First aid

If the brain is deprived of oxygen for more than five minutes, brain damage will result causing total physical and mental disabilities. The victim will be reduced to being a “vegetable’’.

Immediate intervention by giving the infant/child who had stopped breathing, two rescue breaths – that is, two puffs of our breath – before spending precious minutes to seek medical help can reduce this risk. The air that we breathe contains 21% oxygen and our body only takes up 25% of this inhaled air. Thus the air we exhale still contains about 16% oxygen which is sufficient to help the victim.
Events that necessitate CPR:

* Injuries
* Suffocation (caused by food, toys, plastic covers)
* Smoke inhalation (due to fire)

Whilst on the subject, the doctor added that sadly, some parents with little knowledge of first aid had inflicted more harm on their child while trying to help. For example, children with burns turned up in the emergency rooms with honey, butter, dark soya sauce and even toothpaste on their wounds.

The doctor said that the right thing to do when dealing with burns caused by steam, boiling water, hot oil, hot soups or fire is to cool the burnt area under running water and then cover with a clean, sterile cloth before seeking medical attention.

I used to be terrified at the sight of a bleeding child. When one of my sons cut himself, I would turn pale at the sight of blood.

However, after watching how a paediatric surgeon handled a minor surgery and stopped the bleeding, I am glad to say I no longer fear the sight of blood.

The right thing to do whenever there is any bleeding from cuts is to apply pressure with a clean, sterile cloth on the wound. Blood will stop oozing out after a while.

As parents we want to keep our children safe from harm and danger. But accidents do happen, and a little first aid knowledge can help greatly in an emergency.

Recently, I attended a course on cardio-pulmonary resuscitation (CPR) for infants and children. It was conducted by a consultant paediatrician/neonatologist, who is also a certified neonatal resuscitation programme instructor and paediatric advanced life support instructor.

Many of us may think that CPR is something for medical personnel only. The truth is, CPR can be learnt by any of us under proper guidance.

I would like to share with parents some of the things I have learnt at the course. However, there are limitations here as certain things need to be learnt hands-on. For example, it is difficult to describe just how hard the chest compressions and back blows should be, or how fast should the cycle of breath and chest compressions be. It is best to get professional guidance on the proper application.

The Star Online > Features

Wednesday, April 23, 2003

Giving First Aid

By CHAN LILIAN

As parents we need to be prepared to face all kinds of trying situations involving our little ones. But when it comes to first aid, how well-equipped are we? Or do we turn pale at the sight of blood? CHAN LILIAN shares with readers the importance of learning life-saving skills.

DURING the last school holidays, I was at the KLCC park with my three adventurous and boisterous boys. They had disappeared among the wide variety of monkey bars, slides, swings and mazes, while I was relaxing on a bench.

My carefree moment was suddenly shattered by shouts that drew my attention to an eight-year-old boy who was clutching one of his arms, obviously in pain. Apparently he had fallen from one of the monkey bars and fractured his arm.

His mother was in a state of panic and started dragging the boy, looking for his shoes, their bags and asking: “Where is the nearest hospital?” She ran – with her son in tow – to the car park which was quite a distance away.

Meanwhile, the poor boy was trying to use his other hand to straighten the fractured arm. As a mother, it breaks my heart to see the frightened little boy and his helpless mother in a state of panic and confusion.

Anyway, that incident jolted me into realising how ill-equipped I was to handle an emergency like that. Several years ago, my eldest son injured his toe in school. I was informed by the school authorities but I was too weak in the knees to even drive to school to see him! I had envisaged a bloodied white canvas shoe, a detached toe nail, raw flesh, bones sticking out and all that horrible, gory stuff.

Through the years, I have managed to overcome some of the fears and learnt to be a cool cucumber like my husband.

After handling so many cuts, bruises, injuries and even an attempt at CPR to revive my premature baby, I have learnt to be more knowledgeable, practical and calm.

After that incident at the KLCC park, I had the opportunity to ask my son’s paediatrician what should have been done in the boy’s case. He advised that the first thing to do was to immobilise the arm so that there was no movement to the wounded part to reduce further injuries due to bone fragments. In the absence of proper bandages, we could even use the child’s shirt or sweater for that purpose.

Looking back, I was seven when my father died. Being 10 to 14 years younger than my older siblings, I was terrified of all the goings-on because everyone in the family, especially my mother, cried almost continuously. I did not know why everyone was acting like that and could not understand why they were so sad.

Until today, I can still remember vividly the uncomfortable sack-cloth mourning clothes I had to wear and the long distance I had to walk to the cemetery. I can even remember the smell of the hurricane lamps that we lit every night.

I have a friend who lost her sibling when she was small and her family life changed dramatically after that. Another friend related to me that her older sister had died when she was a newborn but her parents did not tell her about this dead sibling. When she was an adult, she started having dreams of a baby in the ICU. Though some quarters may view this as a visitation from her dead sister, I believe she may have heard a lot about her dead sibling when she was small and only started recalling it as an adult.

I know several bereaved parents who would often remind their children of an older sibling who had passed away. Even though their children were not born yet when this older sibling died, they made sure that the older sibling was often in their conversation and given a place in their hearts.

Based on my own childhood experiences and that of others, I always urge my friends who are bereaved mothers to pay special attention to their other children. Never tell a child that their loved one died because a Higher Being has taken the person back. Never give the young child an impression that the person died because he/she was too old, too sick, in too much pain, etc. The child may be terrified of death and of the Higher Being because of this wrong interpretation. Also, avoid telling a small child that grandma has gone into a deep sleep and will not wake up again. The child will feel insecure and may think that you have died each time he sees you sleeping.

Though it is hard to explain to very small children, it can also be hard to deal with older children. Children at a certain age may not be as inquisitive or ask innocent questions like younger children.

I always remind my two older children about their maternal grandma and ask them if they still remember the times they spent with her. Giving them a chance to talk will reveal the feelings hidden in their hearts. At the same time, we often joke about their baby brother Vincent. I reassure them that Vincent is indeed in a wonderful place and independent with wings to fly.

It is unfortunate that my two older sons, Jeffrey and Michael, had to experience so many losses of loved ones at such a young age. However, I believe that they will grow up to be very calm and wise adults as a result of what they have been through.

Though loved ones who are left behind may mourn and grieve, and though the parting is extremely painful, it is made bearable with faith. The promise of being reunited one day will keep the grieving party going, though the journey may be difficult.

Not everyone can see death as this simple transition but I have encountered so many losses in my own life and that of others, that I have learnt to accept it that way.

I suggested that she allow her children to talk and express their feelings as much as they like. Two months later, my friend was very surprised when her three-year-old boy brought up the subject again. He told her that he was very sad because grandma had died and he could not see her anymore. She encouraged him to say what was on his mind and assured him that it was all right to feel sad and to miss grandma.

Her little boy was given lots of cuddles and hugs to make him feel secure. She also told her son that though grandma was not around, he could still love and remember grandma in his heart, and see her photos. The boy was comforted to see my friend wearing his grandma s bracelet.

My three older children encountered a death much worse than losing their grandmothers or teacher: they lost their baby brother, Vincent. They were in Penang while Vincent and I were in Kuala Lumpur when it happened. At that time, I prepared myself with my most composed voice and told them individually over the phone.

As they had not anticipated Vincent s death, I had to find the most acceptable explanation for them. I told them that their little brother had decided that he wanted to go to Heaven and play. When we brought his body back, all my three children had no qualms or fear, and took turns to carry the little body to the funeral parlour.

However, during the funeral, my sons were terribly sad and one of them cried inconsolably. My husband and I were then too emotional to explain further or talk to them. Luckily, their trusted paediatrician was there to comfort them by telling them that Vincent was now a happy angel in Heaven and was playing with all the cute little angels. They witnessed the cremation ceremony and the scattering of the ashes at sea the following day. Children being children, they had a good time travelling in the sampan and enjoyed the trip without feeling too sad about scattering the ashes.

My husband and I had to put aside our emotions and concentrate on making sure that our three children had plenty of things and activities to keep them entertained. Though they did see me crying at times, they coped pretty well.

However, we mention Vincent in our conversations each day and, on special occasions, my children would release helium balloons and make wishes for Vincent.

After the arrival of another baby, Matthew, we continued to make Vincent a part of the family. My seven-year-old son, David, would often pray and ask God to let Vincent go to His giant castle and play in the giant playground. David also asked me how he was to supposed recognise Vincent if he ended up going to Heaven when he was an old man.

My mother was given an elaborate funeral according to Taoist rites. As I was pregnant then, I was not allowed to participate in most of the rituals, including the burial. But I saw to it that my two children witnessed the casket being put into the grave. After the funeral, we often passed by the graveyard and my children were comforted with the knowledge that only grandma s body was in the casket, but her soul was now free.

Though their daily routine was greatly disrupted with the change of environment, they coped pretty well.

Several years later and with the addition of my third son, they encountered the death of their paternal grandmother who died after a long illness.

This was followed by the death of their favourite kindergarten teacher, Colleen, a wonderful young woman who met with an accident while travelling to school one day.

We took all our three children to the funeral parlour to pay their last respects to her. At that time, my third son who was about five years old was rather solemn with the absence of his teacher; the usually chatty boy had fewer things to tell after school. Nevertheless, I assured him that teacher was probably teaching all the children in Heaven.

Several years later, he could still remember dear Colleen and wanted to visit her in the columbarium where her ashes were kept.

Not too long ago, my friend s mother-in-law had a heart arrest in front of her grandchildren. Her friend s hubby who is from the medical profession tried to revive his mother but unfortunately, she passed away. My friend s sons were only six and three then.

My friend was very sad and emotional, and at a loss as to how to pacify her two sons who were very close to their grandma.

The Star Online >

Thursday August 28, 2003

Coping with death

By CHAN LILIAN

SOME years ago, my husband and I thought it would be a great idea to have our two older children keep pets. We started with goldfish. That was the first lesson my children learnt about living things, caring for them and learning to make them part of the family.

However, soon the joy of having Goldie, Blackie and the whole fish gang turned into one sombre  funeral after another. Every time a fish died, we would dig a hole, bury the fish in it, mark the spot with a stone and bid Mr Fish  bye-bye .

From fishes we advanced to rabbits, then hamsters. A few outstanding pets remained in my children’s memories long after they had been buried. Often, my children would ask if rabbits went to heaven, too.

Those pet funerals turned out to be very useful lessons in life for my children. Young minds like theirs cannot grasp the meaning of death. When they watch cartoons, characters die and live again the next moment. But giving their precious pets funerals taught them that once a pet dies, it no longer exists physically.

When my two older children were six and four years old, my beloved mother who was their primary caregiver died unexpectedly. One day she was taking care of them and the next, she was gone. They had depended totally on her and grandma had doted on them.

When they woke up that morning, we told them calmly that grandma had died during the night. Then came their endless questions like:  Why does she want to die? Is it because she doesn t want to take care of us?  Who is going to make barley water for us when we come back from kindy?

Avoid scaring your child with remarks like: “If you don’t behave, the doctor/nurse is going to give you an injection.” Show your child that doctors, nurses, physiotherapists and all hospital staff are friendly, kind and helpful people. Paediatric nurses who are trained to be pleasant and fun with children can ease a lot of fears in their young charges.

If you are staying in a private hospital, you will have the luxury of dealing with only one attending paediatrician whom you may already be familiar with.

However, if you are staying in a government hospital, especially a teaching hospital, several specialists and doctors will visit and assess your child. To avoid miscommunica-tion or confusion, it is best that you liaise with, and obtain information directly from, the consultant in charge instead of asking as many doctors as possible.

One helpful thing to remember is that all doctors have many patients to attend to. Thus it would be wise to seek a proper appointment through the ward nurse if you have something important to ask. Make a note of the questions you wish to ask your doctor and jot down the answers if possible.

With proper respect, understanding and diplomacy, a patient and doctor can have an amiable, working relationship.

As parents, we should make our child’s hospital stay as pleasant as possible. Your child will feel proud having braved a hospital stay and count that as a life experience.

If someone else is taking care of your child in the hospital, do brief him or her on the dangers lurking in hospital wards. A child who has just recovered from an illness may have a burst of energy after being confined in his room for a few days. A responsible adult should always keep an eye on the inquisitive child and keep him out of danger and trouble.

My children have been hospitalised for illnesses like pneumonia, diarrhoea and injuries. They have associated a stay in the hospital with lots of new toys, storybooks, a break from school and a mini-holiday with full attention from mum and dad.

There are several things that I avoid doing when my child is in hospital. I refrain from nagging and telling him: “I told you so.” It is bad enough that he is in pain; it would be very unkind to keep reminding him that his pain is a result of his misbehaviour. Usually, I will reserve the lecture for a more proper time when he is well and has returned home.

I make sure, too, that my child knows everything that is being done to him. I will explain to him why he needs to have a certain injection or why he is in pain. You might want to avoid having too many visitors during the illness. The child may feel helpless lying in bed with so many pairs of eyes looking down on him. Having many adults surrounding the poor child and talking in terms that may be unfamiliar to him can be terrifying. The poor kid may misinterpret all that adult talk and think that something bad has happened to him.

Sometimes, the parents or grandparents may resort to alternative treatment in an attempt to speed up recovery. A small child’s health is fragile so it is best to leave the treatment to the doctors. I have seen a great-grandmother feeding ash water to a very ill baby with breathing difficulties, and applying some traditional ointment on the child. Menthol and methyl salicylate, which are commonly used in traditional ointments, can have adverse effects on some children. Thus it is best to check with your doctor before attempting to cure your child with some traditional remedy.

The Star Online > Features

Wednesday, June 25, 2003

In good hands

A hospital stay need not be a traumatic experience for a young child. Veteran mum CHAN LILIAN shares ways to allay unfounded fears and look at hospitals in a new light – as cheerful, friendly places.

THE very mention of the word “hospital” conjures up images of bedridden patients and very ill people. The whitewashed walls, cold atmosphere and smell of antiseptic add to the stark image of a hospital.

Such negative impressions may cause some parents to procrastinate when it comes to getting medical treatment for their children. Unnecessary emotional pressures are created when their little ones need a short hospital stay.

Being a mother to five, I have more than a decade of experience of hospital trips and stays. I have been to the emergency room, intensive care unit, operating theatre, x-ray room, nursery, labour room and just about every ward in some of the hospitals that I regularly frequent.

Through the years, I have learnt to see hospitals in a different light. In fact, hospitals can be people-friendly and cheerful places.

For the new mother, one of her earliest encounters with a hospital stay for the baby is when the newborn has jaundice, a common condition among babies. I have seen many new mothers, traumatised by the sight of their babies undergoing phototherapy, crying helplessly in the nursery.

It can be rather frightening to see your baby wearing little “sunglasses” and lying almost naked under the purple light which will help convert the harmful bilirubin, the yellow pigment that causes jaundice, into soluble substances that can be passed out of the body through the urine. However, the whole procedure is painless and does not cause any discomfort to your baby. Your baby is in the good hands of the trained and experienced nurses in the nursery.

Older children who are sick and need to be hospitalised will be escorted to the ward after the necessary registration and payment of deposit have been settled. There he will be weighed, his temperature and blood pressure taken, and an identification tag given to him.

The accompanying parents get upset sometimes when their child requires the insertion of an intravenous line in the treatment or procedure room. The fastest way for the medication to work is to go directly into the blood stream. So a tiny needle will be inserted into your child’s hand, foot or a spot near the forehead. The needle is very flexible and fine with an open end where the nurses can administer medication. The nurse will put a big bandage to protect the needle from being accidentally dislodged.

Depending on the hospital policy, either the staff nurses or the doctor will carry out this procedure. If you are a softie, it is best that you leave your child in the good hands of the medical staff and leave the room. Other procedures that may be upsetting for the parents are the cleaning and dressing of wounds, physiotherapy and the suction of phlegm.

I have seen many mothers crying together with their sick child in the treatment room. While it is good to be with your child to soothe his pain and reduce his fears, your crying may frighten your child even more. Even small babies can sense your emotions, so the nurse or doctor may not allow you to be present during certain procedures.

A hospital stay is a good time to bond with your child. There is nothing more important to the child than having the loving, warm and secure embrace of his parent.

Part two