Tag Archives: breathing

New ‘gold standard’ in paediatric first aid launched

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A new initiative to help improve paediatric first aid training in early years settings has been launched today by Education and Childcare Minister Sam Gyimah, in memory of a 9-month-old girl who tragically died in 2012.

Millie Thompson passed away after choking on her lunch while at nursery in Stockport. Since her death, Millie’s parents Joanne and Dan have campaigned for a new ‘gold standard’ certificate to be created in recognition of early years childcare providers that train all their staff in paediatric first aid, going above and beyond the minimum legal requirements.

The quality mark – which has been developed by the Department for Education (DfE), National Day Nursery Association (NDNA) and the Thompsons – will be known as ‘Millie’s Mark’ and will help to give parents assurance that every staff member that cares for their child is trained in these important, life-saving skills.

From summer 2016, early years settings in England will be eligible to apply to be accredited with this unique quality mark that will provide parents with the assurance that their child is being cared for by safe and knowledgeable staff. The quality mark will be in addition to the existing statutory requirements for paediatric first aid that all early years providers must meet as a legal requirement.

Alongside the launch of Millie’s Mark, the government has today published a response to the consultation on changing the paediatric first aid requirements in the statutory framework for the early years foundation stage (EYFS). The majority of those who responded were in favour of increasing the number of paediatric first aiders in early years settings.

So, from this September [2016], all newly qualified level 2 and level 3 staff must also have either a full paediatric first aid certificate or an emergency paediatric first aid certificate to count in the required staff to child ratios.

‘So for Nurseries that have trained with us at BUFFS and have the New Level 3 Paediatric first aid certificate you need to read the information below and if you meet all the criteria you can apply’. PK

Millie’s Mark – Paediatric First Aid

NDNA has been awarded a contract to deliver Millie’s Mark, the new quality mark

for nurseries where all employees are trained in paediatric first aid.

Nurseries will be able to apply for Millie’s Mark, which will be awarded as a special endorsement to childcare providers that can meet a set criteria including:

  • Evidence of needs assessment for setting staff
  • Evidence that all staff hold an appropriate in-date PFA (full or emergency) certificate
  • Evidence of classroom-based training for one-day courses.

The awarding of Millie’s Mark will be dependent on all of the criteria being met in addition to the legal requirements as set out in the Early Years Foundation Stage (EYFS) Statutory Framework.

These childcare providers will work to keep these crucial skills in the forefront of their employees’ minds, so that they are competent and ready to act in an emergency situation. 

The aims of Millie’s Mark are to keep children safe and minimise risk and accidents by:

  • Raising standards in paediatric first aid
  • Increasing numbers of first aid-trained staff
  • Increasing competency in applying first aid
  • Enabling staff to respond quickly in emergencies
  • Raising the quality and skills of the early years workforce and helping them with day-to-day first aid issues, such as allergies
  • And providing reassurance to parents.

Red Poinsettias. Safe for Kids?

Red Poinsettias in Pots on Display in a Plant Nursery

Poinsettia plants are less toxic than once believed.

In most cases, poinsettia exposure causes only discomfort, including:

  • A mild, itchy rash. Skin contact with the sap of a poinsettia plant can cause a rash, If this happens, wash the affected area with soap and water. Apply a cool compress to ease itching.
  • A mild stomachache, vomiting or diarrhea. This can happen after eating part of a poinsettia plant. Severe signs and symptoms are unlikely, If you find a child eating a poinsettia plant, clear and rinse his or her mouth.
  • Eye irritation. If the sap of a poinsettia plant comes in contact with the eyes, they can become red and irritated. If this happens, flush the eyes with water.
  • Allergic reaction. Some people are more sensitive to poinsettia plants than are others. Reactions to poinsettia plants are more common among people who have latex allergies, since latex and poinsettia plants share several proteins. In case of a severe reaction, seek prompt medical attention.
Taken from Answers from Jay L. Hoecker, M.D. at the Mayo Clinic

Amendments to the Human Medicines Regulations 2012 to allow the supply of salbutamol inhalers to schools

For those of you having problems purchasing inhalers from independent pharmacists in the UK who may not be aware of the recent changes to the use of inhalers in schools.

I have attached a copy of the document you need to show them and please refer them to this section below which appears on page 12.

‘These Regulations amend the Human Medicines Regulations 2012, to allow schools to hold stocks of asthma inhalers containing salbutamol for use in an emergency. These regulations come into effect on 1st October 2014.
From this date onwards, schools can buy inhalers and spacers (the plastic funnels which make it easier to deliver asthma medicine to the lungs) from a pharmaceutical supplier in small quantities provided it is done on an occasional basis and is not for profit.
A supplier will need a request signed by the principal or head teacher (ideally on appropriately headed paper) stating:
• the name of the school for which the product is required; • the purpose for which that product is required, and • the total quantity required.
The Department of Health has also consulted on draft non-statutory guidance to support schools in England in their management of inhalers, and has revised this to take on board comments received from respondents. It is hoped that the current draft guidance (published simultaneously with this response) covers the major implementation issues raised in the consultation. DH will continue to refine the guidance in the light of any further comments received – particularly from schools as they implement the new arrangements.
As devolved administrations, Wales, Northern Ireland and Scotland will have respective responsibility for issuing guidance for their schools’.


Hope this helps


How to assess a paediatric patient’s mental status after a fall

How to assess a paediatric patient’s mental status

I think head injuries is one of the most common questions I get asked when teaching so here is some advice to help.

Copied from the EMS1.com website


Spend time with infants and toddlers to learn and understand ‘normal’ responses

With a sickening thud, my two-year-old’s head slammed into the concrete. Despite three stern parental warnings she leaped off the front step, landed on the ice, went airborne, and cratered into the sidewalk. I feared the worst — open head wound and traumatic brain injury — when I began my assessment.

Assessing mental status in infants and toddlers is more complex than adults because they generally can’t tell the date, time, precise location, or preceding events. Kids under two might not even be able to report their name when healthy. My wife asked my daughter, “Where are you?” She literally interpreted her question and answered, “Right here.”

These are tips for gauging the mental status of infants and children:

  1. Ask available parents and/or caregivers.

As they know the child, they can tell you if the child’s mental status is normal or abnormal.

  1. Know age-related norms.

Infants are generally pretty comfortable being around and handled by strangers. Toddlers are more likely to exhibit stranger anxiety. An older toddler should know basic things like their own name, age, where they live, and/or their parent’s names.

  1. Recall of recent activities and favourite things.

Toddlers can recall recent events like what they had for lunch or an activity they were just playing. Check longer term memory by asking a toddler about their favourite toy, game, or memory.

  1. Ask the child to perform a simple task.

Try things like touch your nose, cover your ears, close your eyes, or make a big mouth.

  1. Know normal.

Spending time around kids is the best way to learn what is normal. Take advantage of injury prevention programs or community education events to interact with infants, toddlers, and their parents. Ask questions to see what toddlers are normally able to answer on their own.

My daughter survived her fall with only a painful reminder to listen to her daddy. Although she had a wound that required a few stitches she had no altered mental status and no loss of consciousness. She was lucky and I was relieved.

Greg Friese


When to and when not to refer a head injury to the Emergency Department (ED) / Accident & Emergency (A&E). There is no real answer to this one except if in doubt refer and let the ED triage staff decide. Below is a letter from the Royal College of Paediatrics and child health where it is recommended that under twos be seen in the ED.


Advice from the NHS is:

Minor head injuries are common in people of all ages and should not result in any permanent damage.

The symptoms of a minor head injury are usually mild and short lived. Symptoms may include:

  • a mild headache
  • nausea (feeling sick)
  • mild dizziness
  • mild blurred visionIf your symptoms significantly worsen or you develop any new symptoms after being discharged, you should return to A&E straight away or call 999 and ask for an ambulance.

There are a number of self-care techniques you can use to relieve mild concussion symptoms. If more serious symptoms start to develop, seek immediate medical treatment.

Some self-care techniques for mild symptoms of concussion are outlined below.

Treating concussion 

  • If you or your child experience these mild symptoms after a knock, bump or blow to the head, you won’t usually require any specific treatment. However, you should go to your local accident and emergency (A&E) department for a check-up.
  • apply a cold compress to the injury to reduce swelling – a bag of frozen vegetables wrapped in a towel could be used, but never place ice directly on the skin as it’s too cold; apply the compress every two to four hours and leave it in place for 20 to 30 minutes
  • If you or your child experience minor symptoms after a knock, bump or blow to the head, you won’t usually require any specific treatment.

You should visit your nearest accident and emergency (A&E) department if you or someone in your care has a head injury and develops the following signs and symptoms:

  • loss of consciousness, however brief
  • memory loss, such as not being able to remember what happened before or after the injury
  • persistent headaches since the injury
  • changes in behaviour, such as irritability, being easily distracted or having no interest in the outside world – this is a particularly common sign in children under five
  • confusion
  • drowsiness that occurs when you would normally be awake
  • loss of balance or problems walking
  • difficulties with understanding what people say
  • difficulty speaking, such as slurred speech
  • problems with reading or writing
  • vomiting since the injury
  • problems with vision, such as double vision
  • loss of power in part of the body, such as weakness in an arm or leg
  • clear fluid leaving the nose or ears (this could be cerebrospinal fluid, which surrounds the brain)
  • sudden deafness in one or both ears
  • any wound to the head or face

Which First Aid Course do I need?

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A number of students and managers have contacted me recently with regard to the changes coming up in October regarding the Childcare sector.

I have studied the First Aid training requirements and the advice for each sector is below:

Registered Childminder  – Paediatric First Aid – 12 hours In line with the Early Years Foundation Stage Statutory Framework ( EYFS) the Level 3 Paediatric First Aid (PFA) Course covers all topics required by Ofsted.

Nursery or Pre – School  – Paediatric First Aid – 12 hours In line with the Early Years Foundation Stage Statutory Framework ( EYFS) the Level 3 Paediatric First Aid (PFA) 12 Hour course covers all topics required by Ofsted.

Foundation Stage Teachers  – Paediatric First Aid – 12 hours The EYFS requires that at least one person in a school holds a twelve hour certificate in PFA. The EYFS guidance applies to those who deal with 4, 5 and rising 6 year olds.

School Staff Teaching & Support  – Emergency First Aid at Work for Schools Level 2 (EFAWS) – 6 hours In line with the guidance from The Department of Children, Schools and Families, this course is child orientated and suitable for all school staff who support First Aiders.

After School clubs  – Emergency First Aid at Work for Schools Level 2 (EFAWS) – 6 hours


Level 3 Paediatric First Aid (PFA) 12 Hour course.

Ofsted will expect the course to be relevant to the age of the children. If under 5’s are present you need the Paediatric First Aid – 12 hours

Nanny, Au Pair, Babysitter  – Emergency Paediatric First Aid (EPFA) – 6 hours  There is no set minimum that this course should take. Our 6Hr Emergency Paediatric First Aid (EPFA) course meets the needs of the Voluntary part of the Ofsted Childcare Register, which many Nannies are now opting to join.

The general guidance, as I understand it, is if under 5’s are involved then even if the 12 hour course is not a requirement we still recommend it. The guidance from Ofsted regularly highlights the need for the training to be relevant to the age of the child / children being cared for.

12 Hour Paediatric First Aid update

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12 Hour Paediatric First Aid (UK)

It has recently been brought to our attention that some providers have received misleading information to say they are no longer required to complete the twelve hour paediatric first aid course and instead can access a six hour Emergency Paediatric First Aid Course.

It is a requirement of the Early Years Foundation Stage (EYFS) that at least one person who has a current paediatric first aid certificate must be on the premises at all times when children are present, and must accompany children on outings. First aid training must currently be local authority approved and be relevant for workers caring for young children. Childminders, and any assistant who might be in sole charge of the children for any period of time, must hold a current paediatric first aid certificate.

Ofsted have advised that providers should follow the guidelines outlined in Appendix 1 of the 2008 EYFS Practice Guidance in order to ensure good practice. This states:

Criteria for effective paediatric first aid training

In order to meet the requirements of the EYFS, paediatric first aid courses must be approved by the local authority in whose area the early years provision is located, and must meet the following criteria:

1 Training is designed for workers caring for children in the absence of their parents.

2 The training leading to a certificate or a renewal certificate is a minimum of 12 hours.

3 The first aid certificate should be renewed every three years.

4 Resuscitation and other equipment includes baby and junior models, as appropriate.

5 Training covers appropriate contents of a first aid box for babies and children.

6 Training should include recording accidents and incidents.

7 Training should be appropriate to the age of the children being cared for.

8 The course covers the following areas:

8.1 Planning for first aid emergencies.

8.2 Dealing with emergencies.

8.3 Resuscitation procedures appropriate to the age of children being cared for.

8.4 Recognising and dealing with shock.

8.5 Recognising and responding appropriately to anaphylactic shock.

8.6 Recognising and responding appropriately to electric shock.

8.7 Recognising and responding appropriately to bleeding.

8.8 Responding appropriately to burns and scalds.

8.9 Responding appropriately to choking.

8.10 Responding appropriately to suspected fractures.

8.11 Responding appropriately to head, neck and back injuries.

8.12 Recognising and responding appropriately to cases of poisoning.

8.13 Responding appropriately to foreign bodies in eyes, ears and noses.

8.14 Responding appropriately to eye injuries.

8.15 Responding appropriately to bites and stings.

8.16 Responding appropriately to the effects of extreme heat and cold.

8.17 Responding appropriately to febrile convulsions.

8.18 Recognising and responding appropriately to the emergency needs of children with chronic medical conditions, including epilepsy, asthma, sickle cell anaemia, diabetes.

8.19 Recognising and responding appropriately to meningitis and other serious sudden illnesses.

Practitioners have a duty for the safeguarding and welfare of the children in their care and it is vital that they are able to competently deal with any first aid requirements which may occur to ensure the safety of children. You should be reminded that it is the responsibility of the practitioners attending these courses to ensure they meet their needs both in terms of what the courses cover and the time taken to complete the course, and therefore we would recommend that you take note of the points covered in Appendix 1 above.

First Aid Box Contents Update 15

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1. There is no mandatory list of items to be included in a first-aid container. The decision on what to provide will be influenced by the findings of the first-aid needs assessment. As a guide, where work activities involve low hazards, a minimum stock of first-aid items might be:

  • a leaflet giving general guidance on first aid (for example, HSE’s leaflet Basic advice on first aid at work);
  • 20 individually wrapped sterile plasters (assorted sizes), appropriate to the type of work (hypoallergenic plasters can be provided if necessary);
  • two sterile eye pads;
  • two individually wrapped triangular bandages, preferably sterile;
  • six safety pins;
  • two large sterile individually wrapped unmedicated wound dressings;
  • six medium-sized sterile individually wrapped unmedicated wound dressings;
  • at least three pairs of disposable gloves (see HSE’s leaflet Latex and you6).

Attached is a Pdf list for the suggested workplace and travel kits.

First Aid Box Contents 15