Imagine you’re walking through a busy park on a warm, sunny afternoon. Everything’s serene until a child, perhaps five or six years of age, collapses while running past you.
Alarmed, you approach the child, who appears to be unconscious. The child’s panicked mother rushes over. What should you do?
It’s possible the child has experienced a cardiac arrest. While relatively rare in children, it happens. That’s why it’s best you’re prepared to act. Promptly recognizing a cardiac arrest, calling 911, starting CPR, and using an automated external defibrillator (AED), can significantly increase the young victim’s chance of survival.
Just like adults, children and infants in cardiac arrest need immediate medical attention. The survival rate drops as much as 10% for each minute that CPR isn’t delivered before defibrillation. When CPR is started in the first minutes after cardiac arrest, the survival rate can double or triple.
Let’s dig into the steps you can take, and how they differ from assisting an adult or teen in cardiac arrest.
If you suspect a child or infant is experiencing cardiac arrest:
1. Call 911 so that emergency responders can be on their way.
2. Check if the child is breathing. You don’t need to check for a pulse.
3. If there’s no breathing, or if it’s abnormal, start chest compressions and rescue breaths.
4. Use an AED, if one’s nearby.
While Hands-Only CPR (just chest compressions) is widely recommended for bystanders performing CPR on adults and teens, children and infants require rescue breaths (mouth-to-mouth) too.
CPR should be delivered continuously, or with minimal interruption, until emergency responders arrive – unless the child is revived.
If you’re alone, perform cycles of 30 compressions and two rescue breaths.
If you’re accompanied by another bystander trained in traditional CPR (compressions and breaths), you may switch off to avoid fatigue, being mindful to minimize interruptions.
For an Infant: Encircle your thumbs just beneath the nipple line and press down about one-and-a-half inches or use two fingers to press on the same area. Place both thumbs (side-by-side) on the center of the baby’s chest, just below the nipple line
Use the other fingers to encircle the baby’s chest toward the back, providing support
Using both thumbs at the same time, push hard down and fast about 1 ½ inches at a rate of 100 to 120 per minute
Allow the chest to return to its normal position after each compression
Alternatively, for a baby, use the two-finger technique - use two fingers placed parallel to the chest in the center of the chest
- For a child: Use one or two hands to push down about two inches in the middle of the chest, just below the nipple line.
- For infant and child: The rate of compressions is the same as in adults: 100-120 per minute.
Using an AED
AEDs are increasingly common in public, especially in high-traffic areas.
Some AEDs include pediatric electrode pads, which are smaller than adult pads; some standard model AEDs have pediatric settings. However, if you don’t have pediatric pads, don’t waste time. You can safely use what’s available.
Turn the AED on and follow the voice prompts. It’ll provide clear instructions.
Electrode Pad Placement
For an infant (up to 1 year old):
Use pediatric pads if available. If pediatric pads aren’t available—or the AED doesn’t have a pediatric setting—it’s safe to use adult AED pads or adult levels of energy.
Always use an anterior/posterior pad placement. To do this, apply one pad to the center of the infant’s chest—on the sternum—and one pad to the infant’s back between the scapulae.
Place one pad on the chest and one pad on the back.
For a child: Pads may be placed on the upper right chest and lower left chest.
Pads must be kept separate to work properly. When in doubt on where to place the pads, apply one to the chest and the other to the back.
For a Child 8 years or younger or weighing 55 pounds (25 kg) or less:
Use pediatric pads if available. If pediatric pads aren’t available—or the AED doesn’t have a pediatric setting—it’s safe to use adult AED pads or adult levels of energy.
Use an anterior/lateral placement, according to the manufacturer instructions:
- Place one pad to the right of the sternum and below the right clavicle.
- Place the other on the left side of the chest on the mid-axillary line, a few inches below the left armpit.
- Or, use an anterior/posterior pad placement, if the AED pads risk touching each other on the child’s chest or the manufacturer recommends.
Follow the AED prompts until help arrives
The AED will analyze the victim’s heart rhythm and advise if a shock if needed. Continue to follow the instructions until help arrives, including performing CPR.
That’s it! Remember, you’re key to the out-of-hospital Chain of Survival for cardiac arrest.
At Starting Hearts, we can provide specific training for making a life-saving difference.
Contact us for more information: info@startinghearts.org
Alex Alcon is a registered nurse and healthcare writer based in North Carolina.
