Young girl climbing tree

Tree climbing injuries – a first aid guide for children and early years practitioners

Tree climbing as an activity is seeing a bit of a resurgence at the moment in education and outdoor learning and we are seeing more practitioners including it in their sessions. Forest School activities wouldn’t be the same without a good tree to climb! The reason for tree climbing’s popularity is that it’s an activity that can be hugely rewarding for children – it allows them to assess and take controlled risks and explore the landscape in new ways; it’s great for physical fitness and generally a fun and personally rewarding activity. However, there are obvious hazards involved and it’s important to make sure that you are able to provide appropriate first aid should anything happen with a child in your care as well as preventing harm from befalling others in the group – just remember the ABCs of First Aid.

  • A – Asses for danger, Asses cross contamination risk (wear gloves), check their Alertness level and check that their Airway is clear;
  • B – check for effective Breathing for up to 10 seconds;
  • C- check Circulation – look for any bleeding, bumps or bruises.

Thankfully, in most cases, a fall from a tree (at least in our outdoor learning context) tends only to result in minor bumps and grazes,. We tend to see children sliding down the tree rather than going in free fall. As with all first aid the 1st priority in our ‘A’s is to Assess the situation – we need to be confident the area is safe for us to proceed and that the rest of our group are not in any danger. This can include making sure the rest of the group are suitably supervised and are not going to get lost or cause themselves injury with anything else that may have fallen from the tree or by them trying to help move tree debris on site.

Assessing and treating minor injuries

We need to fully assess the injured child to make sure we do not miss any injuries. If it is a case of cleaning any wounds, applying plasters or sterile dressings to any open cuts or grazes and comforting the child, then they are ready to re-join the activity or move on to something else. However, as we chat with the child, comforting them and making sure they are safe to continue the session we can also help a bit with pain relief. We can do this by providing a cool compress for any bumps or bruises that may be forming. This cooling helps slow the process of inflammation and help reduce the pain in the area.

A child's hands on a tree whilst climbing

Friction burns from ropes or trees

We may also see children receiving rope burns or friction burns when falling, possibly from grabbing at a line when falling or if they were climbing something like a cargo net or rope ladder before falling. We want to treat these like any other burns, seeking medical attention if they are deeper than the skin layer, larger than 5 times the child’s palm or any burns or injuries in sensitive areas.

It is important to remember that a friction burn is still a burn so we want to cool it with tepid running water for at least 20 minutes. This will reduce pain and prevent the burn from worsening. As we cool the wound, we also want to carefully and thoroughly clean these injuries removing as much dirt and debris as we can. This can be done with a drinking bottle squeezing gently to act as a mini-power washer. It may be painful but needs to be done to prevent infection. If you cannot get the wound fully cleaned seek medical help – your GP or minor injury unit can probably help with this.  Finally, to keep the wound clean apply non-stick dressing to prevent infection. Remember, we want to cool the burn but not the child. Keep them warm and reassured, perhaps using a foil blanket if necessary. Monitor them and their injury closely until you can get medical attention.

Have a look at our blog on rope burns here.

Checking for more serious injuries

Although minor bumps and scrapes are the majority of what we will see we cannot discount something more serious. If a child has fallen without slowing, has landed on something, or has just fallen in an awkward way, more serious injuries can happen. Again we check the full ABC and add  ‘D’s into our First Aid checks, D being ‘damage’.  We need to ensure we perform a detailed damage check of the casualty from top of their head to their toes. Whilst doing this, watch their face and keep eye contact with them. The reaction on their face may reveal a tender or sore spot not obvious at first. Your eye contact will also help reassure them,

Any injuries we do find we take care of, treating higher priority injuries first. ABCD in first aid are carried out in priority order – Airway first, then Breathing then Circulation then Damage.

Neck and spinal injuries

We should always consider neck and spinal injuries and be very careful how we move our casualty during our checks. With all casualties, but especially children, we need also to be aware of ‘charismatic injuries’ where the emotions involved with a visible injury such as a cut to the hand can mask something potentially more serious elsewhere. This is the case for both first aider and casualty, both can easily be distracted by the child’s focus on an obvious injury and it is not unusual for more serious damage to be missed in the rush to treat these. For this reason, we again need to make sure our D checks are thorough and take account of the whole body from the top of the head to the toes.

Checking for Head injuries

We should always be alert to any signs of head injury. Any loss of consciousness or other signs of injury should trigger us to seek immediate medical assistance. Head injuries can present in a variety of ways and sometimes the signs can appear quickly but they can also take a few days to manifest. For this reason, after any bump to the head, even if we are seeing no other signs, we should monitor the child closely for any signs of concussion developing. Some of the signs of concussion are listed in the table below.

A table listing the symptoms of concussion

Signs of more serious head injuries such as Compression or Skull Fracture include soft boggy depressions, blood or fluid from the ears or nose, blackening around the eyes, bruising behind the ears and of course falling into unconsciousness. Phone 999/112 immediately if the child shows any signs of these. Any child who has not been fully alert after a fall should be taken to hospital.

It is also essential to discuss these signs and symptoms with parents or carers at the end of the session so they know what to look for at home. It is good practice to offer them something in writing to take away with them as a reminder of what to look out for – some organisations call this a ‘bump card’.

A first aid kit and casualty monitoring card in a woodland setting.
As a parent, a small first aid kit and a casualty monitoring card are easy to carry and may make your response to an injury more effective, especially in remote or out of the way locations.

Evacuation of a casualty

Schools, Forest Schools and Outdoor Nurseries will all have procedures for evacuation as part of their emergency plans. If the child needs to be taken to hospital, phone 999/112 and give them your exact location. They will advise on whether it is necessary or advisable to move the child. Make sure someone meets the ambulance at the roadside and takes them to the casualty.

A child who is unconscious but breathing normally can be put in the Recovery Position and kept warm and monitored until medical help arrives. A casualty with serious injuries (or anxiety in the case of a child) will often vomit and putting them in the recovery position allows the vomit to drain out without choking them.

Watch our video on how to put a casualty into the recovery position here

If the child is mobile and needs to be taken to the roadside or returned home, walk them out slowly with some support such as your hand whilst monitoring their stability and behaviour across the ground. Careful evacuation techniques may need to be employed and their injuries need to be taken into account. This is another reason for carrying out a thorough ‘D’ check for damage before you consider moving them. Improvised seats and stretchers, ‘rucksack carries’ and other techniques are all possible methods that can be used but with extra care.

Get confident – get trained!

If we are confident as well as competent in our first aid skills and can comfort our casualty, most tree climbing accidents are not as daunting to deal with. We just need to remember to follow the systematic approach in treating our casualties (ABCD) and be aware of the effect a child’s injury can have masking other injuries.

Our Outdoor First Aid for Forest Schools and Outdoor Woodland Learning Practitioners course has been developed with FS and OWL professionals. This course is 16 hours and is in keeping with the requirements of Forest School practitioners and other National Governing Bodies. This qualification is a must for all Level 3 Forest School leaders and those supporting Level 3 practitioners.

Find our more about our Forest School First aid and other training courses here:

All participants on our courses receives one of our Digital First Aid Manuals free of charge. These can also be purchased via our online shop for under £4 each. The series includes Outdoor First Aid as well as Paediatric First Aid manuals and can be viewed on our online shop here: