Infant First Aid Training for Parents

Jim Shannon Excerpts

Wednesday 3rd April 2019 Westminster Hall

[Sarah Newton]

The hon. Lady makes a very good point. I hope that in our small way—as a result of this debate, the people watching it from outside the Chamber and the media coverage we secure—we will encourage people to take up that opportunity. That is a really good idea.

I have been listening very much to healthcare professionals in my constituency. Dr Simon Robertson, a consultant paediatrician at the Royal Cornwall Hospitals NHS Trust, told me:

“I have been a consultant general paediatrician for the last 12 years. I see children referred into hospital from their GPs, and the emergency department.

From the view of a general paediatrician a child illness and resuscitation course for all parents makes practical sense for the families and NHS services.

Parents are expected to make important decisions about their children’s health and about seeking medical advice. But we know they find it difficult to work out if their child just has a minor viral illness, or something more serious. Unfortunately not all parents are educationally equipped to read instructions from their red book, NHS Choices or health advice apps like the ‘HandiApp’. For them, we know they really need time and practice in a supportive environment to learn these decision making skills. We repeatedly see this in the families we teach resuscitation to on the wards.

What is needed in my opinion, is a course for all parents and those in child care on how to manage the common emergency problems like choking, diarrhoea and vomiting, a seizure, recognising sepsis, managing a head injury, or in preventing accidents, drowning or cot death. These learnt skills could help keep children safe and healthy, so should be the skills highly valued by families. Vitally, early action may help prevent some medical emergencies deteriorating to life threatening illness.

This can only be good for the health of children, and for children’s acute NHS services.”

I completely agree.

In 2013, the Department for Education undertook a confidential inquiry into maternal and child health in England. It conducted a meticulous audit of deaths of babies and children, and reported identifiable failures in children’s direct care in just over a quarter of deaths, and potentially avoidable factors in a further 43% of deaths. The University of Northampton’s 2017 report “Before Arrival at Hospital: Factors affecting timing of admission to hospital for children with serious infectious illness” stated that parents often find it difficult to access relevant health information or to interpret symptoms, and that it can even be difficult for GPs to determine how serious a case is in the early stages.

I have been working with Cornwall Resus, which was established in 2012 by two paediatric nurses to give parents and carers the necessary skills to empower them to recognise when their baby or child is unwell and to respond appropriately. It runs courses for parents in community centres around Cornwall. Those courses last two to two and a half hours and include practical training on choking and resuscitation using lifelike dummies, with lots of time for questions and discussion at the end. I know that I would not be happy to undertake those actions unless I had practised them on a dummy first; having just looked at instructions or a diagram, I would still be very nervous about the amount of pressure to apply, so using dummies and having practical sessions and reassurance is really important.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this subject forward for consideration, and I commend her for the work she did as a Minister. I am very pleased to see her active on the Back Benches with the rest of us. I became a grandfather for the third time just before Christmas, when my grandson Austin—I already had two granddaughters—was born. I am very mindful that parents are immensely stressed after the birth of their baby, given the care babies require. For each parent to have just a bit of knowledge about these things at that time can be the difference between life and death. Does the hon. Lady agree that there is an opportunity, through the antenatal classes that mothers do with their local trust and GP, to instil in parents the basic skills she refers to?

[Sarah Newton]

I thank the hon. Gentleman for his contribution. I will come on to what I would like the Government to consider doing. I do not think we should be prescriptive about how this training is enabled. Lots of organisations provide such training—Kernow Resus is one such organisation, but we have also heard about the Red Cross, St John Ambulance and Millie’s Trust—and of course there is the NHS workforce themselves: maternity nurses, and healthcare professionals who visit families at home. We should not be at all prescriptive about how we might enable this training, but it is important that all parents have the opportunity to participate.

Most courses cost around £30, which will seem to most of us like a very modest investment, but not every parent will be able to afford that. That will be a real barrier for some families. That is why I would like the Government to enable universal access to high-quality, evidence-based training delivered by fully qualified providers. That would give us the opportunity to reduce morbidity and mortality and, importantly, family distress. It would also help tackle the associated costs of treatment, hospital admissions and even possible litigation. We have seen huge improvements in child and infant health in our country. The number of deaths of babies and small children has fallen significantly, but it is still far too high, so I really hope that the Minister will consider seriously how we might take forward this relatively modest, straightforward intervention.

The NHS is rightly focused on preventing ill health and injury, and I am delighted that the Government are investing so much in it. I am sure everybody in the Chamber is fully supportive of that investment. It would require only modest investment to pilot this training in a couple of geographical areas and work with a couple of local commissioning groups to see how they might go about delivering it. We have heard about a range of options they might pursue. By giving commissioning groups responsibility to see how they might go about that, we could collect proper evidence about not only the impact on families and the reduction of deaths and harm to children, but the impact on acute trusts and primary care in an area if, as a result of being more confident, parents do not engage with the NHS quite so much.

This would be a small but vital step. It would be such a positive contribution. We would have more Rowenas, and far fewer families would have to cope with the dreadful grief of losing a loved one.

--- Later in debate ---

[Douglas Ross]

I fully endorse what the hon. Lady said. If there is not time or there are other constraints that mean a first aid element cannot be included in an antenatal class, perhaps there should be a signpost saying, “This is something you can consider. Here are some of the organisations who could do this,” just to put it on people’s radar. They are very excited about the birth of their child and fascinated by the birth process, which they have gone along to learn about, so just mentioning that may be a trigger that would make some parents consider, “Actually it is important to go to that organisation, or another, to get that training.”

[Jim Shannon]

I congratulate the hon. Gentleman on the birth of his son, which I would have done anyway. Will he be a footballer or a referee—who knows?

There is another option: the health visitor calls to check on the child and the mother, and there is a follow-up after birth. There are many ways other than statutory ways of doing this.

--- Later in debate ---

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this important debate. She has been a champion of raising awareness to reduce avoidable deaths through working with the UK Sepsis Trust—sepsis is also a major killer of adults and children—and I am delighted that she has now lent her voice to the cause of infant first aid training for parents. As a paediatric consultant, this is an issue close to my heart.

My hon. Friend highlighted the alarmingly high number of cases where something could have been done to prevent a child’s death: 21% according to the Royal College of Paediatrics and Child Health. I should declare my membership of that organisation. Working on a children’s ward for the last 15 years, sadly I have seen far too many of those 21%. However, I have also seen children whose lives were saved by passing members of the public, as was described earlier in the case of Rowena, by doctors or health professionals, or by visiting family members who just happened to spot something and were able to help.

My hon. Friend the Member for Truro and Falmouth powerfully described a case of a child choking. As we approach Easter and then summer, mini-eggs and grapes are particular culprits. Advice should include how to manage a choking child, as well as simple measures to prevent choking. Chopping up grapes into little pieces, sitting down while eating and not running about with things in the mouth are helpful in preventing choking, but it can still happen to anybody, young or old, at any time. We should all know some of the manoeuvres that can help, such as the one my hon. Friend described in the case of the baby choking. The baby should be held face down across the adult’s legs, so that the baby’s head is lower than the adult’s knee, and blows should be applied to the baby’s back, between the shoulder blades.

That sort of information does not take long to learn, but can have a huge impact and can be responsible for saving somebody’s life. The information is already provided to a number of parents. I have delivered infant first aid to parents whose children have been in hospital. Each of the neonatal units that I worked on in the midlands provided first aid training to parents before they left hospital, in part because pre-term babies are more vulnerable when they have just left hospital and in part to provide parents with the confidence to manage very small babies when they go home, as was described by my hon. Friend the Member for Moray (Douglas Ross). Training is also provided routinely to parents who have had a child die in the past, but obviously we want to look at prevention.

The hon. Member for Belfast South (Emma Little Pengelly) talked about contact with health visitors and midwives. Evidence shows that parents are particularly receptive to messages about healthcare and first aid when they have just had their baby or when they are expecting their baby, as my hon. Friend the Member for Moray mentioned. That is a time before life becomes really busy, when one can reflect on the joy that is to come and be well prepared for it.

There are lots of opportunities for first aid training to be provided. There are antenatal classes, where training can be signposted or provided, as well as nurseries. I strongly believe that the practical advice should not just include what to do when things have gone wrong, but how to stop them going wrong in the first place. My hon. Friend the Member for Moray mentioned burns. I remember the case of a child who walked past a lit candle; it caught her dress and she got severe burns to her whole front. In that case her mum knew what to do—drop her to the floor, roll her over and stop the burning—and treated the situation appropriately, but even so the injury was severe and could have been prevented if the candle had not been left on such a low table.

Using seatbelts and car seats are among other simple measures that we know we should to do. One major cause of preventable deaths in children is drowning, so there should be simple advice about making sure that children are not left unsupervised around open water. I have seen this particularly in situations where there has been open water and a group of people, often at a big family event, where everybody is looking after the child but there is not one specific person watching to see that they do not end up in the water. At one of my children’s christenings, I was upstairs in a bedroom on the other side of the house when I saw from the window that a friend’s little boy had gone towards the small pond we had in the garden and that he was on his own. I ran downstairs and was fortunate that he had not gone into the pond by the time I got there. My husband was out with a digger the following day getting rid of the pond. It was not worth the risk, but if people have such ponds they need to be carefully managed. I have certainly seen children drown in those situations.

[Jim Shannon]

One thing that can be neglected in homes is fluids in cupboards. Years ago, when we were younger, fluids were kept in lemonade bottles and similar containers, and children did not realise that. I well remember when my second boy was very young—he was the one who everything seemed to happen to—he managed to get a gulp or two of Brasso. He had the shiniest backside that any child ever had, but that is by the way. It can easily happen that a fluid can be drunk or absorbed by a youngster. We need to take steps in our own homes to ensure that all fluids are under lock and key, wherever they may be.

[Dr Johnson]

I take the hon. Gentleman’s point about fluids. I noticed when I bought some washing detergent last week that the lids now have a clasp that is especially difficult to open, so children cannot consume those little bubbles. No one is ever perfect; I know that if I looked for hazards to my three children in my own home they would be there. So far, thank God, I have been lucky and I hope that will continue, but we can all do things to reduce risk.

I am glad that the Government are committed to ensuring that all early learning staff have first aid training, but it is time that they did the same for parents. Since 2016, all newly qualified level 2 and 3 early years staff must hold a current paediatric first aid or emergency paediatric first aid certificate. The Millie’s Mark quality scheme, which was commended by my hon. Friend the Member for Cheadle (Mary Robinson), was also launched in 2016. It requires childcare providers to train 100% of their staff in paediatric first aid, not just to have one trained person on site at any one time. The 300th nursery gained Millie’s Mark last summer, which was a cause for celebration, and I am proud those nurseries include Dappledown House Nursery and Appletree Corner Daycare in my constituency. My son’s nursery has offered parents first aid training in the last couple of months, so the message is getting out there and that needs to continue.

The efforts to provide safety in schools should now be matched to provide safety in the home. The time and financial investment needed to provide that is small. It costs £30 for two and a half hours of invaluable training on some of the most common causes of avoidable death, including choking, and ways of providing resuscitation. Providing preventive medicine is one of the best investments we can make. As well as avoiding tragedy, it takes pressure off our NHS services, which are facing ever-increasing demand. It is the right thing to do for both our children and our country, and I am glad to lend my support to this cause today.