When you begin to research nurseries, you will find that there are various awards and accreditations that nurseries can apply for and achieve and often they will advertise using these. One that you may come across is “Millie’s Mark” but the name doesn’t give away any clues about what this award means, so, what exactly is this award, and what does it tell you about a setting?


In 2012, 9-month-old Millie Thompson died after choking on food in her nursery setting. Millie was given first aid by a trained member of staff, but after her death the coroner publicly called for all nursery staff to have paediatric first aid training. Millie’s parents went about establishing a quality mark for settings to work towards.

The Early Years Foundation Stage (EYFS) statutory framework, which childcare settings in England are required to follow, states that just one person with a current paediatric first aid certificate must be on the premises and available at all times when children are present or on outings. (DfE 2017, page 22). Meanwhile, in Scotland, there is no formal requirement for the number of paediatric first aid trained staff under the Health and Social Care Standards. 

In order to apply for Millie’s Mark, 100% of staff working directly with the children must be qualified in paediatric first aid, and must keep their training up to date. So, this award demonstrates that the setting takes children’s safety extremely seriously and goes well above and beyond the minimum standard.

The award process

Achieving Millie’s Mark not only demonstrates that a nursery has achieved the final aim of having all staff trained in paediatric first aid but also shows that they have been through a fairly rigorous accreditation process to get there.

In order to be considered for Millie’s Mark the nursery setting is allocated a mentor who helps to check the settings policies, processes and procedures and support the setting in getting these things to the highest possible standard. The mentor also works with the setting to conduct an audit of the setting itself, a floor plan review and an audit of staff’s confidence with first aid and medical policies. Together the nursery and the mentor draw up areas for improvement and action plans for achieving this. The setting must then work their way through the action plan and must submit the evidence of this in order to achieve Millie’s Mark.

Once they have achieved the marks settings must keep their knowledge and training up to date, and to ensure compliance with this a percentage of nurseries receive a spot check.

One of the most important features of Millie’s mark is the focus on keeping practitioner’s knowledge up to date. This distinguishing feature ensures that everything learned during the paediatric first aid course is kept in fresh in practitioners’ minds so that they are confident, ready and capable if the need to administer first aid should arise

Millie’s parents, Joanne and Dan, recognise the crucial role of practitioner confidence saying; “The achievement of the mark acknowledges that staff would be confident in maybe one day saving a child’s life if they needed to. Confidence is a key factor in the administration of first aid and Millie’s Mark allows nurseries to feel confident in their own team.”


The benefits of choosing a setting with Millie’s mark should be obvious! When all staff are trained and regularly kept up to date with paediatric first aid they are more aware of the causes of and ways to prevent accidents occurring. You can also feel confident that the setting has robust policies and procedures that have been checked and reviewed by an outside agency.

In addition to this, all staff should be confident and able to provide first aid, this means that should your child need first aid it can be administered straight away without waiting for someone with a first aid qualification to be called because they will already be on hand. It also means that should a serious accident happen more than one first aider will be available to help and if CPR needs to be given staff will be able to take turns, preventing fatigue and ensuring that chest compressions remain at their most effective whilst awaiting further help.

What is paediatric first aid?

Millie’s Mark aims to have all nursery staff working directly with children trained in paediatric first aid, but what exactly does this cover?

The British Red Cross defines first aid as help given to someone who has been hurt or is suddenly taken ill. It is the steps a person can take before the injured or ill person gets expert medical help, from hospital, doctors or paramedics. First aid can sometimes save a person’s life, but more often it is help given in an everyday accident or illness.

Paediatric first aid is particular first aid practice for babies and young children. There are slightly different techniques required when performing first aid on babies and children so the paediatric first aid course is much more tailored and specialised for those working directly with babies and young children which is why it is this particular type of training required for the award of Millie’s Mark.

Ofsted require that at least one practitioner has completed a full 12 hour first aid course, so all settings will have this as a minimum. Settings who have been awarded Millie’s mark must ensure that all staff have either the full 12-hour course required by Ofsted or a 6-hour emergency first aid course. Both courses should take place face to face, not online.

The emergency Paediatric First Aid course covers the following areas; being able to assess an emergency situation and prioritise what action to take, helping a baby or child who is unresponsive and breathing normally or helping a baby or child who is unresponsive and not breathing normally (including the administration of CPR) helping a baby or child who is having a seizure, helping a baby or child who is choking, helping a baby or child who is bleeding; and helping a baby or child who is suffering from shock. 

The full Paediatric First Aid course should cover the areas included in the emergency paediatric first aid course as well as the following areas; being able to identify and help a baby or child who is suffering from anaphylactic shock, safely helping a baby or child who has had an electric shock, helping a baby or child who has burns or scalds, or a suspected fracture, being able to safely help a baby or child with head, neck or back injuries, helping a baby or child who is suspected of being poisoned, helping a baby or child with a foreign body in eyes, ears or nose, helping a baby or child with an eye injury, helping a baby or child with a bite or sting; helping a baby or child who is suffering from the effects of extreme heat or cold ( for example sunstroke, heat exhaustion or hypothermia) helping a baby or child having: a diabetic emergency; asthma attack; allergic reaction; meningitis; or febrile convulsions; and understanding the role and responsibilities of the paediatric first aider, including appropriate contents of a first aid box and the need for recording accidents and incidents.

Much of this is very rare in early years settings but even in good settings there are frequently low-level first aid needs such as bumps, bruises, scrapes and cuts. Bumps to the head are also fairly commonplace as children learn to crawl, walk, run and avoid obstacles. Being able to deal with all of these appropriately, and particularly being able to monitor children who have bumped their heads for signs of concussion is really important in a nursery setting.

The most common serious childhood accidents are said to be falls, burns, choking, drowning, suffocation and poisoning, and the paediatric first aid courses give practitioners a good knowledge in how to prevent, identify and treat these issues until a child can be transferred to professional medical care.

How to find a setting

As you search for a nursery you may decide that a setting that holds Millie’s Mark is of particular importance to you and your family. If that is the case you can search for local settings using the search feature on this site, and you can also find out more about Millie’s Mark and settings in your area from the Millie’s Mark website at;