Essential Training for Childcare Workers

Part of the challenge is that risks of injury change as kids develop their skills and become more independent.

• By Jeff A. Woodin
• Apr 01, 2014

Barbara Batista still remembers the first time she intervened as a 13-month-old choked on a goldfish cracker--a ubiquitous snack for young children--in her preschool classroom. Although the incident happened more than 20 years ago, "I could still tell you what she was wearing at the time," said Batista, director of the Child Development Lab School at Collin College in Plano, Texas. "It was really traumatic, and it sticks with you."

She first coached the girl to continue coughing, but as soon as the toddler became unable to cough, Batista leapt to her aid, administering the quick abdominal thrusts that immediately dislodged the cracker and reopened the airway.

"If I wasn't trained in what to do, I would have froze," Batista said. "I wouldn't have known what to do.”

First aid training is an important skill for everyone, but especially for childcare providers, who are required to undergo training every two years in most states. That frequent training is important for two reasons: It helps to ensure they're trained in the most current and effective skills and research that helps us learn new ways to respond, and also it helps to shake off the dust of skills they've learned earlier. The National Association for Education for Young Children holds a higher standard for its accredited programs, such as the one Batista runs. It requires both classroom teachers and support staff to undergo such training.

The ability to respond effectively in an emergency is critical because unintentional injuries, such as those caused by burns, drowning, falls, poisoning, and road traffic, are the leading cause of death for U.S. children. Each year, more than 12,000 kids age 19 and younger die from accidental injuries and more than 9.2 million are treated in the ER for nonfatal injuries, according to a report by the Centers for Disease Control and Prevention. According to the CDC, most nonfatal injuries stem from five causes: falls, being struck by or against an object, animal bites or insect stings, overexertion, and motor vehicle accidents.

Training Focused on Four Key Steps
So what do we mean by first aid? First aid training encompasses many important skills, ranging from the most basic steps, such as how to create a safe environment to discourage injuries from occurring in the first place, to additional life-saving skills, such as how to perform CPR.

Getting formal training, from robust programs such as the American Heart Association's Heartsaver Pediatric First Aid CPR/AED course, is important because our natural impulse to help may not be effective if we don't have the right skills. Untrained, our reaction may rely on something we've seen in the media or long-held beliefs about how to treat certain injuries.

For example, treating burns with butter, an approach many of us may have heard from our grandmothers, could cause more damage. That's because the fat in butter seals the otherwise porous skin, trapping heat inside, where it can further damage the tissue.

Or, if a child running with a pencil falls, causing it to impale his or her body, your inclination may be to pull it out. But it actually would be better to leave it in because removal could cause life-threatening hemorrhaging of key organs.

The Heartsaver Pediatric First Aid CPR/AED course, which is designed to meet the regulatory requirements for childcare workers in all 50 states, teaches childcare providers and others to respond to and manage illnesses and injuries in a child or infant in the first few minutes until professional help arrives. Training is available in both classroom settings and online and covers the four steps of first aid and first aid skills, such as finding the problem, stopping bleeding, bandaging, and using an epinephrine pen, as well as child CPR/AED and infant CPR. Additional training may include adult CPR/AED, child mask, infant mask, and asthma care training.

More simply, the training focuses on four key steps: prevention, being safe, calling 911, and taking action:

• Prevention is the best way to keep kids from getting hurt in the first place. Studies show more than half of fatal injuries to children are preventable. For childcare providers, that can include everything from making sure electrical outlets are properly protected to ensuring seat belts are fastened and car seats are properly installed. Prevention also includes simple but important steps such as using sunscreen when kids are outside to prevent damage from sun exposure or keeping them well hydrated to avoid becoming sick from the heat.
• Being safe when an emergency occurs is another important step. When responding to an emergency, it's important to make sure you or others aren't also at risk of getting hurt. For example, if a child becomes accidentally severely shocked, it's important to make sure the power is shut down at the main breaker box before touching the injured child.
• Calling 911. That may seem like a simple skill, but it requires training. Unlike a home setting where you can dial directly, some classroom settings can require that you dial 9 first before getting an outside line or go through a switchboard--steps that can waste precious time in an emergency if you haven't been trained on what to do at the childcare facility. It's also important to be able to determine quickly who is best capable of providing first aid and who should be dispatched to call for help.
• Taking action. This is where training becomes more complex. We organize training to three core areas: CPR training, illnesses and injuries that have the potential to become serious very quickly, and illnesses and injuries that may not be as urgent but still have the potential to become serious.

The Importance of CPR and Choking Training
CPR is an especially important skill for childcare workers. Kids don't have the reserves that adults do, and their survival rates are about half of adults, in part because it can take longer to recognize that a child has stopped breathing. For example, if a child passes out, you may think they've fainted, when in fact they can be in cardiac arrest. Acting quickly to provide CPR can triple a person's chance of survival.

CPR training has undergone some important changes in recent years thanks to scientific research that helped demonstrate how the life-saving technique could be more effective in an emergency. The biggest change is that the old approach of A-B-C--checking the Airway for obstructions, providing Breaths through mouth-to-mouth resuscitation, and then providing chest Compressions--has been changed to improve effectiveness. Training now puts a priority on chest compressions, changing the order to C-A-B for compressions, then checking the airway, and then providing breaths. The reason for the change is that chest compressions help to restore blood flow from the heart, and checking airway and providing breaths first costs precious seconds in a cardiac arrest.

Responding to injuries and illnesses is the most common situation childcare providers face, but it's important to quickly assess which ones are minor and which carry the urgency of a life-threatening emergency. Cleaning and bandaging a scraped knee, for example, requires a different set of skills than a puncture wound. Likewise, identifying a bug bite that comes with annoying itching is one thing, but recognizing when it results in a severe allergic reaction is another.

Training for how to respond in a choking situation is a critical skill that falls into the category of situations that can become life threatening very quickly.

Choking is a common hazard during childhood, with 34 children a day admitted to an emergency room because they've choked on food, according to a recent study in the journal Pediatrics. While that amounts to more than 12,000 cases a year, researchers point out that the problem is much more serious than that because most kids who choke don't end up going to the hospital.

Choking risks are highest for children up to age 4, with hard candy being the culprit in about 15 percent of incidents. Other types of candy and gum represented 13 percent of cases. To minimize choking risks, the American Academy of Pediatrics recommends cutting up food given to babies and young children into pieces no larger than a half inch.

Recognizing when a child is having a severe allergic reaction requiring the intervention of an epinephrine pen--and knowing how to use it--is also crucial because it can cause a child's airway to close. In those cases, calling 911 for emergency medical assistance is important, but average response time is between 4 minutes and 6 minutes, which could be fatal if someone isn't breathing.

Risks Change
For childcare workers, part of the challenge is that risks of injury change as kids develop their skills and become more independent, not to mention that caregivers must be vigilant about recognizing and reacting to symptoms of illness because kids don't always have the communication skills to describe what's wrong.

"There's a potential for someone to get injured daily," Batista said. After 25 years in the field, she said she's seen many changes to first aid and CPR protocols for childcare workers. "I didn't know what an epinephrine pen was in the 1990s; now we are sure to have one if a kid has severe allergies," she said.

Today, there's also more attention to the types of food offered due to allergies--no longer do they serve the peanut butter and jelly sandwiches many of us grew up with--as well as better awareness about choking risks and more awareness about cultural differences in a diverse nation.

Risks such as sun exposure also get attention now as a child safety issue, ensuring kids get protection from dangerous ultraviolet rays, Batista said. Even if training weren't required every two years, Batista said it is a clear priority in ensuring childcare workers are comfortable providing first aid and CPR when something goes wrong. "There are many hats that we wear as teachers and administrators, but we definitely wear the first aid hat every day," she said.

This article originally appeared in the April 2014 issue of Occupational Health & Safety.