Why the first few minutes matter most

As a nanny, childminder or babysitter, you are often the adult closest to a child when something goes wrong. Those first few minutes — before a parent arrives, before an ambulance pulls up — can shape the whole outcome. That is not said to frighten you. It is said because it is genuinely good news: most childhood accidents are manageable with a handful of simple, well-practised skills, and knowing them means you can act instead of freeze.

Preparation is what turns knowledge into confidence. Before your first day with a new family, ask about allergies, medical conditions such as asthma or epilepsy, and any previous incidents. Make sure you know where the first aid kit lives, whether there is a thermometer, and how to reach the parents in an emergency. Keep all of this in one place, and check it again whenever you start with a new family.

The order of things: check, call, care

When you find a child who is unwell or injured, resist the urge to rush in. Take a breath and work through a simple sequence.

• Check for danger — to you, to the child, to anyone else. You cannot help anyone if you become a casualty yourself.
• Check for response — call the child's name, tap the soles of their feet for a baby, and gently squeeze the shoulders of an older child.
• Check the airway — is it clear? Are they breathing normally? Look, listen and feel for no more than ten seconds.
• Call for help — if a child is unresponsive or not breathing normally, dial 999 immediately, or ask someone nearby to do it while you start care.

If a child is breathing but unresponsive, place them in the recovery position on their side, with their head tilted slightly back, and stay with them until help arrives. Never leave an unresponsive child alone, not even to fetch a phone — use a mobile on speaker if you can.

Choking: the emergency you are most likely to meet

Choking is frightening because it is silent. A child who is coughing loudly, crying or speaking is moving air, so encourage them to keep coughing. Step in only when the cough becomes silent or they cannot breathe, and act quickly.

For a baby under one year: lay them face down along your forearm, supported on your thigh, with their head lower than their body. Give up to five firm back blows between the shoulder blades with the heel of your hand. If that does not work, turn them over and give up to five chest thrusts with two fingers on the lower half of the breastbone.

For a child over one year: give up to five back blows with the child leaning forward, then up to five abdominal thrusts, pulling sharply inwards and upwards just above the navel. Alternate the two until the object clears. If the child becomes unresponsive, start CPR and call 999. Any child who has received abdominal thrusts should be seen by a doctor afterwards, even if they seem fine.

CPR and unresponsiveness

If a child is not breathing normally, start CPR and keep going. For babies and children, begin with five rescue breaths, then continue with 30 chest compressions to two breaths. Compress the lower half of the breastbone to about one third of the depth of the chest, at a rate of roughly 100 to 120 compressions a minute — the tempo of a fast pop song. For a baby, use two fingers or two thumbs; for a child, one or two hands depending on their size. Push hard, push fast, and let the chest come back up between compressions.

Use an AED if one is available — they are designed to be used by anyone and will talk you through each step. Do not stop until the child shows signs of life, help takes over, or you are physically unable to continue.

Bleeding, burns and bumps

For a cut that is bleeding heavily, press firmly on the wound with a clean dressing or cloth, add more layers on top if it soaks through, and do not remove the original dressing. Raise the limb if you can and call 999 for spurting blood, a wound that will not stop, or anything deep or gaping.

For burns, cool the area under cool running water for a full 20 minutes and remove clothing or nappies only if they are not stuck to the skin. Never use ice, butter or creams. Cover loosely with cling film and seek medical advice for anything larger than a 50p piece, or any burn on a baby's face, hands or genitals.

For a bump to the head, apply a cold pack wrapped in a cloth and watch closely for the next 24 hours. Call 999 if the child is drowsy, vomiting repeatedly, has unequal pupils, has clear fluid from the nose or ears, or was knocked unconscious — even briefly.

Staying ready, and keeping records

Book a practical paediatric first aid course and renew it every three years — hands-on practice with a manikin is worth far more than reading. Keep a well-stocked kit in your bag and check it every term. Know the child's allergies, and if they carry an adrenaline auto-injector, make sure you have been shown how to use it and where it is kept. For suspected allergic reactions, use the device into the outer thigh and call 999 straight away.

Finally, write down what happened. Note the time, what you saw, what you did and who you told, and pass that record to the parents. It protects the child, it helps any doctor who sees them, and it means that if something similar ever happens again, everyone knows exactly what to do.