How to Perform CPR on Children: Lifesaving for Pediatric Patients

When it comes to emergencies involving children, knowing how to perform CPR (Cardiopulmonary Resuscitation) is essential. In this article, we will explore the basics of Child CPR, including the correct hand placement, compression depth, and the importance of early intervention.

Child CPR is a technique used to provide lifesaving intervention during cardiac emergencies in children aged 1 to 8 years old. It aims to restore blood circulation and oxygenation. Below is a step by step guide on how to perform Child CPR:

1. Scene Safety: Check if the area is safe before helping. Assess the situation and look for potential dangers like traffic or fire. See if others can assist.
2. Check for Consciousness: Tap the child's shoulder and ask loudly if they're okay. Wear gloves if available. Check if the child responds or is unconscious.
3. Call 911: If the child doesn't respond, call 911 or ask someone to do so. Look for an AED (Automated External Defibrillator) nearby. If alone and unwitnessed, perform 2 minutes of CPR before calling 911. If witnessed, call 911 first.
4. Check Pulse and Breathing: Place the child on their back, listen for breathing, and check for a pulse.
5. Begin Chest Compressions: Put hands on the sternum, and push hard and fast (100-120 compressions per minute, 2 inches depth). Let the chest recoil fully.
6. Provide Rescue Breaths: If trained, give two gentle breaths. Ensure chest rises. If not, tilt head and retry. If still not on the 2nd breath, focus on chest compressions only.
7. Repeat the Cycle: Keep repeating chest compressions and rescue breaths until the child shows signs of life or professional help arrives.
8. Use AED if Available: If AED is available, use child pads. Apply as directed, adjusting for size. Child pads deliver lower energy. If unavailable, use adult pads as it's better to provide a shock than none.

1. Scene Safety

The first step that you should follow is to check if the scene is safe. Ask how many victims are there and how the accident could have happened. See if other bystanders can assist the victims. It's also important to check the scene for factors that could harm you, such as traffic or fire.

2. Check for Consciousness

When the scene is safe to respond to, check if the child victim is conscious or unconscious. Tap the victim's shoulder and ask, "Are you OK?" loudly. If protective gloves are available, wear them before you check the victim.

3. Call 911

If the child is not responding, activate the emergency medical services by calling 911 immediately or ask a bystander to call and search for an AED machine. You can find AEDs in most offices and public buildings.

If you are alone and the collapse is unwitnessed, perform 2 minutes of CPR before calling 911 to increase the child's chances of survival. However, if you're alone and have witnessed the collapse, call 911 before performing Child CPR.

4. Check for Pulse and Breathing

Put the child on their back carefully and kneel beside their chest. Then, place your ear next to the victim's mouth and listen for 10 seconds. Checking the pulse and breathing of the child will determine the actions you need to take.

• If the child is unconscious but still breathing and has a pulse, do not perform CPR. Instead, put the victim in a recovery position and monitor the breathing. Perform CPR if necessary.
• If the child has a pulse but no breathing, give rescue breaths only. For a child victim, the ventilation ratio is one breath every 3-5 seconds.
• If the child doesn't have a pulse and no breathing, perform CPR starting with 30 chest compressions, followed by two rescue breaths. If there are two rescuers, the CPR ratio will be 15 compressions to 2 breaths.
• Recheck the breathing and pulse after every 2 minutes. If there is still a pulse but no breathing, continue ventilations. If there is still no breathing and no pulse, begin CPR.

5. Begin Chest Compressions

Place two hands (or one hand if the child is tiny) on the child's sternum. Push hard and fast to a depth of at least two inches or 5 centimeters until the child responds. Your hands shouldn't bounce, but you should lift your entire body weight off the patient between each compression.

• Child CPR Ratio for 1 rescuer is 30:2
• Child CPR Ratio for 2 rescuers is 15:2
• Compression rate: 100-120 compression per minute
• Compression depth: 2 inches (5 centimeters)
• Allow chest recoil

6. Provide Rescue Breaths

If you are trained in CPR and comfortable giving rescue breaths, pinch the nose shut and make a complete seal over the child's mouth and deliver two gentle breaths.

If their chest does not rise with the initial breath, tilt their head again to open the airway before you give the 2nd breath. If the chest still doesn't rise on the 2nd breath, stop rescue breathing and do chest compressions only.

7. Repeat the CPR cycle

Repeat the CPR cycles of chest compressions and rescue breathing until advanced medical care from the emergency medical services is available or when the child shows signs of life, such as normal breathing or chest movements. Maintain the proper hand location for CPR compressions for effective CPR

8. Use AED if Available

If available, use child pads when using an AED. Some AED units may have a child key or switch on the AED. If the child is tiny, you may need to put one pad on the center of the chest and the other on the child's back to avoid having them touch. Use adult pads if child pads are not available.

Child pads lower the amount of energy delivered compared to adult pads. However, if child pads are unavailable, adult pads may be used since providing a shock is better than no shock.

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How long should Child CPR be continued until help arrives?

Child CPR should be continued until professional medical help, such as emergency medical services (EMS), arrives at the scene. CPR should only be stopped in specific situations, such as when the child shows signs of life, starts breathing normally, or trained medical personnel take over. It is important to minimize interruptions in CPR and maintain the delivery of high-quality chest compressions and rescue breaths until the arrival of medical professionals.

How do I position an unconscious child in the recovery position?

To position an unconscious child in the recovery position, follow these steps:

1. Assess the child's condition: Ensure that the child is unresponsive and not breathing or only gasping for air.
2. Ensure a clear airway: Gently tilt the child's head back slightly while lifting the chin, being careful not to tilt too far back. This helps open the airway and ensures proper breathing.
3. Extend the arm: Take the child's arm that is closest to you and extend it out from their body, preferably at a right angle to their torso. The palm should face upward.
4. Turn the child onto their side: Carefully roll the child onto their side, using the extended arm as support. Ideally, their upper leg should be bent at the knee to maintain stability.
5. Check the position: Ensure that the child's mouth is facing downward, allowing any fluids to drain easily. The position should be stable, and the child's face should be turned to the side to prevent the tongue from blocking the airway.
6. Monitor the child: Stay with the child and monitor their breathing and condition until medical help arrives.

If you suspect a spinal injury or trauma, do not move the child unless absolutely necessary. Seek medical assistance immediately and follow the instructions provided by emergency medical services (EMS) or healthcare professionals.

Adapting CPR techniques to children is crucial due to their smaller bodies and anatomical differences. Hand placement, compression depth, and rate are adjusted accordingly. Adapting CPR ensures effective care, maximizes survival chances, and minimizes complications specific to children's unique needs and physiology. Proper CPR training enables responders to confidently administer CPR in critical situations involving children.

How is CPR performed on infants versus older children?

When performing CPR on infants, including newborns up to one year of age, there are unique considerations and techniques to ensure their safety and provide effective care. Here are the key adjustments for CPR on infants:

• The compression depth for infants is about 1.5 inches (4 centimeters). It is important to compress the chest adequately to create blood flow without excessive force that may cause harm.
• Place two fingers (index and middle fingers) just below the nipple line in the center of the infant's chest. Avoid pressing on the end of the breastbone (sternum) to prevent injury.
• The compression rate for infants is approximately 100-120 compressions per minute. Maintain a consistent rhythm and avoid excessive interruptions.
• When providing rescue breaths for infants, cover both the nose and mouth of the infant with your mouth. Give gentle puffs of air, making sure the chest rises visibly with each breath. Each breath should be enough to make the chest rise but not excessive to prevent air from entering the stomach.
• Due to the small size of the infant's chest, it is preferable to use two fingers to deliver compressions rather than the palm of the hand. This allows for more precise and controlled compressions.
• For newborns specifically, additional care should be taken to support their head and neck while maintaining an open airway. Avoid excessive tilting of the head to maintain alignment with the rest of the body.

The core principles of CPR remain the same regardless of age—early recognition, activation of emergency response, and high-quality compressions and ventilations. Adapting the technique to the unique needs of infants ensures that CPR is performed effectively and safely. It is important to receive proper training in infant CPR to gain confidence and competence in responding to cardiac emergencies in this specific age group.

In what situations is Child CPR necessary?

Child CPR is necessary in various emergency situations involving infants and children. Here are some situations that may require Child CPR:

1. Cardiac arrest: When a child's heart suddenly stops beating effectively, leading to the absence of a pulse and no normal breathing, Child CPR is crucial to restoring blood circulation and oxygenation.
2. Suffocation or choking: If a child is choking and unable to breathe or has a blocked airway, Child CPR may be necessary to dislodge the obstruction and restore normal breathing.
3. Near-drowning incidents: In cases where a child has been submerged in water and is unresponsive or not breathing, Child CPR should be initiated immediately after ensuring the child's safety.
4. Traumatic injuries: Severe traumatic injuries, such as those from accidents or falls, can cause cardiac arrest or compromised breathing in children, necessitating the need for Child CPR.
5. Respiratory distress: When a child is experiencing difficulty breathing or has stopped breathing, Child CPR can help maintain vital oxygenation until professional medical help arrives.

How many lives are saved annually due to Child CPR?

The American Heart Association estimates that 100,000 to 200,000 lives of adults and children combined could be saved each year if CPR is administered promptly and correctly. Although a specific breakdown for children alone is not available, Child CPR undoubtedly contributes to the overall number of lives saved annually.

A team from the Children's Hospital of Philadelphia took an interest in the effectiveness of compression-only CPR in children. They aimed to resolve the conflicting data surrounding bystander CPR types—specifically, compression-only versus rescue breathing.

The researchers highlight that outside of hospitals, fewer than 10% of children who suffer cardiac arrest survive. Bystander-performed CPR enhances survival rates, but the frequency and types of bystander CPR across different age groups during out-of-hospital pediatric cardiac arrest remained uncertain before this study, as discussed in the Journal of the American College of Cardiology.

Refreshing CPR Skills Regularly

Refreshing CPR skills regularly is essential to maintain proficiency and keep knowledge up to date. It ensures that individuals are prepared to respond effectively in emergency situations. Regular practice helps reinforce the techniques, including rescue breathing and other aspects of CPR, ensuring that the skills remain fresh in your memory.

Many CPR certification programs offer refresher courses specifically designed to update skills and knowledge. These refresher courses provide an opportunity to review and practice the necessary techniques, ask questions, and address any uncertainties. Attending these courses allows individuals to stay current with the latest guidelines and best practices in CPR.

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