CPR, or cardiopulmonary resuscitation, is a basic skill used to restart the heart after it has stopped pumping. You may know the hands-only CPR technique for an adult, but what if a child, or even an infant, has suddenly stopped breathing? In children and infants, the American Heart Association (AHA) still recommends breaths with compressions when performing CPR.
We asked Kristina Deeter, MD, Medical Director of the Pediatric Intensive Care Unit at Renown Children’s Hospital and Section Chief of Pediatric Emergency Medicine and Pediatric Clinical Care at University of Nevada, Reno about infants and children CPR. “Infants and children can progress from mild respiratory distress to complete failure much faster than adults. With their small airways and fondness for putting things in their mouths, they can quickly get into trouble with choking and objects in the airway. Even a little bit of mucus, which is manageable for an adult, can cause complete obstruction in a baby who can’t blow their own nose. With a caregiver nearby that knows how do CPR and basic airway interventions, children have a much better chance at surviving a sudden respiratory or cardiac event.”
Infant CPR is performed on babies under the age of 12 months, and child CPR is performed for those 13 years and under. Learning infant and child CPR is as easy as… ABC.
First, though, you must call 911 and make sure the scene around the child or infant is safe. Tap the child’s chest or shoulders and loudly say, “Are you OK?” to determine if they need help. For infants, tap the bottom of their feet to see if they respond.
Then, remember “ABC.”
A is for Airway. Carefully look, listen and feel for signs of air and breathing sounds coming from their mouth. Infants normally take shallow and rapid breaths. The infant’s tongue may be obstructing their airway if you do not see signs of breathing.
Gently tilt the infants head back to clear their airway using your finger to gently lift under the chin. An infant’s airway is extremely narrow so take extra care not to tilt their head too far back, which may accidentally close off their airway.
B is for Breathing. Breathe into the infant’s mouth with a gentle deep breath, creating a seal over their mouth with your mouth while pinching their nose closed.
Let the infant exhale on their own while watching the chest area and listening and feeling for breathing. If they do not start breathing, place your mouth over theirs again, pinch the nose and give another small puff of air into their mouth.
C is Circulation. Check the infant’s circulation if they are unresponsive (no crying or moving) by performing a pulse check. An infant’s pulse is checked at the brachial artery, located inside of the upper arm between the elbow and the shoulder. Place two fingers on the artery and apply slight pressure for 3 to 5 seconds. You will need to perform chest compression if you do not feel a pulse. No pulse means the heart has stopped beating.
C is also for Compressions. For infants, use two or three fingers in the center of the chest just below the nipples to perform 30 gentle chest compressions. Count the compressions at a rate of 100-120 per minute. Give 30 pumps followed by two breaths, and continue to alternate until help arrives.
For CPR on older children you can use one or two hands to provide compressions, depending on their size. The depth of compressions should be only one and a half inches on children as their chests are smaller. The compression and breath rate for children are the same as infants – 30 compressions to two breaths.
The American Red Cross provides video examples of both infant and child CPR. CPR can double or triple a person’s chance of survival, especially in the first few crucial moments of cardiac arrest. We encourage you to attend a local BLS (CPR) class to learn and practice these skills in order to gain confidence to act in the event of an emergency.