Poisoning in children occurs when they ingest, inhale, inject, or come in contact with toxic substances, leading to adverse health effects. It is a major pediatric emergency requiring immediate identification and treatment to prevent severe complications or death.
✔ Assess ABCs (Airway, Breathing, Circulation).
✔ Call Poison Control Center or Emergency Services immediately.
✔ Check for level of consciousness, breathing, and signs of shock.
| Poison Type | First Aid Measures |
|---|---|
| Chemical Poisoning (Bleach, Acids, Pesticides) | Rinse mouth, DO NOT induce vomiting, give milk/water. |
| Medicine Overdose (Paracetamol, Opioids, Sedatives) | Activated charcoal (If within 1 hour), Antidotes if available. |
| Food Poisoning (Bacteria, Contaminated food) | Oral Rehydration Solution (ORS) for dehydration. |
| Inhaled Poisons (Carbon Monoxide, Smoke inhalation) | Move child to fresh air, give oxygen therapy. |
| Snake Bite or Venomous Stings | Keep child still, immobilize limb, DO NOT suck venom, seek antivenom. |
✔ Keep all cleaning products, pesticides, and medicines locked away in child-proof cabinets.
✔ Store household chemicals in their original containers (Never transfer to drink bottles).
✔ Label all toxic substances clearly.
✔ Use child-resistant caps on all medications.
✔ Never refer to medicine as “candy” to encourage a child to take it.
✔ Dispose of expired or unused medications safely.
✔ Always supervise young children, especially in kitchens and bathrooms.
✔ Teach children about the dangers of unknown substances.
✔ Keep emergency numbers (Poison Control, Ambulance) easily accessible.
✔ Ensure proper food handling, cooking, and storage.
✔ Wash hands before handling food and wash fruits and vegetables thoroughly.
✔ Avoid giving young children honey (Risk of botulism) or raw/undercooked food.
✔ Identify and remove toxic plants from home and garden.
✔ Educate children not to eat unknown berries, flowers, or mushrooms.
✔ Install carbon monoxide detectors in homes.
✔ Ensure proper ventilation when using gas appliances.
✔ Do not leave cars running in closed garages.
✔ Keep alcohol, hand sanitizers, and personal care products out of reach.
✔ Educate teens about the dangers of drug and alcohol consumption.
✔ Teach children to avoid unknown animals and insects.
✔ Wear protective clothing in areas with snakes, scorpions, or spiders.
✔ Use insect repellents in high-risk areas.
✔ Poisoning in children is a serious emergency that can be prevented with proper safety measures.
✔ Household chemicals, medications, and food poisoning are the most common causes.
✔ Treatment includes first aid, activated charcoal, antidotes, IV fluids, and gastric lavage.
✔ Safe storage, supervision, food hygiene, and public awareness are essential prevention strategies.
✔ Immediate action and emergency care can prevent severe outcomes.
Foreign body accidents in children occur when a non-food object is inhaled, ingested, inserted into the nose, ears, or other body parts, leading to choking, airway obstruction, infections, or organ damage. It is a common pediatric emergency and requires immediate medical attention in severe cases.
Foreign bodies can enter the airway, digestive tract, nose, ears, and even genitourinary system, causing serious complications. The most common age group affected is between 6 months to 5 years, as children tend to explore objects by putting them in their mouths, noses, or ears.
✔ Never leave small objects within reach of young children.
✔ Regularly inspect toys for small detachable parts.
✔ Supervise children while eating (Avoid small, hard foods like peanuts, grapes, and popcorn).
✔ Cut food into small pieces for toddlers.
✔ Encourage chewing food properly before swallowing.
✔ Avoid giving children hard candies, gum, or hot dogs in large pieces.
✔ Ensure toys meet safety standards (No detachable small parts).
✔ Avoid giving toys with batteries to small children.
✔ Select age-appropriate toys.
✔ Keep batteries, coins, and sharp objects locked away.
✔ Avoid keeping small magnetic items near children.
✔ Do not allow children to play with small buttons, jewelry, or sewing materials.
✔ Teach children not to put objects in their mouths, noses, or ears.
✔ Make caregivers, babysitters, and teachers aware of choking hazards.
✔ Learn basic first-aid for choking emergencies.
✔ Foreign body accidents are common in young children due to their natural curiosity.
✔ Choking on small objects, food, or toys can be life-threatening.
✔ Prevention includes childproofing the home, supervision, and toy safety.
✔ Emergency management involves first aid for choking, prompt medical attention for ingested objects, and safe removal of foreign bodies in the nose, ears, or eyes.
✔ Educating caregivers on foreign body hazards and first-aid techniques is essential.
Hemorrhage is excessive bleeding due to injury, trauma, or medical conditions, which can be internal or external. In children, hemorrhage is a life-threatening emergency that requires immediate medical intervention to prevent shock and organ failure.
✔ Keep sharp objects (Knives, Razors, Scissors) out of children’s reach.
✔ Use safety gates on stairs and secure windows.
✔ Keep electrical wires and furniture edges child-proofed.
✔ Ensure children wear helmets and knee guards while cycling.
✔ Teach road safety rules and supervise near traffic areas.
✔ Avoid letting children play near glass doors or sharp objects.
✔ Make children wear protective gear for sports.
✔ Ensure playgrounds have soft surfaces (Grass, Sand).
✔ Avoid high-risk stunts or unsafe play structures.
✔ Screen for bleeding disorders in children with frequent bruising.
✔ Give Vitamin K at birth (To prevent newborn hemorrhagic disease).
✔ Monitor children for unusual bleeding after minor injuries.
✔ Assess the severity of bleeding (Arterial, Venous, or Capillary).
✔ Check for signs of shock (Pale skin, Weak pulse, Rapid breathing).
✔ Ensure airway, breathing, and circulation (ABCs) are intact.
Immediate Actions:
Signs of Internal Bleeding:
✔ Abdominal pain, Swelling, Distended belly (Internal organ bleeding).
✔ Headache, Vomiting, Unconsciousness (Brain hemorrhage).
✔ Pale skin, Weak pulse, Rapid breathing (Shock).
✔ Coughing up blood or blood in urine.
Management:
✔ DO NOT give food or drink (Risk of surgery).
✔ Lay the child down with legs elevated (Improves blood circulation).
✔ Transport immediately to the hospital.
✔ Apply firm direct pressure with a thick cloth.
✔ If bleeding does not stop, use a tourniquet (Emergency only).
✔ Seek emergency medical help IMMEDIATELY.
✔ Apply direct pressure and elevate the limb.
✔ Wrap the wound with a pressure bandage.
✔ Monitor for shock symptoms.
✔ Clean the wound with saline or antiseptic.
✔ Apply pressure if needed, then cover with a bandage.
✔ Monitor for signs of infection (Redness, Swelling, Pus).
✔ IV Fluids (Normal Saline, Ringer’s Lactate) – To prevent shock.
✔ Blood Transfusion – If excessive blood loss occurs.
✔ Tranexamic Acid (TXA) – Prevents excessive clot breakdown.
✔ Vitamin K Injection – For newborns with bleeding disorders.
✔ Desmopressin (DDAVP) – Used in hemophilia or von Willebrand disease.
✔ Suturing (For deep wounds, large cuts).
✔ Cauterization (Burning blood vessels to stop bleeding).
✔ Emergency Surgery (For internal bleeding in organs).
🚨 Call emergency services if:
✔ Bleeding does not stop after 10 minutes of pressure.
✔ The child is pale, weak, or unconscious.
✔ There is excessive blood loss from the head, neck, or abdomen.
✔ The wound is deep or gushing blood (Arterial bleeding).
✔ There is coughing or vomiting of blood.
✔ Hemorrhage in children can be external or internal and requires immediate attention.
✔ Common causes include falls, road accidents, sharp object injuries, and medical conditions.
✔ Prevention includes childproofing homes, safety during play, and medical precautions.
✔ First aid management includes direct pressure, elevation, and tourniquets (For life-threatening cases).
✔ Hospital treatment includes IV fluids, blood transfusions, medications, and surgery if needed.
✔ Early intervention can save lives and prevent complications.
Neonatal Advanced Life Support (NALS), also known as Neonatal Resuscitation Program (NRP), is a set of systematic guidelines established by the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) to improve neonatal survival through effective resuscitation practices.
NALS is used during and immediately after birth for neonates who experience respiratory distress, perinatal asphyxia, or cardiac arrest and require life-saving interventions.
✔ Approximately 10% of newborns require some assistance at birth.
✔ 1% of newborns need extensive resuscitation, including chest compressions and medications.
✔ The first 60 seconds (“Golden Minute”) is critical for survival.
✔ Premature birth (<37 weeks gestation).
✔ Absent or weak breathing (Apnea) or gasping respirations.
✔ Heart rate (HR) <100 beats per minute (bpm).
✔ Poor muscle tone (Limp and floppy body).
✔ Meconium-stained amniotic fluid with poor respiratory effort.
✔ Maternal infections (Chorioamnionitis, GBS infection).
✔ Birth asphyxia (Prolonged labor, cord prolapse, placental abruption).
As soon as the baby is born, assess three key factors:
✔ Gestational age (Full-term or preterm?).
✔ Breathing effort (Crying or not?).
✔ Muscle tone (Active or floppy?).
If the newborn is full-term, breathing well, and has good muscle tone → Provide routine newborn care (Skin-to-skin, Delayed cord clamping, Monitor breathing).
If the baby does not meet the criteria for routine care, begin initial resuscitation:
✔ Reassess Heart Rate (HR) at 30 seconds
✔ Start PPV using a T-piece resuscitator or bag-mask ventilation (BMV).
✔ Ensure a proper mask seal and achieve visible chest rise.
✔ Provide ventilation at a rate of 40-60 breaths per minute.
✔ Use room air (21% oxygen) for term infants; 30-40% oxygen for preterm infants.
✔ Reassess HR and breathing after 30 seconds.
✔ If HR remains <100 bpm:
✔ If HR is improving and breathing is spontaneous:
✔ If HR <60 bpm despite 30 seconds of PPV → Start Chest Compressions.
✔ Use the Two-Thumb Encircling Technique:
✔ Compression Depth:
✔ Compression-to-Ventilation Ratio:
✔ Coordinate compressions with ventilation.
✔ Reassess HR every 30 seconds.
✔ Epinephrine (First-Line Medication)
✔ Volume Expansion (For Suspected Hypovolemia)
✔ If PPV fails to improve HR, consider:
✔ Indications for Intubation:
✔ Monitor vital signs (HR, RR, SpO₂, BP, Glucose).
✔ Maintain normothermia (36.5 – 37.5°C).
✔ Prevent hypoglycemia (Treat if blood glucose <45 mg/dL).
✔ Consider NICU admission for continued monitoring.
✔ Use plastic wrap or warming devices to prevent hypothermia.
✔ Avoid excessive oxygen (Use FiO₂ 30-40% initially).
✔ Gentle ventilation to avoid lung injury (Use CPAP if possible).
✔ If baby is vigorous (Good HR, Crying, Normal Tone) → No suctioning needed.
✔ If baby is non-vigorous (Poor tone, No cry, HR <100) → Intubation for suctioning before PPV.
✔ Consider volume expanders (Normal Saline or PRBCs).
✅ Routine Endotracheal Suctioning of Meconium-Stained Infants is NO LONGER Recommended
✅ More Emphasis on Delayed Cord Clamping (30-60 seconds) for Stable Babies
✅ Importance of Monitoring SpO₂ with Pulse Oximetry
✅ Avoidance of Excess Oxygen in Preterm Neonates
✅ Use of Laryngeal Mask Airway (LMA) if Intubation Fails
✔ NALS (NRP) is the standard protocol for neonatal resuscitation.
✔ The first 60 seconds (“Golden Minute”) is crucial for survival.
✔ PPV is the most effective initial intervention for non-breathing neonates.
✔ Chest compressions are indicated if HR <60 bpm after 30 seconds of PPV.
✔ Epinephrine and IV fluids are used for persistent bradycardia and hypovolemia.
✔ Post-resuscitation care includes temperature control, oxygen support, and glucose monitoring.
Pediatric Life Support (PLS) is a structured resuscitation protocol designed for critically ill or injured infants and children who require immediate life-saving interventions. It includes Pediatric Basic Life Support (PBLS) and Pediatric Advanced Life Support (PALS).
The American Heart Association (AHA) updates these guidelines regularly to ensure effective management of pediatric emergencies, improving survival and outcomes in children.
PBLS focuses on early recognition of cardiac arrest, airway management, and high-quality cardiopulmonary resuscitation (CPR).
✔ Assess child’s response (Tap and shout, “Are you okay?”).
✔ Look for normal breathing (Observe chest rise for 5-10 seconds).
✔ If unresponsive and not breathing normally → Activate Emergency Medical Services (EMS) and start CPR.
If a rescuer is alone:
✔ Infants (<1 year): Check brachial pulse (Inner arm, near elbow).
✔ Children (>1 year): Check carotid (Neck) or femoral (Groin) pulse.
If no pulse or HR <60 bpm with signs of poor perfusion (Weak pulse, Cyanosis, Poor capillary refill) → Start CPR.
✔ Compression depth: At least 1/3rd of the chest diameter (~1.5 inches in infants, ~2 inches in children).
✔ Compression rate: 100-120 per minute.
✔ Recoil: Allow full chest recoil after each compression.
✔ Interruptions: Minimize pauses in CPR.
Compression technique:
Compression-to-ventilation ratio:
✔ If breathing is absent, provide rescue breaths.
✔ **Breaths should be delivered over 1 second each, with visible chest rise.
✔ Rescue breathing rate:
✔ If Bag-Mask Ventilation (BMV) is used:
✔ Attach AED as soon as available.
✔ Follow AED prompts and assess rhythm.
✔ If Shockable Rhythm (Ventricular Fibrillation/Pulseless Ventricular Tachycardia):
✔ Shock Energy:
✔ After shock → Resume CPR immediately.
PALS is an advanced resuscitation strategy for managing critically ill or injured children, focusing on systematic assessment, airway stabilization, ventilation, circulation, and medication administration.
✔ Evaluate: ABCDE assessment (Airway, Breathing, Circulation, Disability, Exposure).
✔ Intervene: Provide appropriate life support measures.
✔ Reassess: Monitor response and adjust treatment accordingly.
✔ Early signs of respiratory failure:
✔ Early signs of circulatory failure:
✔ Confirm pulselessness and start CPR immediately.
✔ Attach ECG monitor and identify rhythm.
1. Shockable Rhythms (Ventricular Fibrillation/Pulseless Ventricular Tachycardia)
2. Non-Shockable Rhythms (Asystole/Pulseless Electrical Activity – PEA)
✔ Bag-Mask Ventilation (BMV) first.
✔ Endotracheal Intubation (ETT) if BMV is ineffective.
✔ Confirm ETT placement using Capnography (End-Tidal CO₂).
✔ Post-intubation Ventilation Rate:
✔ Types of Pediatric Shock:
✔ IV/IO Fluid Resuscitation:
✔ Vasoactive Drugs:
✔ Monitor oxygen saturation (SpO₂) and blood pressure.
✔ Prevent hypothermia (Maintain temperature between 36.5-37.5°C).
✔ Correct metabolic abnormalities (Glucose, Electrolytes).
✔ Supportive care (IV Fluids, Inotropic support if needed).
✅ Emphasis on Early Recognition and Prevention of Cardiac Arrest.
✅ Prioritization of High-Quality CPR and Early Defibrillation.
✅ Minimizing Interruptions During CPR.
✅ Capnography Use for Confirming Airway Placement.
✅ Focus on Fluid Resuscitation and Shock Management.
✔ PLS includes PBLS (Basic Life Support) and PALS (Advanced Life Support).
✔ Early CPR, airway management, and defibrillation improve survival rates.
✔ High-quality chest compressions and rescue breaths are essential.
✔ Fluid resuscitation and medications play a critical role in shock management.
✔ Post-resuscitation care ensures better neurological outcomes.
Pediatric Advanced Life Support (PALS) is a systematic approach for managing critically ill or injured children. It is designed to improve survival rates in pediatric emergencies by following evidence-based protocols for assessment, resuscitation, and post-resuscitation care.
The American Heart Association (AHA) updates these guidelines regularly to ensure effective and timely interventions for children experiencing respiratory failure, shock, or cardiac arrest.
PALS follows a structured assessment and intervention strategy, which includes:
Before starting any intervention, quickly assess the child’s condition:
✔ Consciousness (Responsive or Unresponsive?).
✔ Breathing (Normal, Labored, or Absent?).
✔ Circulation (Pulse present or absent?).
✔ Skin Color (Pale, Cyanotic, or Normal?).
A structured approach to assess and stabilize critically ill children.
✔ Assess if the airway is open, partially blocked, or completely obstructed.
✔ If airway is compromised → Open using head-tilt/chin-lift or jaw-thrust.
✔ Consider advanced airway (Endotracheal tube, LMA) if needed.
✔ Observe chest rise, breathing rate, and effort.
✔ Check for abnormal breath sounds (Stridor, Wheezing, Crackles).
✔ Use pulse oximetry (SpO₂ >94% is the goal).
✔ If inadequate breathing → Provide oxygen or assist with bag-mask ventilation (BMV).
✔ Check central pulse (Carotid, Femoral, or Brachial).
✔ Assess skin color, capillary refill time (<2 seconds is normal).
✔ Monitor Blood Pressure (Hypotension is a late sign of shock).
✔ Initiate IV/IO access and fluid resuscitation if needed.
✔ Assess AVPU Scale:
✔ Check for signs of trauma, burns, infection (Rashes, Petechiae).
✔ Maintain normal body temperature (Avoid hypothermia).
✔ S – Signs & Symptoms.
✔ A – Allergies.
✔ M – Medications.
✔ P – Past medical history.
✔ L – Last meal.
✔ E – Events leading to the illness/injury.
✔ Head-to-toe assessment based on history and clinical findings.
✔ Identify and manage life-threatening conditions immediately.
✔ Check unresponsiveness and no normal breathing.
✔ Check for a pulse (≤10 seconds).
If no pulse or HR <60 bpm with poor perfusion → Start CPR immediately.
✔ Compression-to-Ventilation Ratio:
✔ Compression Rate: 100-120 compressions per minute.
✔ Compression Depth:
✔ Shockable Rhythms: Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (VT).
✔ Non-Shockable Rhythms: Asystole or Pulseless Electrical Activity (PEA).
✔ Give First Shock: 2-4 J/kg.
✔ Give Second Shock: 4-10 J/kg.
✔ Resume CPR immediately after shock.
✔ Give Epinephrine (0.01 mg/kg IV/IO every 3-5 min).
✔ Consider Antiarrhythmics:
✔ Continue High-Quality CPR.
✔ Give Epinephrine (0.01 mg/kg IV/IO every 3-5 min).
✔ Treat Reversible Causes (H’s & T’s).
✔ Hypoxia – Ensure adequate oxygenation.
✔ Hypovolemia – Give IV fluids.
✔ Hypoglycemia – Give dextrose.
✔ Hyper/Hypokalemia – Correct electrolyte imbalance.
✔ Hypothermia – Rewarm the child.
✔ Tension Pneumothorax – Needle decompression.
✔ Tamponade (Cardiac) – Pericardiocentesis.
✔ Toxins/Poisoning – Give antidotes.
✔ Thrombosis (Pulmonary or Coronary) – Thrombolysis.
✔ Hypovolemic Shock (Blood Loss, Dehydration)
✔ Distributive Shock (Sepsis, Anaphylaxis)
✔ Cardiogenic Shock (Heart Failure)
✔ Obstructive Shock (Tamponade, Tension Pneumothorax, PE)
✔ Maintain Oxygenation (SpO₂ 94-99%).
✔ Avoid Hyperventilation (Keep CO₂ between 35-45 mmHg).
✔ Monitor Hemodynamics (HR, BP, Perfusion).
✔ Prevent Hypoglycemia (Maintain glucose >60 mg/dL).
✔ Monitor for Seizures and Brain Injury.
✅ Emphasis on Early Recognition and Prevention of Cardiac Arrest.
✅ Prioritization of High-Quality CPR and Early Defibrillation.
✅ Minimizing Interruptions During CPR.
✅ Use of Capnography to Confirm Airway Placement.
✅ Updated Dosing for Epinephrine & Antiarrhythmics.
✔ Early CPR and defibrillation significantly improve survival in pediatric arrest.
✔ High-quality chest compressions and rescue breaths are essential.
✔ Reversible causes (H’s & T’s) must be treated promptly.
✔ Post-resuscitation care prevents further deterioration and brain injury.