What is the Difference Between Adult and Child CPR?

Knowing the difference in performing CPR on an adult, child, and infant will significantly affect the victim's survival. In this article, you will learn the differences in CPR ratio, compression rate, depth, hand placement, and ventilation to a specific age group to avoid complications such as breaking ribs.

What Are the Main Differences Between Adult and Child CPR?

The main differences between adult and child CPR include compression depth, hand placement, and ventilation rates. Child CPR requires shallower compressions and can be performed with one hand for smaller children, whereas adult CPR uses both hands and deeper compressions.

In Basic Life Suppport, a child is typically defined as someone older than one year but not yet reaching puberty. CPR Procedures vary slightly from those used for adults due to anatomical differences.

While adult and child CPR requires abdominal compressions and rescue breaths, their application differs slightly because a child's physiology, bone density, and strength differ from an adult's. It is essential to know the difference between adult and pediatric CPR so that you offer lifesaving aid in an emergency. Here are the key differences between adult and child CPR:

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• Compression depth: Adults need compressions with a depth of at least 2-2.4 inches (5-6 centimeters), while children's compression depth is one-third of the chest diameter, which is about 2 inches.
• Compression rate: Both adults and children benefit from a similar compression rate of around 100-120 compressions per minute.
• Hand placement: For adults, the heel of one hand should be placed on the center of the chest, between the nipples. For children older than 1 year, use one or two hands placed on the center of the chest, just below the nipple line. Infants require even more delicate placement, using two fingers on the lower half of the breastbone.
• Ventilation: Both adults and children require ventilation during CPR to provide oxygen to the lungs.
• Compression to ventilation ratio: When performing CPR alone on both adults and children, the compression-to-ventilation ratio is 30:2. For pediatric CPR with two rescuers, the ratio of compressions to breaths for child changes to 15:2.
• AED: When using an AED on a child, it's important to use pediatric pads or select the child setting to ensure the appropriate energy levels are administered.

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Compression Depth

One of the primary differences between adult and child CPR is the recommended depth of chest compressions. For adults, the chest bone (sternum) is deeper and more robust, necessitating compressions with a depth of at least 2-2.4 inches (5-6 centimeters). In contrast, children have smaller chests and less rigid bones, so the depth of compressions should be adjusted.

For children older than 1 year, the recommended compression depth is about 2 inches (5 centimeters). For infants and younger children, the depth is typically around one-third of the chest diameter, which is roughly 2 inches for school-age children and 1.5 inches for infants.

Compression Rate

Both adults and children benefit from a similar compression rate of around 100-120 compressions per minute. Consistent and timely compressions help maintain blood circulation and oxygen delivery to vital organs.

Hand Placement

Correct hand placement is crucial for effective chest compressions. For adults, the heel of one hand should be placed on the center of the chest, between the nipples. In children, it's important to adapt hand placement based on their size. For children older than 1 year, use one or two hands placed on the center of the chest, just below the nipple line. Infants require even more delicate placement, using two fingers (middle and ring fingers) on the lower half of the breastbone.

Ventilation

Both adults and children require ventilation during CPR to provide oxygen to the lungs. The ventilation technique involves tilting the head back to open the airway, pinching the nose shut, and giving a breath that causes the chest to rise visibly. Maintain a ratio of 30 compressions to 2 ventilations for both adults and children.

Compression-to-Ventilation Ratio

When performing CPR alone on both adults and children, the compression-to-ventilation ratio is 30:2, meaning 30 compressions are given, followed by 2 rescue breaths. For pediatric CPR with two rescuers, the compression-to-ventilation ratio changes to 15:2 to maintain the efficiency of chest compressions.

AED Use

Automated External Defibrillators (AEDs) are crucial in cardiac arrest situations. They analyze the heart rhythm and deliver a shock if necessary to restore normal rhythm. When using an AED on a child, it's important to use pediatric pads or select the child setting to ensure the appropriate energy levels are administered. However, if only adult pads are available, it's generally acceptable to use them on a child if pediatric pads are not accessible.

CPR Survival Rates in Adults and Child

If a child victim receives CPR out-of-hospital, their survival rate ranges from 17-40%. The survival rate, although seemingly low, has dramatically improved over the years from around 2.6% because more people nowadays know how to perform CPR. Additionally, their chances of survival are higher when a child is found within a few minutes.
For Adults, the survival rate to discharge is typically much lower at around 7% if they didn’t get CPR from bystanders. However, this survival rate increases to 11% when a bystander initiates CPR.

Considerations for Children

When dealing with a child who is unresponsive, always check for a pulse within 10 seconds. If a pulse cannot be detected or if the child is only gasping, start CPR immediately. If the child is breathing normally but unresponsive, place them in a recovery position on their side and call for medical help. This is to ensure their airway remains open and they breathe as you wait for professional assistance.

Why is there a difference between Adult vs. Child CPR Protocols?

There are different guidelines for performing CPR for adults and children because they are two different age groups with different needs. Because a child's body is not as developed as adults, they require different techniques and equipment when performing CPR. In addition, children are more likely to suffer from cardiac arrest due to respiratory problems, so the American Heart Association's protocols focus on providing rescue breaths and chest compressions.

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When is CPR needed?

CPR is needed when a person is unresponsive, not breathing, and has no pulse. CPR is used to help maintain blood flow and oxygenation until medical professionals takes over and provide advanced care.

Reasons Why Children Need CPR:

• Choking
• Suffocation
• Drowning
• Trauma

Cardiac Arrest Causes in Adults:

• Previous heart attack
• Thickened heart muscle
• Medication
• Recreational drug use
• Other heart disease-related conditions

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What important factors should you consider when providing CPR to an adult versus a child?

When providing CPR to an adult, it is important to ensure that the chest compressions are deep enough and performed at the correct rate. Additionally, the rescuer should be mindful of not pushing too hard or too fast.

For a child, it is important to provide gentle chest compressions as they are more fragile than adults. It is also important to support the head in order to keep the airway open, and to provide rescue breaths at the correct rate – one breath every three to five seconds.

Chain of Survival in Adults and Children

Unlike the Chain of Survival for adults, which begins with early recognition and calls for emergency assistance, the Chain of Survival for a child dictates that high-quality CPR starts immediately. Infants and children have a higher survival rate than adults following immediate CPR because their bodies are more resilient than adults and because it's usually an airway blockage that causes them to need CPR. Children must receive CPR right away to increase their chances of survival.

What is the chain of survival for adults?

According to the American Heart Association, the five links in the adult Chain of Survival are:

1. Recognition of cardiac arrest and activation of the emergency response system
2. Early CPR or Cardiopulmonary Resuscitation with an emphasis on chest compressions
3. Rapid defibrillation
4. Basic and advanced emergency medical services
5. Advanced life support and post-cardiac arrest care

What is the chain of survival for a child?

The pediatric chain of survival consists of:

1. Prevention of Cardiac Arrest
2. Early, High-Quality CPR
3. Rapid Activation of the Emergency Response System
4. Effective Advanced Life Support
5. Integrated Post-Cardiac Arrest Care

What two chains of survival pathways in cardiopulmonary resuscitation are the same for an adult and pediatric victim?

The two chain of survival pathways in cardiopulmonary resuscitation that are the same for an adult and pediatric victim are early recognition and activation of the emergency response system and early cardiopulmonary resuscitation.

What are the essential considerations when providing CPR to infants compared to adults?

The essential considerations when providing CPR to infants compared to adults include the need for specialized equipment like an infant-sized bag-valve-mask, using two fingers for chest compressions instead of the heel of the hand, and the need to clear the airway of any obstructing material.

What are the critical age cutoffs for determining whether to provide adult or child CPR?

The critical age cutoffs for determining whether to provide adult or child CPR are defined as age 8 or puberty. Children under age 8 or before puberty generally require child CPR, while those over age 8 or after puberty typically require adult CPR.

How do the anatomical and physiological differences between adults and children impact the effectiveness of CPR?

The anatomical and physiological differences between adults and children impact the effectiveness of CPR by influencing the technique required for compressions and ventilations. Children have smaller chest sizes and airways, necessitating adjustments in CPR maneuvers for optimal effectiveness. Additionally, children are more prone to cardiac arrests triggered by respiratory issues, altering the focus of CPR efforts. 

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How would you determine if a victim is an infant, child, or adult?

To determine if a victim is an infant, child, or adult, look at the victim's physical characteristics such as size, weight, and age. Typically, an infant is considered to be under 1 year of age, a child is between 1 and 8 years of age, and an adult is over the age of 8 or after puberty.

Why is complete chest recoil important in CPR?

Complete chest recoil is important during CPR because it allows the chest to fully expand between compressions, allowing for optimal blood flow from the heart. CPR is needed when a person's breathing or heartbeat has stopped.

Why is rapid defibrillation important?

Rapid defibrillation is important because it restores the heart's normal rhythm and improve the chances of survival. Defibrillation delivers an electric shock to the heart, stopping the abnormal rhythm and allowing it to resume its normal beat.

What are two key differences when caring for an unresponsive choking infant compared to an unresponsive choking adult or child?

Two key differences when giving care to an unresponsive choking infant compared to an unresponsive choking adult or child include supporting the infant's head and neck during rescue breaths and using back blows and chest thrusts instead abdominal thrusts to relieve choking.

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Why does rescue breathing techniques vary between adult and pediatric patients?

Rescue breathing techniques vary between adult and pediatric patients, primarily due to differences in anatomical size, physiology, and the emphasis on gentle breaths for children to prevent over-inflation of the lungs. When administering CPR to adults, responders tilt the head back, pinch the nose shut, and provide two full breaths.

In the case of pediatric patients, the process remains similar, but the breaths are administered more gently, maintaining a ratio of 30 compressions to 2 breaths. This adjustment considers the anatomical and physiological differences between adults and children, ensuring effective ventilation during resuscitation.

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Is there a difference in using an AED on adults compared to children or infants?

Yes, there is a difference in using an AED on adults compared to children or infants. AED pads and settings are specifically designed to deliver appropriate energy levels for different age groups. For adults, standard AED pads are used, delivering higher energy shocks.

However, for children and infants, pediatric pads and settings are utilized to administer lower energy shocks suitable for their smaller size and physiology. Additionally, placement of the pads may vary between adults and children to ensure optimal delivery of the electrical shock to the heart.

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Why are the physiological responses to CPR different in children compared to adults?

The physiological responses to CPR differ in children compared to adults due to variations in metabolic rates and potential causes of cardiac arrest. Children often experience cardiac arrest as a result of respiratory issues, necessitating a prompt and effective response.

Adjustments in CPR techniques, such as the ratio of compressions to breaths, are made to address these unique physiological considerations, emphasizing the importance of recognizing and responding to the distinct challenges posed by pediatric patients.

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Are there different training requirements for learning adult and pediatric CPR?

CPR training typically covers both adult and pediatric techniques, but specialized courses, such as Pediatric Advanced Life Support (PALS), provide in-depth instruction on pediatric CPR. These courses focus on the unique aspects of resuscitating children, including age-appropriate techniques, equipment, and medication administration.

Ensuring that responders, especially those in healthcare or childcare professions, receive comprehensive training in both adult and pediatric CPR enhances their ability to handle diverse emergency situations.

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Are there different legal implications when performing CPR on children compared to adults?

Legal implications when performing CPR vary depending on jurisdiction, but generally, individuals who have received proper training and act in good faith during an emergency are protected by Good Samaritan laws. These laws often extend to both adults and children, emphasizing the importance of responding promptly and appropriately in life-threatening situations. However, it is essential for individuals to be aware of and familiarize themselves with local laws and regulations governing emergency interventions.

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In what scenarios might pediatric CPR be more challenging or require a different approach than adult CPR?

Pediatric CPR presents unique challenges in scenarios where children vary in size and weight. Responders must be adept at adapting compression and ventilation techniques based on the child's age and physical characteristics.

Additionally, pediatric cardiac arrests often result from respiratory issues rather than cardiac causes, necessitating a nuanced approach. Proper training and experience are crucial for responders to effectively navigate these scenarios, ensuring the best possible outcomes for pediatric patients.

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What are the key preventive measures to reduce the need for CPR in children? 

Key preventive measures to reduce the need for CPR in children include:

1. Supervision: Ensuring constant adult supervision, especially around water bodies, pools, and during activities with potential hazards.
2. Childproofing: Implementing safety measures at home and in environments frequented by children, such as securing cabinets, installing safety gates, and covering electrical outlets.
3. Education: Teaching children about safety rules, including road safety, fire safety, and stranger danger, as well as basic first aid skills appropriate for their age.
4. Injury prevention: Promoting the use of helmets, seat belts, and other protective gear during recreational activities and while traveling in vehicles.
5. Immunizations: Ensuring children receive recommended vaccinations to prevent infectious diseases that leads to cardiac emergencies.
6. Safe sleep practices: Following guidelines to reduce the risk of sudden infant death syndrome (SIDS), such as placing infants on their backs to sleep and providing a safe sleeping environment.

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Encouraging the learning of CPR and basic life support techniques within communities empowers individuals to respond effectively in emergencies, reducing the incidence of situations requiring pediatric CPR. Provide caregivers, parents, and individuals who work with children with CPR and first aid training to respond effectively in emergencies.

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Hands-only CPR

Hands-only CPR is a method of CPR where you do continuous chest compressions but don't do rescue breathing. This is intended for situations in public where an adult collapses and needs help from a stranger who are more willing to do CPR. This only works for adults. Don't use hands-only CPR with children. Use conventional CPR instead, where you alternate 30 compressions with two breaths.

If you are not trained in CPR and witness an unconscious child or adult, it's an important step to activate EMS by calling 911. The operator will give you basic lifesaving instructions over the phone, including performing hands-only CPR.

Importance of Learning CPR for Adults and Children

You never know when someone will suffer from a cardiac emergency or any emergency that requires compressing the chest and giving recue breaths. It could happen in your home, office, or any public place. However, when you know how to perform CPR for adults and children, you will have the training and confidence to act fast and potentially save a life.

The basic steps of CPR keeps the oxygen-rich blood flowing to the victim's brain and other vital organs until emergency medical treatment restores the normal heart rhythm. Enroll in an online CPR/AED certification course that follows the American Heart Association for Emergency Cardiovascular Care guidelines to do this successfully. Many organizations and training centers like CPR Select are offering this course.

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 Sources:

• American Heart Association (AHA): The AHA provides comprehensive information on CPR techniques, guidelines, and modifications for different age groups and situations.
• Red Cross: The Red Cross offers CPR and first aid training programs. Their website includes resources and guidelines on performing CPR.
• International Liaison Committee on Resuscitation (ILCOR): ILCOR is a global organization that reviews and develops resuscitation guidelines. Their website have information on the latest international standards.