Episode 7: Child Health

Introduction to First Aid Unboxed Episode 7

Louise: Welcome to episode 7 of First Aid Unboxed with Louise Madeley from Madeley's First Aid Plus. Good morning to you, Louise.
Mark: Good morning.
Louise: What are we going to be talking about this week?
Mark: We're going to be talking about children.
Louise: So what you want to talk about is child health, basically.
Mark: Yeah, well, part of it. Things that can happen, for example, choking. It is the biggest killer in children. It's the thing that children are most likely to die of in this country. But also an awareness of serious illness, such as sepsis, septicaemia, meningitis, things to look out for, knowing when to get your child into a medical professional as quickly as possible and not delaying. So, yeah, different conditions that may need seeing much quicker than others.

Frontline Experience in Child Health

Louise: And one of the things that we always point out here with Louise is she worked for many, many years for the NHS in A&E. And these are the things that she saw coming through the door in her time at A&E. So these are not statistical things.
Mark: These are things that actually she knows about and actually happened when she worked in A&E. So it's real frontline service stuff. It's not sensationalist newspaper talk.
Louise: No.
Mark: I think we can say that. The other thing you talked about was measles as well. That's also on the rise again, isn't it?
Louise: It is, yeah. The MMR vaccine hasn't had the uptake that it needed to be. And as a result, we are seeing more of a measles outbreak.

The Rise of Measles and Its Dangers

Mark: And measles is a killer, isn't it?
Louise: It can be. If left not recognized, yes, as a lot of conditions are, if they're not treated, then they get severely worse. And that's when people tend to bring people into A&E rather than getting them seen too early than that with the GP, et cetera.

Understanding Choking in Children

Mark: Let's talk about choking first then. That's the first thing you said is the biggest issue with child health and the thing that is most dangerous because it's something that can happen very easily in the home or anywhere in fact. Tell us what the situation is and how we deal with that.
Louise: Choking is the biggest killer of children who are fit and well and getting on with their life. And there's no serious illness behind it at all. It's something that can happen within the home and does happen within the home. And it's about knowing what to do very quickly because anybody who starts to choke, they have very time limited before things get very serious. So you need to know what to do immediately.

Recognizing Choking Symptoms

Mark: When you say time limited, how long do you have?
Louise: About three minutes.
Mark: And what do you need to look out for and then what do you need to do immediately?
Louise: The first thing is recognizing that somebody is choking. And this is the same for any age group. Children are more likely to choke in a way because they put things in the mouth, especially the younger age groups and their airways, their pipes are much smaller than yours or mine. You know, so they're more likely to get things stuck in there than an older person, and they're more likely to put stuff in there in the first place. So hence, choking is such a huge issue. And we just need to be aware of it, what to look for if somebody is choking.

First Aid Steps for Choking

Mark: And what do we look for?
Louise: First of all, people assume that choking involves lots of coughing. And the early stage of somebody's going to choke, yes, there will be, because the airway has been partially blocked and they do start coughing. So the first thing you need to say is, are you choking? And get them to cough. That's the first thing, because if they're able to cough, there is a gap, if you like, whereby they can cough and try and project it back out, which is what you want them to do. You don't want them to inhale. You want them to cough, to try and push it out themselves. It's a natural response that the body does. And generally, you tend to find that somebody that's choking they'll put their hands up to their neck. They'll lean over in a perfect position to expel an object out of their body to get as much force as possible. The body is an amazing thing. It will try and eject anything that's not meant to be in there.
Mark: And the body recognizes it. So it's working alongside your own body and its natural reaction to expel something. So the first thing you want to do is get them to cough. It may seem like a silly thing to say, but sometimes they do just need that little prompt to people go into shock and all sorts of things. And, you know, they may not immediately try and expel it. So especially with kids, just get them to cough first. That's the most important thing.

What to Do If Coughing Doesn’t Work

Mark: Okay. And then if they can't expel it by coughing, where do we go next?
Louise: Well, everything goes very silent. That's the clue when it comes to choking, both adults and children. The first thing you'll get is an absolute silence. And it is a very, I've had one choking incident. The thing with choking, and paramedics will say it, it's very rare that they actually witness the choking side of things. Because by the time a paramedic gets there or any other medical professional gets there, you're a lot further down the line. You have moments to get something out of somebody. If you think if you are completely blocked in your airway, no air is going into your lungs. You have stopped breathing. And although you're awake to begin with, you will become unconscious fairly quickly. We're talking a matter of a few minutes. So you are suffocating basically?
Mark: Yeah, you are exactly that. It's gone further down than your nasal airways and your mouth airways. It's gone further down. It's in your neck, if you like, without using any terminology, that's where it is. And at that point, there's no other way of air getting into your body. So yes, you are suffocating completely.

Administering Back Blows

Mark: Okay, and when we get to that point, so we get to that silent point, which sounds incredibly eerie, to be honest, then what do we do next?
Louise: Then you need to go to the back of them. If it's a child and you can get them over your knee, for example, fantastic. Just get them so that they are bent over you in some way, bent over table, bent over something, so that you can get your arm around them. And from the back, you give them five hard back whacks. And it's not just a gentle, it's a proper, a full, between the two shoulder blades, back whack. You hit as hard as you can between their shoulder blades and try and jettison it out of their mouth. Never put your fingers in there, so you're not going in and finger sweep or have a look, see, you know, you don't get your fingers in or anything else to try and get it out. It won't work. It'll go further in. So the same as with an ear, you never put anything in there. We always say you never put anything bigger than your elbow, that's smaller than your elbow, into your ear. Same thing, you don't go poking and prodding at all. You need to be able to get enough pressure underneath it to hoik it out. It's not gonna work by trying to push anything inwards. So five very strong back whacks between the shoulder blades.

Transition to Abdominal Thrusts

Mark: How effective does that tend to be?
Louise: It depends on how far down the airway it is, basically, and how big the blockage is. Sometimes that can be enough, and that's great. You'll see it jettison out and they will start coughing. Fantastic. Great thing is you know when something's out because they'll make an awful lot of noise about it, which is what you want to hear. However, that doesn't always work, and then you have to go to abdominal thrusts. It's something that used to be called the Heimlich manoeuvre. It is no longer called that. It's abdominal thrust. It's the same procedure, but it's got a different name.

Performing Abdominal Thrusts

Mark: Okay, and with the abdominal thrusts, how do we do that?
Louise: You go around. It's very difficult without actually somebody seeing me doing it. You go around the back of somebody and you put your hands together, clasp your hands, and then if it's a child, do it with one hand. If it's an adult, do it with two. Depends on how much force you need. And the size of the child. But you then place it into, it's the little soft bit just underneath your ribs that you're going to. It's the peritoneum. So it's a nice little soft bit here. And you push your hands in and then you pull sharply inwards and upwards and do that five times. So you're going into that soft bit of their tummy. Pull sharply inwards and up at the same time. It's almost like a rocking motion, but very sharply. Otherwise, you're not going to get enough pressure inside the chest cavity for it to jettison that blockage out. And you do that five times.
Mark: Okay. Once you've done that, you then, if it still hasn't come out, you go back to the back blows, then the abdominal thrust. So you do five back blows, five abdominal thrusts, five back blows, five abdominal thrusts, and keep doing that. Fingers crossed, it'll come out by you doing that. If it doesn't, then we're back to an unconscious person or unconscious child, and you're doing your CPR. So it's airway breathing circulation.

When to Call Emergency Services

Louise: They have no airway, they're not breathing CPR.
Mark: And this may seem a very difficult question to answer, but I'm going to ask it anyway. At what point do we dial 999?
Louise: The minute you see they're choking. Pure and simple. If anybody's having back blows and abdominal thrusts, even if you do get it out, they need to be seen by medical professionals. You are jerking your hand into their peritoneum. You do run the risk of a little rupture, similar to a hernia. It's that sort of, you know, you've got a tear in the wall. That is considerably better than not being here anymore. It's as simple as that. It has to be done. The same as CPR.
Mark: Yes, you can run the risk of fracturing somebody's ribs. They're not going to be here if you don't. It must be done. And it's exactly the same. So you just make sure that they are seen by a medical professional afterwards and checked over. Usually, they go with the paramedics, go to A&E and get checked by a medical professional. And hopefully, they'll be fine to go later. But they absolutely must be checked over first.

Recognizing Serious Illness in Children

Mark: So what's the next thing you think is what people should be looking out for as regards to their child's health?
Louise: It's looking for those conditions that can lead to going to A&E when they could have been treated much earlier.
Mark: So it's a case of spotting these things early?
Louise: Yeah. Yeah, it's the same with all kids' conditions. Kids can get sick very quickly. That's the thing. And that's different to adults. Adults can sort of manage for a great deal of time, and then they get sick, whereas kids can get sick really quickly. So it's recognizing those symptoms early in order that they don't get to the point whereby they're really sick. And that's the hardest thing. As a parent, I know it well. And sepsis and septicaemia in particular, it's a big one for me because I've had sepsis, and I didn't recognize myself ill, despite the fact that I worked in A&E at the time. And I actually wrapped myself up in a blanket, went downstairs, got the fire going, and laid by the fire. Despite the fact that my temperature was going up and up and up, I was delirious without realizing what was going on. So people can get sick, especially from something like sepsis, very quickly and not realize what's happening to them.

Understanding Sepsis and Septic Shock

Mark: And in children, this happens really fast.
Louise: Yeah, it does. Yeah. Kids, especially if they have meningitis, for example, they can get sick very, very quickly, septicaemia, usually from a completely innocent infection. And the body's reaction is to become septic. And that's when they get sick very quickly. They tend to get better very quickly as well. That's the thing, when they have the right medication, they have the right treatment, they tend to get better a lot quicker. Certainly than adults. But yeah, it's the speed that they can get poorly.
Mark: A slight sideline here, just because something's popped into my head. What is septic shock? Is that all part of the same process?
Louise: Yes, it is. Yeah, septic shock is when the body's reaction has led them to go into shock. And we're talking about quite often, bacteria that may not be that serious, but once they get into the bloodstream and once the system is reacting to it, then yes, they get sick very quickly. And that's septic shock.
Mark: And I assume it's going to happen with children as well?
Louise: Yeah, absolutely.

Symptoms of Sepsis in Children

Mark: Okay, and what are we looking for?
Louise: Yeah, I mean, there's several symptoms, particularly with sepsis, if they've got a very high temperature. We class a high temperature as anything above 38 degrees Celsius. What a lot of people don't know about is if the temperature is particularly low as well. So if it's below 36, that can be a sign of septicaemia. Their heart will beat really fast, and so will their breathing. So a high heartbeat, very fast breathing, and literally you can be talking 40 plus a minute from a child with their breaths. Feeling dizzy and faint, cold and shivery. What people don't tend to realize is as your temperature goes up, you feel cold, because your temperature, you're heating up on the inside. So your skin will feel cold, because your blood is moving out of your extremities and into your core. So it's protecting your brain, your liver, your heart, et cetera. But the rest of you will feel cold. And that was what happened with me. I felt exceptionally cold and couldn't register why that was. And at the same time, because I became quite delirious and couldn't function, I couldn't put my brain together and think, well, why am I feeling cold? Let's check my temperature, see if that's okay. None of that happened. Didn't think about anything.
Mark: So this is the cold sweat people talk about.
Louise: Yeah, absolutely. It goes inwards. So you do become, you can start shivering, start sweating, become very slurred speech, muddled thinking, which is what happened with me. Our eldest, Will, came home and he said that he was the one that found me. And he said, I was exactly like that. It was very bizarre. He just came home to find me lying down, just not able to have a normal conversation with him. And bless me, he was only about 14 at the time. But it was quite scary for him. You can get severe pain, discomfort in certain parts of the body, it become pale, blotchy, your skin can turn blue, especially with kids. They can go blue very quickly and they lose oxygen out of their vessels much quicker than adults do. So it's the same with CPR. We give five rescue breaths for children, mainly or partly because they lose that oxygen really quickly. We breathe in 21% oxygen, that's what's in the atmosphere. We breathe out about 15% because around 6% is what we utilize in our body. So when we're breathing out, there's 15%. So it's very important that children get those rescue breaths in CPR because they've lost that oxygen, whereas adults tend to have that residual oxygen in their bloodstream for a lot longer after they've stopped breathing. Children don't. They go blue and look horrendous very, very quickly. And it's the same with septicaemia and sepsis and other conditions where an inflammatory response is taken over and they become sick very quickly. They look it. Having difficulty breathing, like I said, breathing very fast, there can be a rash. For example, with meningitis in particular, have you heard of the glass test where you put a glass over the skin and just see whether or not it disappears and comes back again? Or whether it doesn't is more the point. If it doesn't, then you know you've got a serious condition and you need to get them to A&E quickly. So it's about recognising those symptoms quickly. They may not have all of them.

Importance of Early Medical Intervention

Mark: They may only have one or two. But if you recognise that they're getting these symptoms, then it's very important you get them seen too fast. And as you have pointed out, with children, things deteriorate very quickly. So fast action is really what you need in these situations.
Louise: Yeah, absolutely. With children under 18 months, where their fontanelle is still there, pressing on the fontanelle and just see if it's boggy. See if it goes up and down. If it does, that's great. If it goes inwards and it sticks inwards, and when you take your hand away, it doesn't come back out or anything, then you certainly need to get somebody to you as quickly as possible. Get them to the GP if you can. Same-day appointment, if not, 111. And if you're really concerned, 999.

Managing Fever and Medication in Children

Mark: So when a parent feels that their child doesn't quite look right, one of the things they're going to do is think, oh, shall I give them some medicine with some description? Calpol, paracetamol. What's your take on that?
Louise: Yeah, generally Calpol, Brufen. Two takes on that. One is yes, it's very good for bringing down temperature and for dealing with pain. If it's pain, then carry on as normal. That's, yeah, absolutely. It's got it written on the back, how much to give depending on the age of your child. That's great. When it comes to temperature, however, it's a little bit different because the body is creating that temperature to fight the infection that they've got. There's an infection somewhere, the body, its natural response is to get a temperature, and you want it to get a temperature. However, what you don't want to do is keep giving Calpol, bring that temperature down, and as a result, they're not going to be fighting the infection. At the same time, if they're getting a high temperature and they're becoming uncomfortable with it, and children tend to become very lethargic and floppy and so on as soon as they start to get a temperature, then giving Calpol, absolutely. Combination of Calpol and Brufen depending, generally we tend to say alternate them. So give some Calpol and then on guidelines, obviously, take some Brufen, later on, take some Calpol. So alternate the medication. However, what you don't want to do is mask whether or not they've got a temperature. So if you keep giving Calpol, Brufen, you'll find that you don't actually know if they've got a temperature, because all you're doing is constantly bringing the temperature down. And we don't want the body to not be able to fight the infection itself. So take advice. If you're needing to give it more than a day or so, then I would most certainly be calling 111 and to say, my kid's got a temperature. I've given Calpol, given Brufen, the child's no better. And as a result, they'll decide what they need to do. Probably need to see a medical professional at that point to decide what the treatment is and what the underlying cause is, which is the most important thing. So yeah, if you're needing to give it for temperature reasons, you should be calling the medical professionals anyway.

Common Childhood Diseases and High Temperatures

Mark: And with all the various diseases that children commonly get, and I'm thinking scarlet fever and measles and meningitis obviously is another one, these are all pre-empted by a high temperature.
Louise: Can be. Yep.
Mark: Okay, which ones aren't then?
Louise: All of them may not have a high temperature. That's the thing. It's really about knowing the different symptoms and if they've got one or two of them, then getting seen because sometimes somebody may have, for example, scarlet fever, which is actually strep throat. It's streptococcus, often begins to look like tonsillitis, and then they look significantly worse where they've got very sore throat and starting to have difficulty swallowing. You can see the tongue goes absolutely scarlet. Hence, we call it strawberry tongue, and they get a rash and so on. So it develops, usually starts looking like tonsillitis and then develops further. They may have a temperature with it. They may not. That's the thing. But it's about knowing those different symptoms. Have a look on the NHS website. It'll give you all the different symptoms and seeing if there are one or two of them. If there are, go and see. Seek medical help.

Measles Outbreak and Prevention

Mark: What about measles?
Louise: Yeah, on the rise, unfortunately. We're in the West Midlands ourselves, which is a hotspot for it at this moment. Measles is a condition that's been around for donkey's years. We did manage to pretty much eradicate it. However, without taking the MMR vaccine, it has started to come up more. Measles tends to look a bit like a cold to begin with. After a few days, you tend to find a rash develops, and it's a very blotchy rash. I think it's the best way to describe it. It starts generally on the face and behind the ears before spreading to the rest of the body. It's not usually itchy at all, but it's very blotchy. Blotchy patches is the best way to describe it. It doesn't look like chicken pox at all. It looks completely different, and it's not itchy generally. That's the clue with measles. You can also get white spots on the tongue, which is another red flag, shall we say, for measles. Sore, watery eyes, cough, sneezing, runny nose, high temperature sometimes, not always, and that rash on the tongue going down the body, that's a pretty high indication of measles. It needs to be seen by a medical professional and get it diagnosed properly.

Importance of Vaccinations

Mark: Well, back to the thing, really, if your child looks ill, they probably are.
Louise: Yes, correct.
Mark: The other one I was talking about when I was young, the things that were always the same, it was mumps, chicken pox and measles. I assume chicken pox and mumps are still out there.
Louise: They are, although having the MMR and vaccine, I've had mumps, I had it in the 80s. I looked at a picture. In fact, you couldn't see the difference from my face down to my chest. It was all joined in the middle. My neck was so swollen that you just couldn't see any difference between me. So that was a picture. I was about 10, I think, something like that. But again, that was before the mumps, the MMR, measles, mumps and rubella, rubella being German measles. So yeah, we don't get it as much as we used to. It is still out there a little, but it's nothing to do what it was when we were kids.
Mark: So would your advice be make sure your child gets the vaccines?
Louise: Yes, it is. I know it's a contentious issue, but certainly from a medical point of view, it is important that kids have the full schedule that's available in the UK. Keep your vaccines up to date.

Final Advice for Parents and Caregivers

Mark: So if there's one thing, one piece of advice you could give to a parent or a caregiver, what would it be?
Louise: If you're in any doubt, get the child seen, full stop. Early recognition saves lives. It's as simple as that. Getting them seen earlier rather than later every time. That's what will get your kids home quicker. And like I said, if they look ill, the child will know they are ill. Yes. Trust your instincts. You're a parent, trust your instincts.

About Madeley's First Aid Plus

Mark: OK, Louise, that's fantastic. Louise runs Madeley's First Aid Plus, obviously. And what do Madeley's First Aid Plus do?
Louise: We deliver physical and mental health first aid training and safeguarding training to individuals, to SMEs, small companies and corporations.
Mark: OK, and what's the best way that people can get in contact and find out more about the services that you offer?
Louise: Have a look on my website, madeleysfirstaidplus.co.uk, or you can email me at enquiries@madeleysfirstaidplus.co.uk.

Upcoming Episode Preview

Mark: So we'll be back in a few weeks' time with another First Aid Unboxed from Louise Madeley from Madeley's First Aid Plus. What are we going to be talking about next time?
Louise: We're going to be talking about seizures. So two different types. They've had different names over the years. It used to be called grand mal and petit mal seizures. We now refer to it as a generalized seizure or a partial seizure. And we'll go into what you need to do from a first aid point of view if you witness somebody having a seizure.

Mark: So if you're listening to this, you obviously found us. Have a listen to the other episodes. There are lots of other episodes on there. We've already talked about the plumbing, the electrics and the mechanics, the circulatory system and bleed and what to do, shock, heart attacks and cardiac arrests and CPR and defibrillators. That was the previous episode. So all those things are available now. All you have to do is go to your preferred podcast platform and put in First Aid Unboxed and they will all pop up. Please subscribe and follow us and review the podcast as well. That really helps. You can also listen to them. If you go to 1386audio.com/havelisten and you click on the picture of Louise on there and you will see all the episodes there for you to listen to. Right Louise, thank you very much for coming in and talking to us.
Louise: Looking forward to the next one now.
Mark: Absolutely. I shall see you then.
Louise: Thanks very much and stay safe everybody.
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Connect with Madeley's First Aid Plus
• Website: madeleysfirstaidplus.co.uk
• Email: enquiries@madeleysfirstaidplus.co.uk
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Stay Tuned for Episode 8: Next week, we'll delve into seizures, discussing the different types and essential first aid steps to take when witnessing a seizure.

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