When an infant or child unexpectedly needs cardiopulmonary resuscitation (CPR), knowing what to do can save lives. Here are the steps to resuscitating an infant or child:
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One: Always make sure the area is safe for you and the victim.
Two: Assess the need for CPR:
- Check for responsiveness: Gently tap the victim and ask aloud, “Are you okay?”
- Call the child by his or her first name, if known to you. If the child is responsive, he or she will respond, move, or make a sound. If the child is non-responsive, call for help.
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Check for breathing: If you observe regular breathing, the victim does not need CPR.
- If you are alone and the child is breathing, leave him/her to call 112, but return quickly to monitor his/her condition regularly.
Children in respiratory distress often assume a position that maintains the airway open and optimizes breathing. Allow the child to assume the position that is most comfortable for them. If there are no signs of trauma, you can turn the child onto their side (recovery position) to maintain the airway open and reduce the risk of aspiration.
Three: Start CPR
If the victim is unresponsive and not breathing (or is only gasping), begin CPR. Refer to the chart with complete CPR instructions at the end of this article.
Sometimes, victims requiring CPR may gasp, which can be misinterpreted as breathing. Treat the gasping victim as if they are not breathing and begin CPR.
Four: Open the airway and give rescue breaths.
For infants and young children, two rescue breaths may be given before beginning chest compressions. If a known breathing problem has caused the child to lose consciousness, CPR should begin with rescue breaths. For unresponsive adolescents and adults, CPR should begin with chest compressions.
Use the head tilt and chin lift maneuver to open the airway for both injured and uninjured victims. For trauma victims, avoid manipulating the spine when opening the airway.
Ensure that the breaths are effective (i.e., the chest rises). Each breath should last approximately 1 second. In an unconscious infant or child, the tongue may obstruct the airway and prevent effective ventilation. If the chest does not rise, reposition the head, make a better seal, and try again. It may be necessary to move the child's head through a range of positions to ensure an optimal airway opening.
Five: Begin chest compressions
If possible, place the victim on a hard surface before beginning chest compressions. Ensure that the chest returns completely to its original position after each compression.
Six: Coordinate chest compressions and rescue breaths:
After giving 2 breaths, immediately give 30 chest compressions. The single rescuer should continue this cycle of 30 compressions and 2 breaths for about 2 minutes (approximately 5 cycles) before leaving the victim to call for help and obtain an automated external defibrillator (AED) if one is available.
When to use an automated external defibrillator (AED):
If a child (or adult) suddenly collapses for unknown reasons, they may have a treatable cardiac arrhythmia. In this case, apply an AED to the chest as soon as possible if one is available. Follow the AED instructions and make sure no one (including yourself) touches the victim while shocks are being delivered. For children weighing less than 25 kg, use pediatric pads. For infants, a manual defibrillator should be used by healthcare professionals.
How to handle a choking child:
One: Choking with partial breathing:
If a child is choking but can still talk or cough violently, do not do anything yourself; the child's cough is more effective than any back blow or Heimlich maneuver. Call 112 to have the child taken to hospital, as a partial airway obstruction can develop into a complete obstruction.
Two: Choking without breathing or with a weak cough:
- Ask someone to call 112.
- Perform the Heimlich maneuver. For a conscious child, position yourself behind the child and wrap your arms around the child's waist. Place the thumb side of your fist on the middle of the abdomen, well below the breastbone, and then grasp your fist with your other hand. Press quickly and firmly inward and upward. Repeat these thrusts five times until the object is expelled or the child begins to breathe or cough.
If this doesn't work, you can also give five slaps on the back to help expel the object.
Three: Choking with loss of consciousness:
Try to clear the airway by laying the child on his or her back and using the jaw and tongue lift technique. Open the child's mouth, place your thumb on his or her tongue and your fingers under his or her jaw. If you see the object, gently remove it with a sideways motion of your finger. However, be careful, as this may push the object deeper. Never perform a blind maneuver.
Give two rescue breaths if the child is still not breathing. If breathing is not restored, repeat the Heimlich maneuver.
If the child remains unresponsive, continue CPR until help arrives, alternating chest compressions with rescue breaths.
How to handle a choking infant:
One: Take a sitting position and hold the infant face down on your forearm, resting on your thigh. Support his head and neck with your hand, keeping the head lower than the trunk.
Two: Give five back slaps with the heel of your hand. Avoid touching the infant's head with your fingers.
Three: Turn the infant face up and give five rapid chest compressions with two fingers placed on the center of the sternum, pressing about 4 cm.
Four: Give two rescue breaths.
Five: Repeat back blows and chest compressions if breathing does not resume and call for help.
Six: If the situation does not improve, begin infant CPR by alternating rescue breaths with chest compressions.
For more information on children's health and first aid, see this article .
