Handling Emergencies with the Newborn

Some conditions should be considered emergencies and treated immediately. Following are instructions for handling these life-threatening situations. You should become familiar with these procedures so that they will not be confusing to you if you ever need to use them. All parents should take a course in infant cardiopulmonary resuscitation (CPR) to get firsthand practice on a manikin under the guidance of a certified instructor. Baby sitters, grandparents, and other caregivers should also be trained, as accidents can happen at any time. Never practice CPR on a living person.

What to Do for Choking

If an infant or small child is choking because his airway is obstructed, you will need to do something to dislodge the obstruction. The signs of obstruction are blue lips, hoarse or crowing breathing, and inability to speak or cough. (If the child can speak or cough, allow him to expel the object on his own. Unnecessary intervention may cause further problems.) Call for help if you can. However, if you are alone, do not take the time to use the phone. You are the lifesaver at this time. Warning: Do not sweep your finger blindly in the child’s mouth. This could cause further obstruction. Instead, for a child over 1 year old, use the Heimlich maneuver, and for a child under 1 year old, use back blows and chest thrusts. Never perform abdominal thrusts, such as the Heimlich maneuver, on an infant under 1 year of age because of the risk of injury to the abdominal organs.

Back Blows and Chest Thrusts

If the baby is under 1 year old and conscious, do the following:
1. Place the baby facedown over the length of your arm, with his head lower than his chest and supported by your hand.
2. Using the heel of your free hand, give the baby 5 sharp blows on his back between his shoulder blades.
3. Turn the baby onto his back, supported on your arm, with his head lower than his chest. Give him 5 chest thrusts, compressing his breastbone quickly and firmly one finger-width below the nipple line, using two fingers of your free hand. (This step is the same as the Cardiac step in infant CPR.)

Back blows for a conscious infant. Chest thrusts for a conscious infant

Repeat these steps until the object is expelled or the infant loses consciousness.

If the baby is under 1 year old and unconscious or lost consciousness while you tried to unblock his airway with the preceding steps, do the following:

1. Call out for help. If an extra person is available, have that person call 911.
2. Place the baby on his back and kneel next to him.
3. Open the baby’s mouth, using your thumb on the tongue to lift the jaw, and look for the obstruction. If you see it and can easily access it, remove it.
4. If the obstruction is not visible or is inaccessible, open the baby’s airway by tilting his head back, lifting his chin up gently with one finger, and pushing his forehead down with your other hand. Cover his nose and mouth with your mouth and breathe out twice slowly and gently, using just enough force to make his chest rise and fall as in normal breathing. Reposition his head and repeat the breaths if they were unsuccessful the first time.

Perform steps 1 through 3 for a conscious infant (back blows and chest thrusts), followed by steps 2 through 4 for an unconscious infant (obstruction check and rescue breathing) until the obstruction is dislodged or medical help arrives. If you are alone, call 911 after 1 minute of effort.

Obstruction check for an unconscious infnat. Rescue breathing for an unconscious infant.

Heimlich Maneuver

Choking in older babies and children can be treated the same as in adults. If the child is over 1 year old and conscious, use the Heimlich maneuver:

Heimlich maneuver for a conscious child over 1 year old.

1. Stand behind the child and wrap your arms around his waist between his navel and rib cage.
2. Make a fist with one of your hands and grasp that fist with your other hand. With your fist, make a quick upward thrust into the child’s abdomen to force air up through his windpipe.

Repeat these steps as necessary until the obstruction is expelled.

If the child is over 1 year old and unconscious or lost consciousness while you tried to unblock his airway with the preceding steps, do the following:
1. Call out for help. If an extra person is available, have that person call 911.
2. Place the child on his back and kneel next to him.
3. Open the child’s mouth, using your thumb on the tongue to lift the jaw, and look for the obstruction. If you see it and can easily access it, remove it.
4. If the obstruction is not visible or is inaccessible, open the child’s airway by tilting his head back, lifting his chin up gently with the fingers of one hand, and pushing his forehead down with your other hand. Pinch his nostrils closed, cover his mouth with your mouth, and breathe out twice slowly and gently, using just enough force to make his chest rise and fall as in normal breathing.
5. If the child’s airway is still obstructed, kneel at the child’s feet or straddle his thighs, depending on his size. Place the heel of one of your hands on the child’s abdomen midway between his navel and rib cage. Place your other hand directly on top of the first and make 6 to 10 quick upward thrusts into the child’s abdomen to force air up through his windpipe.

If you are alone, call 911 after 1 minute of effort. Then repeat steps 3 through 5 for an unconscious child (obstruction check, rescue breathing, and abdominal thrusts) until the obstruction is dislodged or medical help arrives.

Abdominal thrusts for an unconscious child over 1 year old.

How to Prevent Choking

The best way to save your child from choking is to take precautions beforehand. Although most people realize that small objects such as buttons and coins can be dangerous to babies and young children, many parents are not aware that some foods also pose hazards. The following foods are the most frequent causes of fatal choking in children under 5:
Hot dogs and sausages.
Round candy.
Peanuts and other nuts.
Whole grapes.
Hard cookies and biscuits.
Meat chunks and sticks.
Raw carrot slices and sticks.
Peanut butter and peanut butter sandwiches.
Apple pieces.
Popcorn.

Never leave a baby alone while he is eating and always make sure that a small child is adequately supervised at mealtime. Children can also choke when a bottle is propped. Many children choke when they run or play with food in their mouths, or when they talk and laugh while eating.

Cardiopulmonary Resuscitation (CPR)

If your child stops breathing, he is not receiving the oxygen he needs to maintain life. If his breathing has stopped, his heart may also soon stop. (Other causes of cardiac arrest are electric shock, drowning, and sudden infant death syndrome.) You must act immediately to breathe for him, possibly pumping his heart.

While you tend to your child, have someone else call for a rescue unit. If you are alone, perform CPR for at least 1 minute before quickly calling the emergency squad yourself.

To perform CPR on a baby under 1 year old, remember your ABCs:
1. Airway. Gently tap or shake the baby’s shoulder to gauge his responsiveness. Place the baby on his back and kneel next to him. Tilt his head back by gently lifting his chin up with one of your fingers while pushing his forehead down with your other hand. His head should be positioned as if he were trying to sniff something. Warning: Do not exaggerate the tilt, as this may close the airway completely.
2. Breathing. Place your ear over the baby’s mouth, your face pointing toward his chest, to look, listen, and feel for breathing. If all the signs of breathing are absent, cover the baby’s nose and mouth with your mouth and breathe out twice slowly and gently, using just enough force to make his chest rise and fall as in normal breathing. Warning: Do not blow hard. Blowing too hard can injure the baby’s lungs. However, blowing too softly will not give the baby enough oxygen. When blowing, you should make each inflation 1 to 1 1/2 seconds long.

Guage the baby's responsiveness. Tilt his head back slightly. Look, listen, and feel for breathing.
Check for a pulse. Imagine a line between the nipples. Do chest thrusts and rescue breathing.

Next, check to see if the baby’s heart is beating by placing the tips of your index and middle fingers on the inside of his upper arm, between his elbow and shoulder. Press gently to feel for the brachial pulse. Keep your other hand on the baby’s forehead to maintain the position of his head. If you feel a pulse but the baby is not breathing, continue breathing for him at the rate of 1 breath every 3 seconds, or 20 breaths a minute. If you do not feel a pulse, proceed to the Cardiac step, below. If you are alone, continue breathing and performing the heart compressions for 1 minute before phoning for emergency help.
3. Cardiac. Imagine a line drawn between the baby’s nipples. Place your index finger below the line, with the middle and ring fingers next to the index finger. Lift up the index finger and use the tips of the other two fingers to compress the breastbone (sternum). Make sure that you are not on the tip of the breastbone. Compress the area about 1/2 to 1 inch at a rate of at least 100 times a minute. Use your other hand to maintain the baby’s head position. After every 5 compressions, give the baby 1 breath. After 20 cycles, check for a pulse and look for spontaneous breathing. If you do not find a pulse or signs of breathing, continue compressing the chest and giving breaths, rechecking for a pulse and breathing every few minutes until medical help arrives.

For children 1 to 8 years of age, follow the same procedure. However, when breathing for the child, pinch his nostrils shut and cover just his mouth with your mouth. Also, use the heel of your hand instead of the tips of your fingers to depress his sternum. To locate the correct hand position, find the lower tip of the sternum with two fingers and place your hand above this area. Compress the sternum 1 to 1 1/2 inches at the rate of 80 to 100 times per minute. Determine if the heart is beating by checking for a pulse on the carotid artery, located on the side of the neck.

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