CPR for infants and children requires recognizing anatomical differences, the appropriate depth of chest compressions, and careful rescue breathing. Infants (under one year) need gentler, two-thumb encircling hand technique or two fingers, with a compression depth about 1.5 inches (4 cm) and a rate near 100 to 120 compressions per minute. For children (ages one to puberty), the hands-position changes to one or two hands depending on size, with a compression depth about one third of chest diameter or roughly 2 inches (5 cm). Rescue breaths should be delivered smoothly, ensuring visible chest rise. In any age group, minimize interruptions and call for professional help as soon as possible. Correct technique reduces delays and improves the chances of a favorable outcome.
Before performing CPR, quickly assess responsiveness, confirm no normal breathing, and call emergency services. If an adult or child is unresponsive, begin compressions immediately, but tailor your approach to the child’s age. For infants, use two fingers in the center of the chest just below the nipple line, compressing firmly without leaning on the chest. For larger children, shift to a two-handed technique if necessary, allowing the chest to return fully between compressions. If you are alone, perform 30 compressions before giving two breaths, then continue cycles. If an automated external defibrillator (AED) is available, turn it on and follow voice prompts, applying pediatric pads when appropriate. Time is critical during resuscitation.
Use age-appropriate force, rhythm, and breathing to stabilize the child.
A practical CPR approach emphasizes observation and consistency. For an infant, chest compressions should be rapid and centered, with minimal pause between chest compressions and breaths. Pediatric guidelines prioritize a ratio of 15 compressions to two breaths if two rescuers are present, but in one-rescuer scenarios, a ratio of 30:2 remains common for older children. Ensure the head tilt is neutral, not hyperextended, to keep the airway open. When using an AED, pediatric pads are recommended for children up to eight years old or under 55 pounds (25 kg). In any event, maintain rhythm, monitor the chest for movement, and continuously reassess the situation as help arrives. Practice improves performance.
Because infants have more delicate bones and airway structures, avoid excessive force during compressions. A gentle but firm technique reduces thoracic injuries. For infants, the two-thumb-encircling method distributes pressure and stabilizes the chest, while the two-finger approach can be easier for untrained bystanders. With children, prioritize full chest recoil to allow blood return to the heart. Ensure you keep your own posture upright to apply consistent force without fatigue. After the first cycle of compressions, recheck for responsiveness and breathing, and adjust your technique if the patient shows signs of life or deterioration. Training helps responders act confidently under pressure.
Maintain calm, deliberate action with precise pauses and teamwork.
Airway management plays a crucial role, especially in infants with narrower airways. If a trained responder is present, gentle mouth-to-mouth breaths for infants can be used if local choking or rescue breathing guidelines permit. Alternatively, administer breaths through a face mask or resuscitation mask when available. For older children, provide breaths that are clearly visible as chest rise. If the patient regains consciousness or begins breathing spontaneously, monitor closely and place in the recovery position if necessary. Avoid excessive ventilation, which can raise intrathoracic pressure and hinder circulation. Clear, steady breaths plus persistent compressions improve the likelihood of heart and brain perfusion during CPR.
In real-world settings, interruptions during CPR reduce the chance of survival, so responders should limit pauses to less than ten seconds for necessary checks. When an AED arrives, attach pads quickly and follow prompts. For infants, place pads on the chest and back if single-pad placement is confusing or impractical. For children, ensure the pads do not touch and follow pediatric mode if available. After shock delivery, resume chest compressions immediately. Continuous training, including practice with mannequins of different ages, helps responders maintain micro-skills such as correct hand placement, depth, and rate. Effective teamwork also minimizes delays and improves overall outcomes in pediatric CPR.
Regular, practical training keeps pediatric CPR skills sharp and reliable.
As a caregiver, knowing when to switch rescuers is essential. If a single rescuer performs CPR, switch roles every two minutes to prevent fatigue and maintain compression quality. When two rescuers are present, one can focus on compressions while the other manages breaths, rotates every two minutes. For infants, a partner should be ready to maintain secure head and neck support while exchanging duties. When the patient is being moved or relocated for advanced care, keep the airway open and continue CPR during transport if possible. Clear communication among bystanders reduces confusion and ensures that each action aligns with the overall resuscitation plan. Honest practice builds confidence.
Training options for CPR in infants and children include certified courses with hands-on practice, video simulations, and community workshops. Seek programs that emphasize pediatric anatomy differences, safe airway management, and rhythm checks with an AED. Rehearsals should cover both one-rescuer and two-rescuer scenarios, plus how to adapt for small, tantrum-averse infants who may resist rescue breaths. Additionally, practice with different chest wall compliances helps responders understand how to modulate force for various body sizes. After training, maintain skills with periodic refreshers and keep a ready-to-use CPR kit accessible in the home or workplace. Regular refreshers prevent skill decay.
Courage, awareness, and proper technique empower rescuers to act decisively.
Legal and ethical considerations guide bystander CPR. In many regions, performing CPR on a child is encouraged, and Good Samaritan laws protect well-intentioned responders from liability. Do not hesitate due to concerns about causing harm; the potential benefit far outweighs the risk of doing nothing. When responding, document actions taken and seek medical follow-up for the patient as soon as possible. Understanding local guidelines helps ensure actions align with accepted standards of care. Pediatric CPR emphasizes action, not perfection, and training reduces hesitation. In emergencies, the priority is to maintain perfusion and oxygenation until professional help arrives.
When fatigue or fear arises, responders should pause to reassess and seek assistance. If the scene becomes unsafe, move to a safer area before continuing CPR. Do not abandon the child; instead, call for emergency services and request an AED as soon as possible. For infants, consider evolving techniques only within your training boundaries, avoiding improvisation that could worsen injuries. Remember that even imperfect compressions can sustain life while awaiting advanced care. After the patient’s condition stabilizes, participate in post-resuscitation care discussions with health professionals to understand next steps and potential complications.
Post-resuscitation care is as important as the action during CPR. After a successful resuscitation, monitor vital signs, ensure airway support, and avoid intermittent ventilation that could cause instability. Airway management may involve supplemental oxygen or advanced devices if trained professionals take over. Pediatric patients require careful thermoregulation, glucose control, and monitoring for neurological status. Evaluate potential injuries from chest compressions, such as rib fractures in older children, and provide appropriate comfort and pain management. Early transfer to a pediatric-competent facility improves outcomes. Parents and caregivers should receive guidance on what to expect and how to prevent future events.
Finally, prevention and preparedness reduce the frequency and severity of pediatric emergencies. Teach children basic safety around water, roads, and household chores to reduce injury risk. Equip caregivers with first-aid kits tailored for infants and children, including pediatric masks and appropriately sized pads for an AED. Practice makes confidence, so involve the whole family in drills that simulate real scenarios without panic. Emphasize calm communication, quick assessment, and timely calling of help. By embracing education, regular training, and thoughtful planning, communities can improve survival rates and decrease long-term harm in pediatric resuscitation.
