Choking

From the moment of conception, parents know what it is like to live in fear for their child. Living in South Africa, there are many legitimate reasons to be fearful. But beyond the many issues unique to this country are the more mundane but no less serious safety issues that all parents face. Few of us would know what to do if our baby suffered a severe burn or appeared to be choking. And how many of us can recognise the signs of meningitis?

Knowing what to do to prevent the dreaded from happening or how to react if it becomes a reality should be as important as learning how to change a nappy. Although it can feel like there’s a lot to take in – in addition to all the other new-parent skills you need to acquire in the early days – getting a good handle on the key essentials will give you enormous peace of mind.

1. Choking
Choking is a common worry. Alice Walsh, a paediatric health and safety expert, says what might appear to be a choking infant, may not be, especially when a baby is just starting on solids, learning how to eat and swallow, and is developing his or her reflexes.

"Sometimes, food may appear to have gone down the wrong way, but it hasn't. They'll cry, cough, splutter, go red in the face, their eyes will water, but if they're crying, they're not choking," she says. A few gentle slaps on the back should bring up what they've probably got stuck in their food pipe, she adds. "But if they're not crying and they are going blue, then they're choking."

Firstly, get someone to call an ambulance. The Heimlich manoeuvre is necessary and although training in the procedure, with demonstrations on dummies, is far preferable, here are the basic procedures.
* Turn your baby face down with his head supported by his chin between your open thumb and forefinger, not around the neck, his body running the length of your forearm.
* With the heel of your free hand, give him five robust claps between the shoulder blades.
* If that doesn’t dislodge the obstruction, turn him over so the back of his head is
supported in the palm of your hand.
* Jab two fingers firmly into the abdomen five times, halfway between the navel and the triangle of bone in the centre of the chest below the lungs.
* Turn over and repeat if necessary; don’t be afraid to apply a little more force.
To avoid choking, keep small swallowable items such as buttons, coins and other detachable items well away from babies.
"To eat, babies should be sitting up in a chair and not distracted by anything," says Alice. "Sloppy food, with solid food chopped small and kept moist with plenty of fluid, is the way to go. Avoid feeding your baby big and dry lumps of food."

Allergic shock

Anaphylaxis is a severe allergic reaction. Symptoms may include wheezing, sweating, swelling and rashes (especially around the lips and face), diarrhoea or vomiting, floppiness, faint pulse and loss of consciousness. It is extremely rare in babies under six months, as most allergies – especially food allergies – tend to develop in toddlerhood. Foods such as dairy, eggs, wheat, soya and nuts are typical triggers, as well as Latex, drugs and insect stings.

It is unusual for a first allergic reaction to be serious, so it is likely you’ll have had a prior warning, had your baby’s allergy diagnosed and been advised on what to do. To handle a suspected anaphylactic reaction, the key message is to keep calm, call an ambulance at once (or get your baby to hospital – whichever is quicker), lie your baby down with his feet up. Don’t try to feed him anything at all, as he may choke. Paramedics may give him an injection of adrenaline when they arrive, and he should recover fully.

Wounds and bleeding

Never remove anything embedded in your child, such as a shard of glass, as you can do more harm and increase blood loss. “Wrap and pad the affected area with bandages, tea towels, handkerchiefs – anything you have to hand,” says Alice Walsh. “Obviously, it’s better if you have clean material, but in an emergency it doesn’t matter; if it’s dirty, any infection they catch can be treated later.” If you’re sure nothing is embedded, apply firm pressure to the area with gauze or tea towels to stem bleeding, and elevate the site of the wound. Then, seek medical attention at once.

Watch out for meningitis

Sudden and potentially life-threatening, meningitis is one of the most feared diseases. Simply, it is an inflammation of the membranes that surround and protect the brain and spinal cord, and is most dangerous when caused by bacteria.
“Children under five are most at risk,” says Lisa Slattery, a community services nurse working in the field of meningitis, “but especially babies under one, as their immune systems are still developing and are less able to fight bacteria.”

The good news is that some forms are preventable and vaccines against them are available. But because not all forms of the disease are covered, it’s essential you are aware of the symptoms. These include feverishness, cold hands and feet, a stiff neck, an arched back, drowsiness, pale blotchy skin – and possibly a distinctive rash which does not fade under the pressure of a glass (a sign of meningococcal septicaemia, or blood poisoning, a very serious symptom).

Lisa says key danger signs are rapid changes and newly emerging symptoms over a period of a few hours. Remember that not all symptoms will be present. “The characteristic rash, if it comes, can start anywhere, even in places you may not think of looking, like buttocks or soles of the feet, or palms of the hand. But never ‘wait’ for the rash if other symptoms are strong. Act at once.”

Trust your instinct, and take your child to accident and emergency or your doctor if you’re in any doubt.

Immunisation

Fact: immunising your child offers the most important protection from life-threatening illnesses. According to the World Health Organisation, a 95 per cent uptake of vaccines is needed to prevent outbreaks recurring. “Immunisation is completely safe,” says Dr Brenda Corcoran, a consultant in public-health medicine. “Parents can be reassured that there is no evidence for any association with the vaccine for measles, mumps and rubella, and autism or bowel disease. And although minor adverse reactions to the jabs – like sore arms, redness, irritability, mild raised temperatures – are possible, more serious side-effects, such as allergic reactions, are extremely rare.”

But with more vaccines seemingly being added to the schedules in childhood vaccination, won’t additional jabs further overload an infant’s system to breaking point? Dr Corcoran says vaccines’ safety record is high. “Obviously it’s distressing to see children receive injections but it’s much worse to see them acutely ill with a very serious infectious disease which could’ve been avoided. That’s what it all boils down to.”

Liver disease

Checking the contents of your baby’s nappy could save his life. About 20 per cent of babies are born with jaundice – with its characteristic yellowy skin caused by excess of bilirubin (a bile pigment) in the blood, produced when the liver has to break down the glut of red blood cells that babies are born with. Encouraging greater feeding can help clear up jaundice, and baby may need some time under a phototherapy lamp in hospital, but if jaundice persists for more than two weeks, it could be a sign of liver disease or a thyroid problem.

You can get a further clue about possible liver disease by keeping an eye on his nappies. Catherine Arkley, a leading authority on paediatric liver disease, says, “There is no specific group at risk of liver disease. It could strike any family, any time, so it is important that everyone remains alert to the signs, which are easy to spot. A healthy newborn’s urine is usually colourless, whereas the stool should be mustard yellow or green in bottle-fed babies, and daffodil yellow or green in breast-fed babies.” Report any deviation – that is, pale stools and/or yellow urine – to your midwife or doctor.

Dehydration

This can happen during very hot weather, in feverish children, or when a baby is suffering from diarrhoea or has been vomiting. Babies are particularly at risk. Signs include: dark yellow urine, no urination in the last six hours, fewer than six wet nappies in 24 hours, lethargy or lack of playfulness, a sunken, soft spot (fontanelle), and dryness of the mouth.

Paediatric dietician Margot Brennan says young babies are capable of “self-regulating” their fluid intake, taking what they need and stopping when they need no more, but that during warm weather they may need extra. Frequent feeds should be offered. Babies of over six months can also be given boiled and cooled water in addition to their formula or breastmilk.

“Look out for constipation,” she advises. “If your infant is normally regular, and suddenly becomes constipated, that could indicate dehydration. Be aware that too much milk can cause constipation, as milk is quite high in solutes and salts, so some water is important, too.”

Burns

The immediate treatment for any type of burn – be it fire, a hot iron, sunburn or a chemical burn – says Alice Walsh, is running the affected area for a full and timed 10 minutes under cold running water. Following that, if it’s a second-degree burn, which is oozy, blistery or angry – cover with clingfilm (this offers non-stick protection against infection) and take your child to accident and emergency at once. Never use ice directly on a burn, although keeping a burned hand, for instance, in an iced bucket during transportation to hospital is OK.
With any chemical burns in the eye, “again, 10 minutes rinse under the cold tap”, advises Walsh. “It’s difficult, and you can give your child little breaks, but the more flushing, the less risk of losing sight in that eye. Make sure the affected eye is lower than the good eye, so that you don’t rinse the chemical from one eye to the other.”

With internal burns, due to accidental swallowing of toxic chemicals, do not attempt to make your infant sick, which may further damage the oesophagal tube. Take him to hospital at once, with the bottle of fluid you suspect he drank, showing the ingredients. Do not give him water or milk unless advised to by medical teams.

Drowning

Babies and toddlers are at risk of drowning in so many different places – not just a swimming or paddling pool or at the beach, by a river or near a dam. There’s the bath, a toilet, a basin and a bucket of water to think about. Prevention is so much better than cure. Never leave a baby or child alone near water. Never leave your baby or toddler in the bath, even for a moment. Make sure there are never any buckets of water in the house (remind your domestic constantly), the toilet seat is kept down and the bathroom door is permanently closed. Never leave baths full of water when a toddler is able to climb in on their own. Make sure all pools, ponds, even braai pits that can fill with water in the winter are off-limits (fences, nets) whatever it takes to protect your child. It’s a tragic fact that a child can drown in less than 5cm of water within 30 seconds.

In the event of your baby or child falling into water, the first thing you should do is get them out of the water. If they are awake and coughing, let them cough. Raise their arms above their head to help them cough. If the infant or child is unconscious, lie them on their back and perform CPR – chest compressions and rescue breathing.
Probably the single most valuable thing you could do for your child’s safety is a course in CPR – it could save your baby’s life! Book today.