Responding to Injuries in Childcare

Children who run, climb and explore will sometimes get hurt, even with good supervision. How you respond in the first minutes can limit the injury and calm a frightened child. What you do afterward, from the phone call to the written report, protects the child, the family and your program.

This guide covers how to respond to injuries in a childcare setting. It does not replace CPR and pediatric first aid training, which most states require and which need hands-on practice. Your state rules and program policy set the exact steps for notifying families and licensing.

What You Will Be Able to Do

• Keep the other children safe while you care for an injured child
• Give basic care for common minor injuries
• Decide when to call 911 without waiting for a second opinion
• Watch a child after a head bump
• Tell a family what happened, and write a factual incident report

The First Minute

1. Stay calm. Children read your face and voice. Walk quickly, but don't run.
2. Check the scene. Make sure you and the child are not in more danger.
3. Keep the group safe. Call another adult to take over the other children, or gather them nearby. You can't leave them unsupervised.
4. Check the child. Is the child awake, breathing and bleeding? Do not move a child who may have a neck or back injury, unless the area is unsafe.
5. Get the first aid kit and the child's records. Protect yourself with gloves if there is blood or other body fluid.
6. Act. Give first aid, or call 911.

If there is blood, follow your program's procedure for handling and cleaning it up, and wash your hands well afterward.

When to Call 911

Call 911 right away for any of these. Do not wait for a director or a parent. Call first, then call the family.

• Not breathing, or trouble breathing
• Unconscious, or hard to wake
• Choking that does not clear
• Bleeding that does not stop with firm pressure
• Head injury with repeated vomiting, confusion, seizure, or loss of consciousness
• Possible neck or back injury
• A seizure, unless the child has a plan that says otherwise
• A suspected broken bone, especially if the limb looks bent or the bone shows
• A severe burn
• Signs of a serious allergic reaction, after giving epinephrine as the plan says
• Any time you think the child may be seriously hurt

For a possible poisoning, call Poison Help at 1-800-222-1222. Call 911 instead if the child has trouble breathing, collapses or has a seizure.

Tell the dispatcher your address, the child's age, what happened and how the child is now. Stay on the line. One adult goes with the child if the child is taken to the hospital, and that adult brings the emergency contact and health forms.

Choking

If a child can cough, cry or speak, stay close and let them keep coughing. If they cannot cough, cry or breathe, act immediately. For a baby under 1 year, give 5 back blows, then 5 chest thrusts. For a child, current American Heart Association and American Academy of Pediatrics guidance is 5 back blows, then 5 abdominal thrusts. Repeat until the object comes out. If the child stops responding, call 911 and start CPR. Your CPR class is where you practice this.

Common Injuries and Basic Care

Keep a stocked first aid kit where you can reach it, and take it on walks and field trips. Check it on a schedule. Do not give any medicine for an injury without written permission, including ointment unless your policy allows it.

Head Bumps

Toddlers bump their heads often, and most bumps are minor. Every head bump still needs care, because the signs of a serious injury may not appear right away.

1. Comfort the child, and apply a cold pack wrapped in a cloth if they will allow it.
2. Check for a loss of consciousness, a large swelling, or a cut that needs care.
3. Stay with the child and watch them closely for the rest of the day.
4. Write an incident report.
5. Call the family right away, even if the child seems fine. Many programs treat every head injury as needing a same-time call.

Watch for signs of concussion and call 911 if you see any of these: repeated vomiting, confusion, unusual sleepiness or trouble waking, unequal pupils, a seizure, weakness, unsteady walking, or a severe or worsening headache. Check on a sleeping child after a head bump, following your program's policy, and be sure you can wake them.

Telling the Family

Tell the family about every injury. For minor injuries, tell them the same day, at pickup at the latest. For anything serious, including any head injury, any injury needing medical care, and any bite that breaks the skin, call right away.

• Start with how the child is now: "Ava is okay. She's playing, but she bumped her head."
• Say what happened, what you did and what to watch for.
• Stick to facts, and don't guess or blame.
• Do not name other children involved. When a child has been bitten or hit by another child, each family hears only about their own child. If a parent asks who did it, say you can't share that, and that you are working with both children.
• Offer a copy of the report, and ask the parent to sign it if your policy requires it.

Writing an Incident Report

An incident report is a legal record. Complete one for every injury, no matter how small, and do it the same day while your memory is fresh. Your program's form will likely ask for:

• The child's name, age and date
• The time and exact location
• What the child was doing, and who was supervising
• What you saw, in order
• The injury and the body part
• What first aid or care you gave, and who gave it
• Who was notified, when and how
• Your name and signature, and the parent's signature if required

Write only what you saw or heard. Separate facts from opinions, and do not guess at a cause. The report may be read by a parent, a licensing inspector, an insurer or a court.

Never change a report after it is filed, and never leave out something that looks bad for the program. If you need to add something, write a new, dated note. Keep reports confidential, and file them as your policy says.

Reporting to Licensing

Many states require programs to report serious injuries to the licensing agency within a set time, such as when a child needs medical treatment. Your director usually does this, but you should know the rule. An injury may also point to a hazard. After any incident, ask what could prevent the next one, then fix it or report it.

If an injury doesn't fit the story you've been told, or you suspect it happened through abuse or neglect, your duties as a mandated reporter may apply.

Common Mistakes

Check Your Understanding

1. A toddler falls from a low step and hits his forehead. He cries for a minute, then wants to play. What do you do?

Comfort him and use a wrapped cold pack if he allows it. Check for a cut or swelling, keep him close and watch him for the rest of the day. Call the family right away and write an incident report.

2. During outdoor play, a child falls and her arm looks bent. She is crying and you are alone with eight children. What do you do first?

Call for another adult, and keep the group together. Keep the child still, call 911, and don't try to straighten the arm. Call the family once help is on the way.

3. A parent at pickup asks, "Who scratched my son's face?" What do you say?

Say you cannot share another child's name. Tell the parent what happened, what you did and how you are working with both children to stop it from happening again.

4. You are writing a report and want to say a child was "acting out." What should you write instead?

Describe what the child did and when: "At 2:10, Sam threw two blocks across the room, and one hit Ella on the arm." Leave out labels and guesses.

Key Takeaways

• Stay calm, keep the group safe, then care for the injured child
• Call 911 first for any serious injury, then call the family
• Practice choking response and CPR in a real class
• Every head bump gets watching, a report and a same-time call to the family
• Tell families about every injury, without naming other children
• Write facts, not opinions, and do it the same day