CPR and Choking

Originally published 22 March 2009.

Many health hazards exist in a child's world that require immediate treatment when a child is in danger. While care is taken to create a developmentally appropriate learning environment, an early childhood education center may have a number of developmental stages within one classroom. This is also often the case in a home with more than one child. This means that while older children may be prepared to interact appropriately with items such as scissors or very small objects, younger children in the home or classroom may not be. In many cases, this mixed-development environment results in items dangerous for younger children being accessible to them. Caregivers must be prepared to deal with potential emergencies resulting from these circumstances.

In the 2-3 toddler classroom, young Amy has just moved up from the infant room. She is still unsteady on her feet and chooses to crawl around her new environment. Still in the oral learning stage, her first instinct when she encounters a button on the floor during her explorations is to put it in her mouth. The button had fallen from the table where her not-quite-four year old classmate is working on a button sorting project. The lead teacher is sitting on the floor with another child in her lap, and the aide is returning from the bathroom with a potty-training child. They both scramble towards Amy as she pops the button in her mouth and begins to choke on it. One teacher moves to intervene with Amy while the other tends to the rest of the class.

As long as Amy is coughing well, the teacher encourages her by demonstrating good coughs, and lending assistance if necessary. The button does not appear, however; Amy begins having weaker coughs and the teacher must perform the Heimlich Maneuver, or abdominal thrusts. Because Amy is two years old, the teacher will do this in the method used on children, and not the one used on infants. This should force the button out of Amy's airway. Cigna Healthcare provides good pictures of the Heimlich Maneuver on their website.

Little Tommy is playing on the playground with his friend from the older class. They get along very well; however, sometimes his friend forgets that Tommy is younger and still much smaller and lighter than he is. Tommy and his friend decide to play on the teeter totter in the older grade playground. Suddenly, his friend drops his end of the teeter totter and smacks it on the ground when Tommy isn't holding on. Tommy flies off the teeter totter, knocks his head on the ground, and stops breathing.

When the recess teacher arrives, Tommy is unconscious. The teacher checks carefully for breath by watching his chest, listening, and feeling for air. She also sends two older children to get the other recess teacher on the ball field, who calls 9-1-1 when informed of the accident. The teacher treating Tommy looks in his mouth to be sure that there is nothing in the airway that she can see. If a child is unconscious and the airway needs to be cleared, the teacher can tip his head back; but this teacher knows that Tommy hit his head from falling and is afraid there might be damage to his spine, so she will have to use her best judgment on whether or not to tip his head to clear the airway. Tommy's airway seems clear but he's not breathing, so she plugs his nose with one hand, and breathes lightly twice through his mouth.

Giving Tommy air to breathe doesn't start him breathing on his own, so the teacher checks for a pulse. Tommy has no pulse, so she must administer CPR, or Cardio Pulminary Resuscitation. Following the steps she learned in training, she locates his sternum and presses down five times, performs rescue breathing, and alternates the two until Tommy begins breathing or emergency help arrives. First Aid Web has great information on child CPR with pictures.

As shown in both Amy's and Tommy's cases, some advanced planning could have prevented both of these accidents. Better choices of play material, organization, clean-up practices, fences for keeping crawlers away from certain areas, or only allowing small object games for older children while the younger ones had an extra nap could have all helped prevent Amy from swallowing the button. Enforcing playground rules or having older child playground equipment in a separate area from the younger equipment could have prevented Tommy's accident. Paying attention to keeping the environment developmentally appropriate can prevent a large number of accidents. For many accidents that do occur, teachers can prevent them from becoming life-threatening emergencies by being trained in infant and child CPR, first aid, and the use of a defibrillator if one is available to them. Planning ahead can make a vital difference even in something as seemingly small as choosing to carry a cell phone when outside the school building so that another teacher or emergency personnel can be called if necessary.

Teachers and parents must work together to prepare children and adults for the possibility of an accident or medical emergency. Both the home and the classroom should have a first aid kit available to them. The home kit may include medications, bandages, creams, tweezers, and a thermometer, among other things. KidsHealth from Nemours has a more complete list on their website. The first aid kit for the classroom should be designed in accordance with school health policy and the school nurse, but may contain band aids and bandages, a thermometer, and tweezers, among other things. In many schools, classroom kits may not include medications unless it is specifically written into a student's health plan that these medications are available in the classroom. Teachers should also keep family emergency contact information and hospital plan, any unique student health plans such as an asthma care plan, and even picture flashcards of emergency procedures just in case. If a student is on regular medication and a prescription is on file, a copy (labeled as "copy") may be useful to have available if emergency personnel respond to the scene. All of these documents should be kept with the first aid kit so they are readily available if needed.

A final thing that parents and teachers must do is prepare their children. Teaching children that there are plans in place for emergencies, that accidents happen and adults are ready to handle them, and allowing the children to participate in preparing if developmentally appropriate can help them be calm and assured during an emergency. Both the Red Cross and the American Heart Association, as well as other organizations, have school curriculum and family activities geared towards preparing children of all ages for health emergencies. Teach children what to do in any personal emergency that may happen to an adult while they are in their care, such as how to dial emergency numbers on the phone and where they can find the next nearest adult. Provide a plan for the children and role play emergencies in both the home and the school setting so that they can practice what to do. Parents should encourage the children to share school procedures with them and role play them at home; likewise, teachers should encourage and lead role play on home procedures as reasonably appropriate.

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