Childcare First Aid

First aid Regulations for Childcare Services

The Australian Children’s Education and Care Quality Authority (ACECQA) is an independent national authority, based in Sydney, which assists governments in implementing the National Quality Framework (NQF) for early childhood education and care.

The National Quality Framework (NQF) provides a national approach to regulation, assessment, and quality improvement for early childhood education and care and outside school hours care services across Australia.

The NQF operates under an applied law system, comprising the Education and Care Services National Law and the Education and Care Services National Regulations.

Important laws and regulations for the early childhood sector that affect First Aid, Record Keeping & Reporting requirements are sections: Law 169, 174, Regulations 12, 85-87, 89, 136, 168, 176-178, 183

Image/logo © 2020 Australian Children’s Education and Care Quality Authority

Incident, injury, trauma, and illness policies & procedures and reporting (slide 11.10) Law Section 174, Regulations 12, 85-87, 168, 177-178, 183

• Centres must have an incident, injury, trauma, and illness policies and procedures in the event that a child: (a) is injured; (b) becomes ill, or (c) suffers a trauma.
• A Centre must ensure that a parent of a child is notified as soon as practicable, but not later than 24 hours after an occurrence if the child is involved in any incident, injury, trauma, or illness
• The details of the occurrence must be correctly and accurately recorded within 24 hours
• The occurrence records are stored safely and securely until the child is aged 25 years
• That the Regulatory Authority is notified of a serious incident which includes: (c) death of a child; or (b) where medical assistance was required; or (c) attendance of emergency services at the education and care service premises was sought, or ought reasonably to have been sought.

Incident, injury, trauma, and illness record

The approved provider of an education and care service must ensure that an incident, injury, trauma, and illness record is kept in accordance with the Education Care Services National regulation.

The incident, injury, trauma, and illness record must include;

Details of any incident in relation to a child or injury received by a child or trauma to which a child has been subjected while being educated and cared for by the education and care service or the family day care educator, including:

• The name and age of the child; and
• The circumstances leading to the incident, injury or trauma; or details of illness including symptoms and
• The time and date the illness presented, an incident occurred, the injury was received, or the child was subjected to the trauma.
• Actions taken
• Any medical personnel contacted
• Any witnesses
• Names of any persons that the education or care centre attempted to notify of the incident and times and dates of these attempted notifications

National Regulations 89 & 136: First Aid Kits & Qualifications

89 First aid kits: … must ensure that first aid kits are kept … appropriate number … suitably equipped … easily recognisable and readily accessible … First aid qualifications 136: (1) … must ensure that the following persons are in attendance at any place where children are being educated… at least one educator who holds a current approved… first aid qualification; … anaphylaxis management training … emergency asthma management training.

Note that regular refresher training is required to maintain currency in first aid related qualifications. Within 3 years for first aid, asthma, and anaphylaxis and within 1 year for CPR.

The Safe Work Australia First Aid in the Workplace Code of Practice recommends that first aiders should attend refresher training on a regular basis to maintain their first aid knowledge and skills, and to confirm their competence in providing first aid including Anaphylaxis and Asthma.

In workplaces where children are in attendance, there is a regulatory requirement for a Working with Children check and/or Police Check to be conducted for any person working on the premises.

Emergency Action Plans

Planning for students with identified health care needs

Schools are required to have a school-level management policy for Asthma and anaphylaxis in addition to individual action plans. In addition to plans for management, there must also be a plan for minimising the triggering events and annual risk assessments.

A Student Health Support Plan must be completed for each student with an identified health care need, other than anaphylaxis or an allergy

To develop a Student Health Support Plan, schools must:

• Work with families to develop the plan, guided by advice from the student’s treating medical/health practitioner
• Include actions in the plan as to how the school will support the student’s health care needs
• Communicate regularly with parents about the student’s health care needs at the school and update the plan if necessary

Students with Asthma, Diabetes, or Epilepsy need to provide their (condition-specific) health management plan to the school and have a Student Health Support Plan developed, which outlines how the school will support the student’s health care needs.

The above excerpt from: https://www2.education.vic.gov.au/pal/health-care-needs/policy;

Parents or carers must provide the school with a personalised Action Plan or Student Health Support Plan completed by the student’s medical practitioner if their child suffers from any medical conditions.

The plan must outline the student’s known triggers and the emergency procedures to be taken in the event of a medical episode or emergency.

Parents or carers and the student’s general practitioner (GP) should annually complete or review each student’s Action Plan or Student Health Support Plan. The Plan should contain:

• The prescribed medication was taken and when it is to be administered
• Emergency contact details
• Contact details of the student’s medical or health practitioner
• Details about deteriorating conditions including signs to recognise triggers and/or worsening symptoms, what to do during an attack or medication to be used
• Child’s details, including a photo (does not apply to all plans)

Emergency Action Plans: Anaphylaxis

Personal ASCIA Action Plan for Anaphylaxis

These Action Plans are called REACTIVE, which means they are followed after something has happened. A photograph and a short description of the sufferer should be displayed on the plan.

However, if the patient is a child, the photo should be updated each time, so they can be easily identified. Most plans will include the administering of an autoinjector that has adrenaline in it.

It is crucial that if you have anyone who suffers from anaphylaxis in your workplace, a personalised Action Plan has been received and incorporated into the individual’s Anaphylaxis Management Plan which should be reviewed and updated at the beginning of each year or as per organisational procedures.

Emergency Action Plans: Asthma

These should be completed by a doctor or nurse and kept with the casualty’s medication. They should be followed when treating the casualty as everyone’s asthma is different.

They should be updated every 12 months, when there is a moderate or severe attack, if any details change or if they need a reliever 3 times a week. Children should see a doctor every 6 months to update their Action Plan.

After a person has had a moderate or severe Asthma attack, you should recommend that they go back to their doctor and update their Action Plan and get their medication checked in case they need something else or more medication.

Please read through the following Action Plans so that you are familiar with them when you come to your course. Either one may be used and provided for a child suffering from Asthma:

• First Action Plan by Asthma Australia
• Second Action Plan by National Asthma Council Australia

Emergency Action Plans: Diabetes

A student’s diabetes management plan is an essential document that will guide how schools can support students to learn and participate fully in their school experience.

The diabetes management plan will usually be developed by the student’s clinical treatment team in collaboration with the student and parents or carers. A student’s diabetes management plan will outline their monitoring, insulin, and daily type 1 diabetes management needs while at school. The plan should provide schools with clear information about when a student requires supervision or support with key tasks, such as checking their blood glucose or taking their insulin at school.

A diabetes management plan should include a diabetes action plan – this is a tailored plan written by the student’s clinical treating team for the urgent management of blood glucose highs and lows outside a student’s target range.

Diabetes management plans will differ in format and detail in different states and territories and may vary for different clinical treatment teams.

The above excerpt from: https://www.diabetesinschools.com.au/resources/diabetes- management-plan-staff/

There are two notable Australian Peak Bodies that can assist with the creation of epilepsy management and actions plans:

• Epilepsy Foundation: https://epilepsyfoundation.org.au/.
  o Refer to the sample chart (page 1 only)
• Epilepsy Action Australia: https://www.epilepsy.org.au/

The plans are a practical guide that can be used by first aiders in settings to manage seizures and seizure emergencies, treatments, and safety. This will help to minimise both the impact of seizures on the person’s daily life and the risk of injury in the event of a seizure.

Medical Conditions: Hyperventilation

Hyperventilation is rapid and deep breathing. It is also called ‘over breathing’, and it may leave a person feeling breathless. We all breathe in oxygen and breathe out carbon dioxide.

Excessive breathing creates a low level of carbon dioxide in a person’s blood, causing the arteries to constrict, and reducing the flow of blood throughout the body. When this occurs, the brain and body will experience a shortage of oxygen. This causes many of the symptoms of hyperventilation.

A person may hyperventilate from an emotional cause such as during a panic attack, or often during periods of anxiety, fear, or emotional distress.

Signs and Symptoms

• Feeling lightheaded, dizzy, weak, or not able to think straight
• Shortness of breath
• Rapid breathing
• Rapid pulse
• Chest pain or fast & pounding heartbeat, palpitations
• Dry mouth
• Anxiety, feeling of panic, and/or impending death

Advanced attacks:

• Muscle spasms in the hands and feet
• Numbness and tingling in the arms or around the mouth

Treatment

• Rest, calm and reassure the casualty
• Encourage the casualty to slow down their breathing
• If possible, remove the cause of distress/anxiety
• Follow DRS ABCD
• If the casualty does not improve, call Triple Zero (000) for an ambulance
• Continue to monitor and reassure until help arrives

Note: Though recommended by some websites, the ARC guideline 9.2.8 clearly states not to use any bag for re-breathing as this practice may prove to be dangerous.

Images for Hyperventilation material from wikiHow. License: Creative Commons

Medical Conditions: Pain

Causes of pain

Injuries or trauma are common causes of pain in children, but pain can also come from disease. Some common causes of pain in children and infants can include:

• Stomach aches
• Headaches
• Toothache (including teething in infants)
• Sprains and strains
• Fractures
• Cuts
• Bumps and bruises
• Burns/scalds
• Muscle, bone, or joint pain

Pain in children is more likely to be acute (~80%) than chronic but chronic pain can occur – in adults, chronic pain is more common (back pain, arthritis, nerve pain etc.)

Signs and Symptoms

It is important to recognise signs of pain in children as they may not be able to tell you exactly what is occurring.

• Body posture
• Facial expressions – wincing, frowning
• Protection of sore/injured area, favouring one arm or leg over the other
• Holding or rubbing the area of pain
• Crying, Moaning/Groaning
• Flushed skin
• Sweating
• Rapid breathing
• May become noticeably quiet and subdued or they may become highly active.
• Are not acting as they usually would

Chronic pain can result in:

• Crying easier or more frequently than usual
• Not wanting to play or do normal activities as much as usual
• Refusal to eat
• Increased affection/clinginess
• Changes in sleep

School-age children may attempt to hide pain to show bravery, particularly when their peers are present.

Management

• Identify that pain is occurring and at what level (ask how much pain – use a face chart or ask older children to rate out of 10)
• Manage any obvious injuries
• Have parents attend when possible to make a child feel more secure
• Comforting touch – stroking or holding helps to reduce pain
• Give children some control – ask them if they want to sit, stand, or lay down
• For abdominal pain laying or semi-reclined with knees bent up will often provide relief
• Breathing control – deep steady breathing can sometimes help to reduce pain
• Heat or cold can help relieve pain

Medications

Schools must not:

• Store or administer painkillers such as aspirin and paracetamol as a standard first aid strategy as they can mask signs and symptoms of serious illness or injury
• Allow a student to take their first dose of any new medication at school in case of an allergic reaction. This should be done under the supervision of the parent or carer, or health practitioner

Over-the-counter medications (including paracetamol) require a medication authority form, even if the student is carrying or self-administering their medication.

Schools must have a medication policy outlining protocols and procedures.

Medical Conditions: Vomiting and Diarrhoea

Causes

• Viral infections (Gastroenteritis)
• Bacteria such as Salmonella, E.coli, Listeria (food poisoning)
• Parasites like giardia
• Allergies (food allergies, bites, and stings)
• Medications:
  o Antibiotics
  o Laxatives
• Disease
  o Irritable bowel disease
  o Celiac disease
• Stress and Anxiety

Throwing up is the body’s way of protecting the lower intestines. Diarrhoea is the body’s way of getting rid of germs.

Signs and Symptoms

The child is Vomiting and/or has Diarrhoea. This can result in:

• Dehydration:
  o Dryness and stickiness of tongue and mouth (dry lips are not a reliable indication)
  o Dizzy or lightheaded
  o Dark yellow, or very little urine output
  o Few or no tears when crying
  o Skin cool and dry
  o Lack of energy
  o Rapid pulse
  o Seizures

Gastroenteritis can last 5-14 days

Food poisoning generally lasts shorter periods (24-48 hours)

Management:

• Good hygiene – wash hands frequently
• Rest
• Avoid stress
• Prevent dehydration:
  o For infants and young children oral rehydration solutions (if recommended by a doctor) or increased breastfeeding
  o For older children oral rehydration solutions or rehydrating type drinks (names usually ending in ‘lyte’)
  o Clear fluids, soups
  o Water does not have enough sodium, potassium, or nutrients to be effective in rehydration
  o If vomiting – give smaller but more frequent amounts of fluids
• Probiotics can help with diarrhoea caused by antibiotics

Do not give the child:

• Undiluted fruit juice and cordial, fizzy drinks, or energy drinks may make the diarrhoea or dehydration worse
• Drugs to stop the vomiting or diarrhoea are not generally recommended because they may slow down the recovery of the bowel and cause serious side effects
• Antibiotics may prolong the infection and are rarely needed except for certain bacterial or parasitic infections

Call 000/112 if the child:

• Cannot be woken up; Is too weak to stand up; Is confused or dizzy

Call a doctor if the child:

• Has had Diarrhoea for more than three days
• Is younger than 6 months old
• Is vomiting bloody green or yellow fluid
• Cannot hold down fluids or has vomited more than two times
• Has a persistent fever or is under age 6 months with a fever over 38C (Do not give any fever medication before seeing the doctor).
• Seems dehydrated
  o Has not urinated in 6 hours if a baby or 12 hours if a child
• Has bloody stool
• Passes more than four diarrhea stools in eight hours and is not drinking enough
• Has a weak immune system
• Has a rash
• Has stomach pain for more than two hours

Medical Conditions: Fever

Fever in children

A fever is a high temperature. A child’s normal body temperature may vary depending on their age and the time of day. A child with a temperature above 38°C has a fever.

All children will have a fever at some time. It is one of the most common reasons for children to see a doctor and often causes parents to worry. However, it is extremely rare for a fever to cause long-term harm.

What causes it?

More than 90 percent of fevers in children are caused by viral infections. Less commonly, a fever can be due to a bacterial infection. Depending on a child’s other symptoms, a doctor may perform some tests to look for the bacteria or virus causing the fever.

The above excerpt from: https://www.childrens.health.qld.gov.au/fact-sheet-fever-in-children/

Signs and Symptoms

Depending on what’s causing the fever, additional fever signs and symptoms may include:

• Sweating
• Chills and shivering
• Paleness
• Flushed skin
• Headache
• Muscle aches
• Loss of appetite or refusal to drink or eat
• Greater irritability than usual
• Dehydration
• General weakness

Management

If a child develops a fever whilst in care:

• A digital thermometer is used to take the temperature of the child
• All efforts should be made to reduce the fever naturally by first removing excess clothing and/or sponging the child
• Offer fluids (rehydrating types) to the child and encourage the child to rest
• If fever remains above 37.5c, parents (or emergency contact if parents are unavailable) should be contacted and requested to immediately collect their child and are advised to contact their doctor
• Monitor the child for any additional symptoms
• Continue to monitor the child’s temperature until the parent/s arrive
• In an emergency, always call 000 immediately

Illness in Children and Infants

General signs and symptoms of illness in children and infants:

• Generally, a child who is not behaving normally may be unwell
• Lack of appetite
• Altered sleep patterns
• Listless, irritable when disturbed
• Cry more readily than usual
• Unusually quiet with no or little interest in play
• Lack of appetite
• Feel hot to touch
• Tired
• Flushed or pale
• Complaining of feeling cold.
• Fever (if over 38C in a baby they should be taken to hospital immediately)
• Vomiting
• Diarrhoea
• Pain
• Rash (if purple and does not fade when pressed they should be taken to a doctor immediately)
• Headache (if combined with a stiff neck, or comes and goes, or persists the child should see a doctor)

General signs and symptoms of acute illness in children and infants:

• Cough
• Fever
• Sore throat
• Ear pain
• Upper respiratory issue (blocked or running nose, sinusitis)
• Abdominal pain
• Vomiting
• Diarrhoea
• Dermatitis / Rash / Itching
• Joint limb pain
• Headache
• Seizure/convulsions
• Blurred vision, crusty eyes, discharge from eyes

Management

• Managing a sick child or infant can be hard
• Listen to them, generally, unless a child is extremely sick, they will be unlikely to want to stay in bed, a blanket and laying on the couch may be better for them
• Keep the room well ventilated – do not let it get too warm
• Give them plenty to drink
• Do not worry too much about food for the first day or so unless they want it
• Let them have plenty of rest
• Keep sick children away from others – do not send them to school or childcare

Call an ambulance for the following signs/symptoms:

• The child seems extremely sick
• Under 3 months old and temperature >38C
• Difficulties breathing
• Stiffness in the neck
• Photosensitivity (light hurts their eyes)
• Bulging fontanelle (soft spot on the baby’s head)
• They are listless, floppy, cannot be woken, or are unusually sleepy
• They have had a seizure or convulsions lasting more than 5 minutes, or for the first time
• Refusing to drink or drinking < half normal fluid intake
• Not passing urine or passing < half normal
• Vomiting repeatedly or vomiting has a green colouring
• Flu-like symptoms with drowsiness, pale skin, not drinking or urinating

An ambulance should be called in the following circumstances:

• Loss of consciousness, even if only briefly
• A less than alert conscious state
• Suspicion of a fracture
• Suspicion of a spinal injury
• Damage to eyes or ears
• Penetration of the skin
• Deep open wounds
• A severe asthma attack
• An anaphylaxis reaction

Emergency (Triple zero) 000 or 112

Referral Options

Poisons

Poisons information Centre – 131126

Non-urgent medical advice

Health direct – 1800 022 222

Crisis services

• Lifeline – 13 11 14
• Kids Helpline – 1800 551 800 for young people 5-25 years
• Suicide Call Back Service – 1300 659 467
• MensLine Australia – 1300 78 99 78 for men of any age

If a child feels unwell, the school or care centre should assess the child, act based on the summary signs and symptoms, and, if the condition is deteriorating or there are any doubts about the condition emergency assistance should be sought.

Communication and Distraction Techniques

Age-Appropriate Communication

By applying the use of age-appropriate communication, as well as numerous distraction techniques, first aiders can successfully assist their young casualties while administering the required first aid procedures, resulting in the best possible outcomes.

• Avoid the use of negative words
• Explain the process of what is going to take place. This reduces anxiety and any misunderstandings by allowing the child to comprehend the purpose of the procedure, rather than view it as a form of punishment.
• Tell the truth – but keep it simple. Explain slowly in small bits, repeat if necessary
• Encourage them to ask questions about anything they do not understand.
• Do not give false reassurances
• Provide assurance of their safety
• Encourage them to show emotions – its ok to cry or be scared
• Be aware of limited attention span.
• Allow children to make simple choices and express opinions
• When correcting behaviour calmly provide reasons

 Age-appropriate Distraction Techniques

Evidence strongly supports the use of distraction to reduce pain and distress during medical procedures in children. Duff et al. (2011) identified two main principles:

1. Attention can be shifted away from potentially distressing procedures via the use of age-appropriate activities; and
2. The more interactive and varied the chosen distraction technique is, the greater the cognitive need, and therefore, the greater likelihood that distress levels are reduced.

The above excerpt from: https://www.ausmed.com.au/cpd/articles/nursing-paediatric-patients- effective-procedural-communication

• Talk to them about something else
• Allow play (toys, video games, phone games)
• Play music – this calms nerves
• Deep breathing
• Rewards
• With infants colourful shiny and noisy objects will help distract (jingling keys, rattles) The following Table shows Age-appropriate Distraction Techniques and is by the Royal Children’s Hospital Melbourne (2016)

Basic Physiological Differences in Children

It is important to be aware of differences between age groups and adults as they can factor into the more common serious outcomes for each age group.

Table: Australian Institute of Health and Welfare Copyright ©

Risks for age groups

As children age and grow, the risks and consequences change.

Infants 4 to 12 months

The majority of injuries occur in the family home

• Inhaling foreign objects
• Falls

Young children – 1 to 4 years of age

Are now quite mobile and curious about their surroundings without being risk aware

• Burns
• Falls
• Swallowing items unintentionally
• Objects placed and stuck in the ear

School-age children – 5 to 9 years of age

Involved in outdoor active play. Learning physical activities and involved in sport

• Falls from equipment
• Bruising, sprains, fractures
• Head knocks

Anatomy and physiology in children develop over several years to gradually assume the adult form. These anatomical differences are more pronounced in younger children (infant to preschool age); they begin to fade as they enter into school age and adolescence. By the time they are 18, most of the changes are complete. As a child is not simply a small adult, we need to be aware of these differences.

The head

• The disproportionally greater weight of the head (larger head-infants and small children) also affects the movement of the head when a child falls or is struck by a moving object.
  o Greater likelihood of head trauma as infants & young children are more susceptible to primary and secondary brain injuries
  o Greater heat loss

Airways

• Smaller diameter airways and more pliable
  o Hyper-extension leads to partial or full airway obstruction
  o Relatively minor swelling of the tongue or tissues in the neck can cause occlusion
  o Larger tongue in relation to space in the oral cavity
  o More likely to have an airway obstruction
• Infants have very short and softer tracheas than adults.
  o This means that overextension during airway manoeuvres may result in airway collapse (not too dissimilar to kinking a narrow garden hose). This is why an infant’s head /neck should never be tilted back when providing first aid.
• Large head size of an infant compared to its body.
  o When laid on its back, the head naturally tips forward towards the chest. A slight Backward tilt may be needed to place the head into a neutral position.
• Infants are nose breathers for the first 6 months
  o Means that a blocked nose can lead to respiratory failure!
• Flatter nose and face
  o May be more difficult to create a mask seal when providing ventilation to an infant

Basic Physiological Differences in Children

Various

• Faster heartbeat
• Faster respiration. Children breathe faster as they compensate
  o Slow breathing is an especially bad sign
• More flexible bones and less likely to fracture
  o But also offer less protection to underlying organs
  o Greater chance of partial (greenstick) fractures of long bones
• The greater surface area of skin-to-body mass
  o Increasing possibility of hypothermia; must keep younger children covered.
• Fewer body fluids & blood volume
  o Increased risks from dehydration or blood loss
  o Does not take much blood loss to cause shock; control bleeding early
• Thinner skin layers
  o Compared to adults have more serious burn trauma
• The liver and spleen less protected by the lower rib cage
  o Greater risk of blunt trauma to internal organs

Post-Incident Debriefing for Children

When a first aid incident arises, children may have observed the occurrence or have become aware of it. Besides the level of the actual frightening and distressing experience, a child’s response to it will depend on their age, personality, and level of development (emotional & mental).

Refer back to Module 3.2 ‘Post Incident Reactions’. The noted reactions apply to children as well. Some practical steps that can be taken to help a child that has been distressed:

• Staff to talk with children about their emotions and responses to the events
  o Listen carefully to them
• Reassure the child that they are safe and that the incident is over
• Explain events in a manner and level that the child can understand without overwhelming them
• Be understanding, calm, and supportive
• Inform all parents/caregivers of what had happened

If you are concerned about how the child is coping, recommend to the parents to seek professional advice and support