Child Chest Compressions

Chest compressions in a child require you to place one or both of your hands directly over the lower half of the victim’s breastbone. You will need to lock your arm and push down about 1/3 of their chest or about 2 inches. You will then release all of the pressure off of the victim’s chest. This should be performed 100 to 120 times per minute.

Child chest compressions are very similar to adult chest compressions however you may perform one handed chest compressions if you are more comfortable or to prevent yourself from going too deep. Make sure to ensure adequate chest recoil after each compression and not to rest on the victim’s chest between compressions.

Child Rescue Breathing

One of the main reasons children and infants go into cardiac arrest is respiratory failure. That is to say, rescue breathing in children and infants is extremely important. This rescue breathing allows you to replace depleted oxygen in the victim’s blood. Two options of rescue breathing are mouth-to-mouth and bag-valve-mask. With either technique, you will want to provide two breaths stopping once you notice chest rise for every thirty chest compressions.

Compression-to-Ventilation (CV) Ratios

If you’re acting as a single rescuer you should perform a compression-to-ventilation or CV ratio of 30:2. That means after 30 chest compressions you should perform two rescue breaths.

However children and infants have a higher baseline demand for oxygen and low oxygen is a leading cause of pediatric cardiac arrest. That means if you have multiple rescuers and can effectively do it you should utilize a CV ratio of 15:2. **That means if you have multiple rescuers you should deliver 2 breaths after every 15 chest compressions.

Child Mouth-to-Mouth

  • Pinch the child’s nose closed

  • Tilt their head back being careful not to extend too far

  • Place your mouth over their mouth forming a seal

  • Exhale one breath into their mouth watching for chest rise and stopping when you see chest rise

  • Take in a breath and exhale once more into their mouth same as before

Child BVM

  • Place a child sized BVM mask over the victim’s nose and mouth with your thumb and index finder with enough pressure to form a tight mask seal

  • Tilt the child’s head back while keeping a tight mask seal without expending too far

  • Deliver one breath over one second (stopping when you note chest rise)

  • Release the bag over one second allowing the child to exhale

  • Deliver one more breath over one second (again stopping when you note chest rise)

Child AED

AED’s are to be implemented immediately upon availability during your chest compressions and rescue breaths. The person delivering the AED should be directed to work around the chest compressor to deploy the AED.

Most AEDs have separate pads or modes for children and infants to deliver a lower energy. If present and able use the child pads or child AED mode. If unavailable, you may use adult pads/mode on a child or infant.

Some cardiac arrests are caused by disorganized electrical activity within the heart. In these specific cases resetting the electrical system of the heart can restore organized and coordinated electrical activity restoring the circulation of blood. The AED is able to determine these types of cardiac arrest, and restart the heart by sending a large impulse of electricity through the heart.

To operate an AED follow these three steps:

  • Turn AED On

  • Place Pads on Victim

  • Follow AED Prompts

Make sure to avoid touching the patient while the AED is analyzing and during shock delivery.

For a child, place one pad on the center of their chest over the breastbone with the other pad placed on the center of their back opposite of the first pad. Make sure to avoid placing the pads on breast tissue, over clothing, over medical patches, or over bulges in the skin.

Child Team CPR

If you have multiple rescuers, one person should establish themselves as a team coach. The role of the team coach is to ensure all important steps are being taken effectively and to promote effective communication. An effective team coach will:

  • Identify and designate a person to activate 911 and ensure responders have access to the area

  • Identify and designate a person to perform chest compressions and switch them every two minutes

  • Provide encouragement and coaching to the chest compressor if/when necessary

  • Identify and designate a person to retrieve the closest AED and deploy it

All of the steps of CPR need to be performed and having a team with a team coach allows a resuscitation to happen quicker and with greater efficiency.

Child Choking

Children may choke for any number of reasons. It is important to quickly identify a choking child and respond appropriately. A choking child may or may not appear in distress as the first few moments can be filled with confusion and panic.

You will need to determine if the child has a complete airway obstruction or a partial airway obstruction. Is their airway completely blocked preventing any airflow or is it just partially blocked allowing some airflow. For a victim with a complete airway obstruction you will want to attempt to dislodge the object and relieve the choking. Victims with partial obstructions that are able to move air and speak should be monitored until first responders arrive.

Do not forget to introduce yourself and obtain permission to intervene.

Complete Obstruction

  • No ability to speak

  • No ability to scream

  • No ability to breath

  • Attempt Choking Relief and Call 911

Partial Obstruction

  • May be able to speak

  • May be able to scream/screech

  • May be able to move some air

  • Call 911 and Monitor

If choking relief fails and the child becomes unresponsive, start CPR.

Child Abdominal Thrusts

Child choking relief may be performed with abdominal thrusts. To properly perform abdominal thrusts wrap both hands around the abdomen just above the belly button. Form one hand into a fist with your thumb facing up and into their abdomen and your second hand wrapped around your fist. Pull in firmly and brisk repeatedly until the object becomes dislodged.

Review

Where do you place your hands in child CPR?

How deep do you compress in child CPR?

How many times in one minute do you compress in child CPR?

How many compressions are performed before delivering two breaths in child CPR?

How should the AED pads be placed on a child?

Can you use adult pads on a child?