It is very important that you take a course in first aid and cardiopulmonary resuscitation (CPR). This lesson does not replace that course. This lesson only provides a brief introduction to keeping children safe when they are injured.

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Children are natural explorers. Have you ever thought, “That child has no fear!”? You were probably right: Children do not always recognize the danger in situations. They challenge their developing bodies and minds. In school-age programs, we have to be prepared to respond to a range of injuries.  Some injuries will only require cleaning and bandaging. Other injuries require immediate medical attention. You must be able to tell the difference between the two. You must be prepared to respond during any situation. Consider these examples:

Your program space is designed to minimize risks when accidents occur. For example, properly inspected playground equipment and cushioned fall zones make it unlikely Simone would be seriously injured in a fall from the slide. The safety rules you teach make it less likely children will collide with one another at high speeds. Even in the best situations, though, accidents happen. You must be prepared to act on injuries big and small. Some injuries are small and only require minor first aid. For example, when Dante skins his knee, the staff member will likely respond by cleaning the wound, applying a bandage, and completing an incident report. Dante is able to continue playing.

Other injuries are serious but not life-threatening. For example, Madison and Simone may need medical treatment for their injuries, but they are not likely to face permanent disability or death.

Some injuries are life-threatening and require immediate medical attention. For example, Luke’s accident with a moving vehicle, ingestion of unknown pills, and Millie’s choking could all result in serious injury or death. As a school-age staff member, you must be able to recognize these situations and respond appropriately.

You must know what resources are available for helping an injured child. Depending on the severity of the injury, you can:

• Perform, or find someone who is trained to perform, first aid or CPR. Training on first aid and CPR is offered by your employer and community agencies, such as the Red Cross.
• Call emergency medical services (EMS) or its equivalent in international locations. EMS refers to any emergency responders in your area. These may be firefighters, ambulance companies, or the police. EMS services are reached when you dial 911 in the United States. Outside of the United States, talk to your administrator, trainer, or coach about how to obtain emergency medical services.

Identifying and Responding to Concussions

As children are growing and learning, accidents are bound to occur. But what happens when a child suffers a significant head injury? What if they are unable to communicate how they feel as a result? With increasing research about the long-term effects of traumatic brain injuries, it is important for caregivers to understand how to properly identify and respond to head injuries in young children.

Childhood concussions are common. They can affect a child’s ability to think, learn, and interact with the world around them. According to Dr. Sam Torbati of Cedars-Sinai Hospital (2021), a concussion is “a mild, temporary form of brain injury that can result after a forceful blow to the head or jolt to the body which causes the brain to bounce against the skull.” Concussions are often thought to be the result of sports injuries, however, the most common reasons for a concussion in younger children are falls or collisions with objects such a ball, peer, table, or wall. The following are a few scenarios in which a concussion could occur in a school-age child:

Symptoms of a concussion can appear immediately following the injury or up to a few days afterwards. For this reason, it is important for caregivers to carefully observe the child and track their symptoms over the course of several days. Below are common symptoms you may notice in school-age children and youth who have experienced a concussion:

• Vomiting
• Headache
• Dizziness/ balance problems
• Changes in vision
• Sensitivity to light or sound
• Difficulty concentrating
• Memory loss/ slowed response time
• Changes in mood
• Significant changes in sleep patterns
• Changes in appetite

Regardless of the perceived severity of the head injury, caregivers should take the following actions after a blow to the head occurs:

1. Stay calm: We know that young children’s actions and feelings are affected by their caregivers’ responses. When you remain calm, the child can focus on calming themselves if they are upset.
2. Take action: Use your knowledge of the typical appearance and behavior of the child. If anything seems out of the ordinary, or you observe any of the symptoms listed in the table above, seek appropriate medical care. Once the situation has been evaluated, provide appropriate first aid (stop any bleeding, clean any cuts or scrapes, apply bandages or cold compress).
3. Notify: Whenever a child suffers a head injury, providers should contact the child’s family to notify them of what occurred and the status of the child. If immediate medical attention is needed, ask a coworker or administrator to contact the family after Emergency Medical Services (911) has been contacted.
4. Document: Be sure to complete the incident reporting form used by your program or Service. One copy will be provided to the child’s family, and one will go in the child’s program records. This is an important step as symptoms of a concussion may not appear for a few days. Refer to your program or Service specific guidelines for additional required documentation.

Concussion symptoms that warrant an emergency visit to a doctor or hospital (in all ages) include worsened headache, increased confusion, inability to stay awake, slurred speech, weakness, seizures, and loss of consciousness.

Symptoms of a concussion will look different for every child. The recovery time will look different as well. Regardless of how the injury occurred or presented in a child, monitoring and rest is important for all ages to properly recover from a concussion. For older children, modifications to their learning environment and school workload may be necessary. If mild symptoms persist for longer than a week or you observe signs of a regression in the child’s development, talk with their family about contacting their pediatrician for follow-up care.

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You must know what to look for when you are deciding how to respond to an injury.

After you have called EMS, remember to contact the child’s legal guardian.

If a child has any of the following symptoms, call EMS right away:

• The child has difficulty breathing, is having an asthma exacerbation, or is unable to speak.
• The child’s skin or lips look blue, purple, or gray.
• The child has rhythmic jerking of arms and legs and a loss of consciousness (seizure).
• The child is unconscious.
• The child becomes less and less responsive.
• The child has any of the following after a head injury: vomiting, headache, balance problems, difficulty concentrating, slowed response time, or changes in vision, mood, sleep patterns, or appetite.
• The child has increasing or severe pain anywhere.
• The child has a cut or burn that is large, deep, or won’t stop bleeding.
• The child is vomiting blood.
• The child has a severely stiff neck, headache and fever.
• The child is significantly dehydrated: sunken eyes, lethargic, not making tears, not urinating.
• Multiple children are affected by injury or serious illness at the same time.

Always call EMS if you believe the child’s life is at risk of there is a risk of permanent injury. When in doubt, call EMS.

Follow your program’s policies if a child has any of the following symptoms or get medical attention within one hour: 

• Fever in any age child who looks more than mildly ill
• A quickly spreading purple or red rash
• A large volume of blood in the stool
• A cut that may require stitches
• Any medical condition specifically outlined in a child’s care plan requiring parental notification

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