition, and health in early education 4th addition. Belmont, CA: WadsWorth.


WebMD, Initials. (2010, April 20). Choking rescue procedure. Retrieved from http://firstaid.webmd.com/tc/choking-rescue-procedure-heimlich-maneuver-person-faints