Pediatric First Aid: Emergency Care for Children and Infants
Children are not simply small adults. Their anatomy, physiology, and developmental stages create unique patterns of injury and illness, and they require distinct first aid approaches. The American Academy of Pediatrics (AAP) reports that unintentional injury is the leading cause of death in children over age 1 in the United States, and that many pediatric deaths are preventable with timely and appropriate first aid. This guide covers pediatric-specific first aid including fever assessment and management, common injuries by developmental stage, pediatric CPR and choking modifications, poison ingestion, and clear criteria for when to call 911 for a child.
Fundamental Differences in Pediatric Anatomy and Physiology
Several anatomical and physiological differences make pediatric first aid distinct from adult care. Infants and children have a larger body surface area relative to their weight, meaning they lose heat faster and are more vulnerable to hypothermia. Their heads are proportionally larger, making head trauma more common and more serious. The pediatric airway is smaller, narrower, and more easily obstructed by swelling or foreign objects. The ribs are more flexible, so significant internal chest injury can occur without rib fracture.
Children also have higher metabolic rates and oxygen consumption, so they decompensate more rapidly when respiratory or circulatory function is compromised. The AHA emphasizes that the most common cause of pediatric cardiac arrest is respiratory failure — not primary cardiac disease as in adults. This means that effective rescue breathing is especially critical in pediatric resuscitation.
The CDC notes that children’s developing immune systems make them more susceptible to certain infections, and their natural curiosity and lack of risk awareness place them at higher risk for poisoning, falls, and drowning.
Fever Management in Infants and Children
Fever is one of the most common reasons parents seek medical attention. The AAP defines fever as a rectal temperature of 38°C (100.4°F) or higher. While fever can cause discomfort and parental anxiety, it is the body’s natural defense mechanism against infection. Treatment should focus on comfort rather than achieving a normal temperature.
For infants under 3 months of age with a rectal temperature of 38°C (100.4°F) or higher, the AAP recommends immediate medical evaluation — do not wait for other symptoms. These young infants have immature immune systems and are at risk for serious bacterial infections including meningitis and sepsis. For infants between 3 and 6 months with fever but normal behavior, feeding, and activity, call your pediatrician for guidance. For children over 6 months, fever alone without other concerning signs can be managed at home.
The Mayo Clinic recommends acetaminophen (15 mg per kg of body weight every 4 to 6 hours, not exceeding 5 doses in 24 hours) or ibuprofen (10 mg per kg every 6 to 8 hours, not exceeding 4 doses in 24 hours) for fever-related discomfort. Never give aspirin to a child, as it is associated with Reye syndrome — a rare but potentially fatal condition affecting the liver and brain. Dress the child in lightweight clothing, maintain a comfortable room temperature, and encourage fluid intake. Tepid sponging is no longer recommended by the AAP, as it causes discomfort and may induce shivering, which raises core temperature.
Febrile seizures — convulsions triggered by rapid temperature elevation — occur in 2 to 5 percent of children ages 6 months to 5 years. The CDC advises staying calm, placing the child on the floor on their side, clearing nearby objects, timing the seizure, and never putting anything in the child’s mouth. Call 911 if the seizure lasts more than 5 minutes, the child does not return to normal responsiveness within 10 minutes, or it is the first febrile seizure.
Pediatric CPR and Choking: Modified Protocols
The AHA pediatric CPR guidelines differ from adult protocols in important ways. For infants (under 1 year), compressions are performed using two fingers in the center of the chest just below the nipple line, compressing to a depth of approximately 1.5 inches (4 cm). For children (age 1 to puberty), compressions may be performed with one or two hands as needed for adequate depth — approximately 2 inches (5 cm). In both cases, the compression-to-ventilation ratio for single rescuers is 30:2, the same as for adults, but for two-rescuer healthcare providers, the pediatric ratio is 15:2.
Rescue breathing is of paramount importance in pediatric arrest because most pediatric cardiac arrests originate from respiratory failure. Deliver each breath over 1 second with enough volume to produce visible chest rise. For infants, cover both the mouth and nose with your mouth. For children, use the mouth-to-mouth technique. The AHA recommends providing 20 to 30 rescue breaths per minute (one breath every 2 to 3 seconds) if there is a pulse but no breathing.
Choking management also differs by age. For infants under 1 year who are choking and cannot cough, cry, or breathe, the AHA recommends alternating 5 back blows (between the shoulder blades with the infant face-down on your forearm) and 5 chest thrusts (on the sternum, similar to compression location). Do not use the Heimlich maneuver (abdominal thrusts) on infants, as it can damage the liver and spleen. For children over 1 year, abdominal thrusts — or the Heimlich maneuver — are used as described in the choking emergency guide.
Common Pediatric Injuries by Developmental Stage
The CDC classifies pediatric injury patterns by developmental stage, as motor and cognitive abilities determine the types of hazards children encounter.
Infants (0 to 12 months) are most vulnerable to falls from changing tables, beds, and sofas, as well as burns from hot water and accidental suffocation from soft bedding or strangulation hazards. First aid focuses on fall assessment — observe for vomiting, lethargy, or unequal pupils after head trauma. Scalds from hot liquids are common; remove wet clothing immediately and cool the burn with running water as described in the burns treatment guide.
Toddlers (1 to 3 years) explore actively but lack judgment. Poisoning peaks in this age group — household cleaners, medications, and small objects all present hazards. The AAP recommends keeping the national Poison Help number (800-222-1222) programmed into all phones. Drowning is the leading cause of injury death in this age group — never leave a young child unattended near any water source, including bathtubs, buckets, and toilets.
School-age children (4 to 12 years) experience more sports-related injuries, playground falls, and bicycle crashes. Fractures of the forearm are extremely common in this age group. The RICE protocol and splinting techniques from the fractures and sprains guide are directly applicable. Helmets reduce the risk of head injury by 85 percent in bicycle crashes, according to the CDC.
Adolescents (13 to 18 years) face risks from motor vehicle crashes, sports, and activities of daily living. This age group also has the highest incidence of concussion from sports and recreation. The CDC recommends using the Concussion Recognition Tool for any adolescent with head injury presenting with headache, dizziness, confusion, or visual disturbance — and removing them from play immediately.
Poison Ingestion: Immediate Steps
If you suspect a child has ingested a toxic substance, the American Red Cross recommends these steps. First, call the Poison Help number (800-222-1222) or 911 immediately. Have the container or substance available to identify the ingredients. Do not induce vomiting — the AAP no longer recommends syrup of ipecac, and activated charcoal is generally not administered in the home setting. Vomiting can cause aspiration of stomach contents and may worsen the effects of caustic or petroleum-based substances.
If the child is unconscious, not breathing, having a seizure, or showing signs of anaphylaxis to an ingested allergen, call 911 first. Place the child in the recovery position (on their side) to protect the airway if they vomit. Do not give the child any food, drink, or antidote unless directed by a medical professional. The Poison Control specialist will provide guidance on whether the child needs emergency department evaluation based on the substance ingested, the amount, and the time since ingestion.
When to Call 911 for a Child
Deciding when to call an ambulance for a child can be stressful. The AHA and AAP provide clear criteria: any difficulty breathing or no breathing at all, unconsciousness, seizure lasting more than 5 minutes, severe allergic reaction, bleeding that does not stop with pressure, suspected poisoning with altered mental status, head injury with loss of consciousness or vomiting, near-drowning, or any situation where you feel the child’s life is at risk.
In addition, specific conditions warrant emergency transport: a fever with a non-blanching rash (which may indicate meningococcal meningitis), a stiff neck with fever, dehydration with no urine output for 8 hours, suspected appendicitis (right lower quadrant pain, vomiting, fever), and any injury that visibly deforms a limb or causes the child to refuse to move it.
Trust parental instinct. The AAP advises that if you genuinely feel something is seriously wrong with your child, even if you cannot identify a specific condition, seeking emergency evaluation is justified.
FAQ
What is considered a fever in infants?
A rectal temperature of 38°C (100.4°F) or higher is the standard definition. Infants under 3 months with any fever should be seen by a doctor immediately.
At what age can children receive adult CPR?
Standard adult CPR protocols apply from puberty onward. For children age 1 to puberty, use pediatric modifications — shallower compressions and the 15:2 ratio if you are a trained two-rescuer provider. For lay rescuer single-provider CPR, the adult 30:2 ratio is used for all ages.
How do I treat a child with a febrile seizure?
Place the child on their side on a soft surface, clear nearby hazards, time the seizure, and do not put anything in their mouth. Call 911 if the seizure lasts more than 5 minutes or if the child does not recover quickly.
What should I do if my child swallows a button battery?
Go to the emergency department immediately. Button batteries (lithium coin cells) can cause severe esophageal burns within 2 hours. Do not induce vomiting or give food or drink. Call the National Battery Ingestion Hotline (202-625-3333) as well.
When can I give ibuprofen to a child for fever?
Ibuprofen is approved for children 6 months and older. The dose is 10 mg per kg of body weight every 6 to 8 hours, with a maximum of 4 doses per day. Use weight-based dosing rather than age-based dosing for accuracy.
Internal links: For pediatric choking protocols, see our choking emergency guide. For full pediatric CPR and AED instructions, see CPR techniques.