CPR and Choking Emergencies

A three year old girl is eating grapes. She all of a sudden has a terrified expression on her face and she is trying to cough. The teacher quickly realizes that she is not breathing; she is choking on one of the grapes. The teacher needs to act quickly and calmly. Since the child is coughing the best course of action is to encourage the child to continue coughing. She may be able to cough the grape up. If the coughing become weak then the teacher should perform abdominal thrusts until the object is coughed up or if the child becomes unconscious. At the same time another adult should be calling 911 for assistance. At this point a teacher who is CPR qualified should begin performing CPR. CPR should be continued until the object is expelled or until emergency personnel arrives and can take over. There should be another teacher watching the other children, preferably taking them to a different area or room.

A person who uses CPR on a child is breathing for the child and keeping their heart pumping until emergency personnel arrive. To start CPR the child’s airway must be opened up by tilting their head back. The nose is then pinched and your mouth is placed over the child’s mouth. Two small breaths are then given to make sure that the child’s stomach does not distend or protrude. This would indicate that the air is getting into the child’s stomach and not her lungs. If this happens then you must readjust their head. This is called “rescue breathing”. If the child does not respond after performing rescue breathing then you will need to check the circulation. Apply two fingers to the carotid artery to check for a pulse. If you feel no pulse then compression thrusts will need to be performed. Place the heal of your hand on the child’s sternum and press down five times, then do one breath. Repeat this 20 times, then check for a pulse. Continue this procedure until help arrives or until you are tired and can switch with another adult.

A four year old boy climbed to the top of a jungle gym, slips and falls. He does not move and appears to be unconscious. The teacher immediately checks the child for breathing. She discovers that he is not breathing. She stays calm, has another teacher call 911, and if CPR qualified she starts to perform CPR. If she is not CPR certified a teacher who is should begin CPR. CPR should be continued until the child can breath on his own or until emergency personnel arrives and can take over.

All teacher and daycare providers, daycare facilities and school should have an emergency plan in place. When adults who work with children know what is expected of them in emergency situations the lives of children will be saved. In PA it is required that all childcare providers be CPR certified. Chocking can be prevented by making sure that food is cut small enough, that children do not fool around while eating, and that children should be sitting while eating. All personnel should also have first aid training. There may not always be another adult around when an accident occurs.

Every room in a childcare center should have a first aid kit. Included in this kit should be band aids, gauze pads, cloth adhesive bandage tape, scissors, tweezers, antiseptic wipes, hand sanitizer, antibacterial hand soap, bottled water, CPR microshield and a CPR instruction card. This kit should be taken along when children are taken outdoors. There should be emergency contact information on each child in the rooms and copies of these sheets should be taken with the first aid kit when going outdoors or leaving the childcare premises. Cells phones should also be taken when children are taken outdoors or off the premises. First aid kits should be checked periodically to make sure that items do not need to be replaced. Emergency contact information should also be updated regularly. When children are taken off the premises of the childcare center then certain medication may need to be taken also. If a child has asthma their inhaler should be included in the first aid kit. If a child has severe allergies an epipen may be required. If a child is epileptic their medication should be in the first aid kit. Every childcare center should have all of this information written in a policy that parents have access to.