Tag Archives: Care Plan

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

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

Supporting pupils at school with medical conditions

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Every course I get emails asking for a template for the Health Care Plan.

These attachments are the templates for the Health Care plan you need for children in your care.

Every child with a special health care need or serious health condition should have one of these completed.



Supporting_pupils_with_medical_conditions_-_templates  Copy and paste into google search this will take you to the .Gov site to be able to download the word documents.

Supporting_pupils_with_medical_conditions_-_templates These are the word documents you need.

Or email me paulkenny@me.com and I will forward the word files to you.

The website address with the word document templates is:

Copy and paste this link into your web browser.


As usual any problems let me know.