Your role as a paediatric first aider

In an EYFS setting you are the first responder until professional help arrives. Your job is to keep yourself and the child safe, work out what has happened, and give the right care fast, calmly and confidently. You are not expected to diagnose - you are expected to assess, act and hand over clearly.

The DR ABC framework

DR ABC is the memory aid used to assess every casualty in order, every time, without skipping a step.

• D - Danger: check the scene for hazards before you approach. Never put yourself at risk.
• R - Response: use AVPU - is the child Alert, responding to Voice, responding to Pain, or Unresponsive? Gently tap shoulders and call their name; never shake a baby or young child.
• A - Airway: open the airway with head tilt, chin lift. For a baby, keep the head in a neutral position; for a child, tilt slightly further, similar to an adult but gentler.
• B - Breathing: look, listen and feel for up to 10 seconds. Normal breathing, agonal gasps and no breathing are all different findings that change your next step.
• C - Circulation/CPR: if not breathing normally, start CPR straight away.

Calling for help

Shout for help immediately once danger is checked. If alone with an infant or child and it is a suspected primary cardiac arrest, give one minute of CPR before phoning 999. In most paediatric collapses (usually breathing-related), call 999 on speakerphone while starting CPR, or send someone else to call while you begin.

CPR ratios and rates

• Compressions to breaths: 30:2 for a lone first aider (matches adult ratio, simplest to remember and teach).
• Rate: 100-120 compressions per minute.
• Depth: about one-third of the chest depth - roughly 4cm for an infant, 5cm for a child.
• Infant technique: two fingers (or two thumbs, encircling hands, if two rescuers) in the centre of the chest.
• Child technique: one or two hands depending on the child's size, centre of the chest.

Common mistakes to avoid

• Skipping the danger check because the child is distressed - you help no one if you become a second casualty.
• Confusing AVPU levels or spending too long assessing response instead of moving to airway.
• Over-extending a baby's neck, which can close the airway instead of opening it.
• Forgetting the specific paediatric compression depths and using adult depth instead.
• Delaying the 999 call - decide early who calls and when, based on the one-minute-CPR rule for lone rescuers.

Recording and handover

Always note the time symptoms started, what you did and when, and hand this over clearly to paramedics or the next responsible adult. Accurate timings can change treatment decisions.

Why child and infant CPR differs from adult CPR

Children and infants usually collapse because of a breathing problem (like choking or asphyxia) rather than a sudden heart problem. This is why paediatric CPR always starts with rescue breaths, not straight to compressions.

Age definitions

• Infant: under 1 year old
• Child: 1 year old to puberty
• Once a child reaches puberty, use adult CPR guidance

The first steps

• Check the scene is safe
• Check for a response: tap and shout
• Shout for help but do not leave the child yet
• Open the airway: head-tilt chin-lift (use a neutral position for infants, not a full tilt, since their airway is more easily kinked)
• Look, listen and feel for normal breathing for up to 10 seconds

If not breathing normally

• Give 5 initial rescue breaths before starting compressions
• For an infant: seal your mouth over both the mouth and nose
• For a child: pinch the nose and seal your mouth over theirs, as with an adult
• Each breath should make the chest visibly rise

Compressions

• Ratio is 30 compressions to 2 breaths for a lone rescuer
• If two trained rescuers are present, use 15:2
• Compression depth: at least one third of the depth of the chest
• Rate: 100 to 120 compressions per minute
• Infant technique: two fingers in the centre of the chest, just below the nipple line
• Child technique: one hand (or two hands for a larger child), heel of the hand in the centre of the chest

Calling for emergency help

• If alone with an infant or small child, give CPR for 1 minute before stopping to call 999
• If others are present, send someone to call 999 immediately while you start CPR
• Put the phone on speaker if you are alone so you can keep going

Common mistakes to avoid

• Skipping the 5 rescue breaths and jumping straight to compressions
• Tilting an infant's head back too far, which blocks the airway instead of opening it
• Compressing too shallow through fear of hurting the child
• Forgetting to call 999 after the first minute when alone
• Stopping too soon: continue until help arrives, the child shows signs of life, or you are physically unable to continue

Recognising choking

Choking happens when an object blocks a baby's or child's airway, partly or fully. A mild (effective) cough means some air is still moving - encourage them to keep coughing, it's the most effective way to clear it. A severe (ineffective) cough means little or no air is moving, they cannot cry, speak or breathe properly, and their lips may turn blue. This needs immediate back blows and thrusts.

Babies under 1 year

• Lay the baby face down along your forearm, head lower than chest, supporting the head and jaw with your hand.
• Give up to 5 sharp back blows between the shoulder blades with the heel of your hand.
• Check the mouth after each blow and remove any visible obstruction (do not finger-sweep blindly).
• If still blocked, turn the baby face up along your other arm, head low, and give up to 5 chest thrusts using two fingers on the lower half of the breastbone, sharper and slower than CPR compressions.
• Alternate 5 back blows and 5 chest thrusts. Never use abdominal thrusts on a baby under 1 - it can damage internal organs.

Children over 1 year

• Give up to 5 back blows between the shoulder blades, bent forward, with the heel of your hand.
• Check and remove any visible obstruction between blows.
• If not cleared, give up to 5 abdominal thrusts (the Heimlich manoeuvre): stand behind the child, fist just above the navel, grasp with the other hand and pull sharply inward and upward.
• Alternate 5 back blows and 5 abdominal thrusts.

If the child becomes unresponsive

• Shout for help and call 999 immediately (or send someone).
• Open the airway, look in the mouth and remove any visible object.
• Start CPR straight away, beginning with chest compressions, even if a pulse is present - the compressions can help dislodge the object.
• Check the mouth briefly each time you open the airway to give breaths.

Common mistakes

• Doing a blind finger sweep (can push the object further down).
• Using abdominal thrusts on a baby under 1 year old.
• Not calling 999 once the child becomes unresponsive, or once an abdominal thrust has been used (they should always be checked by a doctor afterwards).
• Panicking and not checking effectiveness of cough first when it's still a mild, effective cough.

Why this matters

Bleeding and shock are true emergencies in paediatric first aid. Children have a smaller total blood volume than adults, so a loss that looks small can quickly become serious. Your job is to control the bleed, spot shock early, and manage wounds safely while waiting for help if needed.

Controlling bleeding

• Put on disposable gloves first if available, to protect yourself and the child.
• Apply direct pressure to the wound with a clean pad or dressing, pressing firmly.
• Raise the injured limb above the level of the heart if possible, unless you suspect a broken bone.
• Do not remove an object embedded in a wound. Build up padding around it and bandage over the top, applying pressure either side, not directly on the object.
• Once bleeding is controlled, secure the dressing with a bandage. If blood soaks through, add more padding on top rather than removing the first layer, which could restart bleeding.
• Call 999 for severe bleeding that will not stop, deep wounds, or bleeding from major areas such as the neck, chest or abdomen.

Recognising shock

Shock happens when the body cannot deliver enough blood and oxygen to vital organs, often following blood loss, severe burns or dehydration.

• Look for pale, cold, clammy skin.
• Fast, weak pulse and rapid, shallow breathing.
• Weakness, dizziness, nausea or a feeling of anxiety.
• Yawning, sighing, or eventually loss of consciousness if untreated.

Treating shock

• Lay the child down and raise their legs above heart level to help blood flow to vital organs.
• Keep them warm with a coat or blanket, but do not overheat them.
• Do not give anything to eat or drink, as they may need surgery or could vomit.
• Loosen tight clothing around the neck, chest and waist.
• Call 999 immediately, and monitor breathing and responsiveness constantly until help arrives.

Wound care basics

• Clean minor cuts and grazes under running water and pat dry with a clean gauze swab.
• Cover with a sterile, non-fluffy dressing sized to the wound.
• For nosebleeds, sit the child forward, pinch the soft part of the nose for 10 minutes, and tell them not to sniff or blow their nose afterwards.
• For a bleeding tooth socket, get the child to bite on a clean pad for at least 10 minutes.

Common mistakes

• Removing an embedded object, which can make bleeding worse.
• Tipping the head back for a nosebleed, which risks blood going down the throat.
• Giving a child in shock food or drink.
• Peeling off a soaked dressing instead of padding over it.
• Forgetting gloves, risking cross-infection for both first aider and child.

Febrile seizures

A febrile seizure is a fit triggered by a rapid rise in body temperature, usually with a viral infection. They happen in children aged roughly 6 months to 6 years, most commonly between 12 and 18 months.

During a seizure: protect the child from injury, do not restrain them, do not put anything in their mouth, and time it. Once shaking stops, place them in the recovery position and check breathing.

Call 999 if it is the child's first seizure, if it lasts longer than 5 minutes, if a second seizure follows the first, if breathing seems abnormal afterwards, or if you are in any doubt. A seizure lasting under 5 minutes that stops on its own in a child with a known history can be followed up with a routine GP call, but as a setting you should still inform parents immediately and follow your policy.

Fever basics

Fever in a baby or child is usually defined as a temperature of 38C or above. Under 3 months old, a temperature of 38C or above is an emergency needing urgent medical assessment. Between 3 and 6 months, 39C or above needs urgent assessment.

Watch for red-flag signs alongside fever: pale, mottled or blue skin; a weak, high-pitched or continuous cry; difficulty waking or staying awake; a bulging fontanelle; neck stiffness; reduced skin turgor; reduced urine output; rapid breathing or grunting.

Meningitis and septicaemia

Key warning signs include a stiff neck, severe headache, dislike of bright light (photophobia), a high fever with cold hands and feet, drowsiness or floppiness, a high-pitched cry, and a non-blanching rash. Test a rash by pressing a clear glass firmly against the skin: if the marks do not fade under pressure, treat this as a medical emergency and call 999 immediately, even if the child seems otherwise well.

Common mistakes to avoid

• Do not restrain a child having a seizure or try to stop the shaking.
• Do not put anything in the mouth during a seizure, including fingers.
• Do not wait to see if a non-blanching rash spreads before calling 999.
• Do not assume a fever below 38C in a young baby is nothing to worry about; any concern in an under-3-month-old warrants urgent advice.
• Do not forget to time the seizure; the 5-minute mark is the trigger for calling an ambulance.

Anaphylaxis

Anaphylaxis is a severe, life-threatening allergic reaction that can develop within seconds to minutes of contact with a trigger (common ones in children: nuts, eggs, milk, insect stings, some medicines). It affects the whole body, not just one area.

• Signs: swelling of lips, face, tongue or throat, difficulty breathing or noisy breathing, widespread blotchy skin rash, floppiness or loss of consciousness, and sometimes vomiting or stomach pain.
• Action: call 999 immediately and state 'anaphylaxis'. If the child has their own auto-injector (such as an EpiPen, Jext or Emerade), help them use it, or use it for them, without delay.
• Lay the child flat with legs raised if breathing allows, or sit them up if breathing is difficult; never stand or walk them.
• If there is no improvement after 5 minutes, and a second auto-injector is available, give it.
• Common mistake: waiting to 'see if it gets worse' before using the auto-injector or calling 999. Do not wait.

Asthma attacks

Asthma is a common chronic condition causing narrowed airways, wheeze, coughing and breathlessness, often triggered by exercise, cold air, allergens or infection.

• Signs of an attack: persistent cough, wheezing, tight chest, rapid or laboured breathing, difficulty talking or feeding, blue tinge to lips (a medical emergency sign).
• Action: keep the child calm and sitting upright, help them use their own prescribed reliever inhaler (usually blue), ideally via a spacer, one puff at a time up to 10 puffs, waiting about 30-60 seconds between puffs.
• Call 999 if there is no improvement after 10 puffs, if this is their first attack, if symptoms are severe, or if you are in doubt at all.
• Common mistake: assuming a spacer is not needed for young children — spacers improve drug delivery at any age and should always be used with a metered-dose inhaler if available.

Common childhood illnesses

Settings must know when a common illness becomes an emergency.

• Febrile illness: a temperature of 38C or above in a baby under 3 months, or 39C or above in a baby 3-6 months, needs urgent medical advice.
• Febrile convulsion: seizure triggered by fever, usually in children aged 6 months to 6 years; protect from injury, do not restrain, place in the recovery position once jerking stops, time the seizure, and call 999 if it lasts longer than 5 minutes or recurs.
• Meningitis warning signs: stiff neck, severe headache, dislike of bright light, non-blanching rash (does not fade under a glass tumbler), high fever, drowsiness — treat as a medical emergency and call 999.
• Croup: barking cough and stridor, usually worse at night; sit the child upright and calm, seek urgent help if breathing is severely laboured or the child turns blue.
• Common mistake: assuming a fever alone is the danger sign — it is the combination of fever with other red-flag symptoms (rash, drowsiness, breathing difficulty) that signals an emergency.