Hazards in the home

Accidents happen every day, and children, being naturally curious and often oblivious to danger, are especially vulnerable. Yet few parents in Hong Kong have an understanding of basic emergency first aid. "Most people think [mistakenly] nothing life-threatening will happen to their children."

That's the view of Jackie Simpson, first aid and CPR (cardiopulmonary resuscitation) instructor at First Aid Plus.

"When I teach domestic helpers, I always ask them what their employer has told them to do if the child they are looking after has a life-threatening condition. Most of them say their employer has never discussed it with them, or has said to call them if anything happens, but they don't say what to do if the helpers can't reach them on their mobile phone, which happens often."

This mindset could explain why Simpson says the paediatric course at First Aid Plus is among the least popular.

Almost 25 per cent of injuries to children in Hong Kong under the age of 14 occur in the home, 82 per cent of which involve children under four, according to an Injury Survey for the Health Department published in 2008.

The survey found falls were the most common cause of injury in that age group (64 per cent), followed by injury from a hit or strike from an external force.

Drowning, accidental poisoning from medicine and cleaning products, traffic accidents, exposure to smoke or fire and assault also contribute to injury among young children, says Dr Chow Chun-bong, honorary professor in the department of paediatrics and adolescent medicine at the University of Hong Kong.

"The concern in Hong Kong is that children left unattended at home leads to falls, poisoning and foreign body ingestion," he says. "And the law on car seats is still very primitive. Only children under age two may not legally sit in the front seat, and that's all."

Overall, the most common household accidents involve burns, choking, injuries or strangulation from dangling blind cords and cuts, according to Annerley Maternity and Early Childhood Professionals, which also runs paediatric first aid courses for parents and helpers.

Because of the work ethic in Hong Kong, the responsibility for the safety and care of the family's children generally falls to domestic helpers. But cultural differences can lead to misunderstandings, as parents assume the helper's approach will be the same as theirs.

"Helpers are used to a different family network and support system in their own countries, so their sense of play and safety is different," says Conchita Amende, a health visitor and instructor at Annerley. "Many helpers in Hong Kong also work with multicultural, ethnic and multilingual families, and are pulled in many directions, which makes it hard to work out what the right thing to do is."

She cites one example of a parent who insisted on putting a feverish child in a cold bath, which distressed the child and the helper.

"This is an example of where a little information can be dangerous," she says. "Cooling the temperature of a child with a fever is appropriate using tepid sponging and appropriate medication. Putting a child into a cold bath is wrong and could have caused much more harm than good."

Another potential for conflict arises when a helper does have first aid training and knows what to do, but the parent disagrees or hesitates. "The helper will do what the parent wants because they fear losing their job. This is why it is essential for both parents to attend courses as well as the helpers," Amende says.

Experts say the most common misconceptions involve the treatment of burns and choking. Using butter or oil on a burn will only help it to continue burning.

"When a child is burned by water or steam, immediate care is needed," says Joyce Moir, a registered nurse who runs CPR and first aid courses at Annerley. "The burn needs running water on the area, and if clothes are worn and it is over that area, the item needs to be removed. After those two things, immediate professional help is required."

On the subject of choking, Moir advises against slapping the back of a child when something becomes lodged in an air passage. "Parents immediately slap on the back when the body is naturally trying to expel the foreign object. When a child appears to be choking but can cough and cry, let them, but watch them closely."

In a medical emergency, every second counts, but knowing which situations need immediate action and which can wait for professional help is what first aid classes teach.

Unconsciousness, breathing difficulty, neck or head injuries, severe bleeding, seizures and choking are some circumstances that require emergency first aid, says Simpson of First Aid Plus.

On the other hand, a nosebleed, rash, fever, vomiting, diarrhoea, small cuts and sprains are situations that require first aid now and professional help later. "Each case needs to be assessed by a first aider. Symptoms such as vomiting may need immediate medical help, as might a fever, but it depends on the whole situation," Simpson says.

When children are unresponsive or breathing abnormally, CPR can keep oxygen flowing to the brain, heart and other vital organs until professional help arrives. That's a basic first aid skill every parent and child minder should have, Moir says, and knowing how to do rescue breathing and how to handle choking, fever or bleeding, in her view, "are the bare minimum".

In a medical emergency, Simpson says: "Stop and have a quick look to see what actually happened before you rush in and miss a very obvious clue that could reveal what the real problem is and its severity.

"It will also give you a moment to collect yourself. Ask yourself: 'Can I manage this first aid situation, or do I need to call for medical help?' If in doubt, call for help as soon as possible," she says.

Above all, remain calm. "Remember, the child is already scared," Moir says. "They are looking to you to save them and care for them."

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