Child Cardiovascular Resuscitation (CPR)

Most non-traumatic cardiac arrest situations involving children are the result of some type of asphyxia or respiratory failure. Therefore, it is highly recommended that CPR on infants and children include the rescue breathing portion of the technique. However, if you are not properly trained or are uncomfortable with performing rescue breathing, compression-only CPR is now appropriate for children and infants if that is the only intervention available at the time.

Child CPR is performed on victims between the ages of one and eight, even though most CPR procedures are the same for children as they are for adults.

Remember: Check scene safety first the child second!

In a few seconds (less than 10), determine if the victim is not responsive and isn't breathing effectively. To assess the responsiveness of a child, it is appropriate to tap/shake their shoulder and ask, "are you okay"?

If an unconscious child victim is breathing normally and spinal trauma isn't suspected, place them in the recovery position and monitor their breathing. If the victim is not breathing normally, such as gasping for breath or not breathing at all, begin CPR immediately!

Call for Help - 911! If you are alone with a child, begin CPR immediately or two minutes (5 cycles of CPR with a cycle being 30 compressions/2 breaths) before leaving the child to call 911. Children cannot sustain life as long as an adult can without oxygen.

Always combine universal precautions with the appropriate
personal protective gear before initiating first aid and/or CPR on ANYONE!

The minimal universal precaution requirements for conducting CPR on any person of any age consist of protective exam gloves and the use of a barrier device when mouth-to-mouth rescue breathing is used

Employ C, A, B, D: Compressions - Airway - Breathing - Defibrillation

Layperson rescuers no longer have to check for a pulse to determine if the victim's heart is beating, but they should check for injuries. Is the body disfigured or bleeding? Check for consciousness by tapping the victim on the shoulder and shouting "Are you okay?"

No Response?

• 1. Quickly position the victim so they are lying flat on their back (supine position) on a hard stable surface (not a bed or sofa).
  (The victim should be positioned on a hard stable surface; not a bed or sofa)
• 2. Position your body beside the child victim as you would for an adult, positioning your shoulders directly approve the victim's chest to ensure straight down, effective compressions.

Compressions

• 3. The proper hand placement for chest compressions on a child is to place the palm of one hand on the center of the child's sternum (picture an imaginary straight line connecting the victim's nipples). Chest compressions can now begin. Either one-handed or two-handed compressions can be used on a child depending on their size and your strength.
  
  Press straight down on the child's chest hard enough to compress their sternum 2 inches (5 cm) or approximately 1/3 the depth of the child's chest. Switch to two-handed CPR if one-handed compressions become uncomfortable or if you are not delivering the proper compression depth using just one hand. Once you deliver a compression, let the chest completely recoil without taking your hand off the child's sternum and continue with the next compression. Deliver chest compressions to children at a rate of 100 to 120 per minute.

One-handed child chest compression method

Two-handed child chest compression method

Airway

• 4. After delivering the first "hard-n-fast" 30 chest-compression cycles, open the child's airway before attempting to deliver the 2 rescue breaths. Opening the airway is a crucial step in getting air into the victim's lungs. Use the head-tilt/chin-lift maneuver to open the airway of a child who isn't suspected of sustaining a spinal injury.
  The tongue is the most common airway obstruction in an unconscious person. While they cannot swallow their tongue, it can fall back into their throat when they are not conscious enough to prevent it from occurring.
  To open the airway, use the head tilt/chin Lift method for non-trauma victims. With the victim flat on their back, place one hand on the victim's forehead and the other hand underneath their chin. Gently push down on the forehead while lifting the chin to open their airway.
  

Caution: Lifting the chin too hard can close the child's mouth and tilting the head too far back can occlude their airway.

Note: Remember, the rescue breathing portion of child/infant CPR is highly recommended when attempting to resuscitate a child in cardiac arrest. However, if you are not properly trained or are unable/unwilling to perform rescue breathing, "fast-n-hard" chest compressions delivered at a rate of 100 to 120 compressions per minute are appropriate. The child would greatly benefit from rescue breathing, but do not attempt it without the proper knowledge. Rescue breathing must be conducted properly to be effective.

Breathing

• 5. After opening the child victim's airway with the proper technique, pinch their nose shut and deliver the first rescue breath slowly and evenly until the chest visually rises. It should take about one second to fill a child's lungs using manual rescue breathing. Allow the delivered breath to naturally escape the victim's lungs before delivering the second rescue breath. Children have smaller lung capacities than adults, so it will not take as much air to adequately fill their lungs. Keep this in mind when delivering rescue breaths to children and infants. The best way to approximate the amount of air being delivered to the child is to watch out of the corner of your eye for their chest to rise as the breath is being delivered.
  Note: Delivering a rescue breath too forcefully or with too much volume can cause a higher than normal pressure within the lungs, potentially causing them to collapse (especially in infants/children). Excessive or high-pressure rescue breaths can also allow air to enter the stomach and cause gastric distension and alter the effectiveness of CPR by causing the victim to vomit, potentially aspirating the material into their lungs.
  
• 6. Continue CPR cycles consisting of 30 "fast-n-hard" chest compressions followed by 2 rescue breaths until an AED or EMS arrives at the victim's side, the victim shows obvious signs of life, or the scene becomes too unsafe to continue care.
  Remember; NEVER knowingly place yourself in harm's way.
  

Defibrillation (AED)

Automatic external defibrillators (AED) are designed to detect the presence of a lethal dysrhythmia that often occurs in the first few minutes of a sudden cardiac arrest. Once an AED determines that a lethal dysrhythmia is present, it can initiate counter shocks in an attempt to correct the chaotic nature of the dysrhythmia by potentially converting the heart's rhythm back into a "more normal" or viable rhythm. However, if the AED doesn't detect the presence of one of the two "life-threatening" dysrhythmias, no shock is delivered, and CPR should be continued until definitive help arrives.

AED Operation

AED's equipped with both child/pediatric and adult defibrillation pads are designed to deliver lower energy levels for children and higher levels for adults. Lower energy levels are considered appropriate for defibrillating children from infancy to eight years old or who weigh up to 55 lbs.
Note: If pediatric-specific equipment is not available, it is appropriate as of 2015 to use adult AED pads and energy levels on infants and children in cardiac arrest with a few guidelines/recommendations.

• 7. Turn the AED on and follow all voice prompts.
  Note: If the AED has the child/pediatric pads included in the unit, make sure you use them on children up to age eight and/or under 56 lbs.
• 8. Expose the child's chest and make sure it is dry before applying one pad to the upper right side of the victim's chest and the other pad to the lower left side of the chest.
  Do not allow the two pads to touch each other once they've been applied to the victim's chest. If they are too large to ensure they won't touch once applied, it is appropriate to apply one pad to the child/infant's chest and the other pad on their back between the shoulder blades.
  (When using anterior/posterior pad placement on a small child/infant, make ensure the chest pad electrode placement doesn't interfere with administering chest compressions after the AED analysis or defibrillation attempt.)
• 9. After the pads are properly attached, plug the connector into the AED console, if needed.
• 10. At this point, all CPR and victim contact should be discontinued so the AED can properly analyze the victim's heart rhythm. Some newer models can auto-analyze the victim, while other models, particularly older ones, require the rescuer to push a clearly marked red analyze button to initiate the analysis and then again if the AED determines a shock is indicated.

If the AED determines a shock is indicated:

• 11. If a shock is indicated, it is very important to follow the voice commands/prompts closely to prevent yourself or others from being injured during the electrical discharge (defibrillation) and to give the victim the best chance of survival.
  Clearly announce and repeat to everyone assisting in the resuscitation attempt or standing near the victim "CLEAR, EVERYONE STAND CLEAR"
  Deliver the shock by pushing the red button, if necessary. Some newer models are fully automatic and work on voice prompts.
  Important Note: After clearly/loudly announcing for everyone involved to clear contact with the victim, the rescuer is responsible for visually scanning the area and the victim's body to ensure no one is still in contact with ANY part of the victim before pushing the shock/defibrillation button.

If the AED determines no shock is indicated:

• 12. After the AED delivers a shock or it determines that "no shock is indicated," the rescuer should continue high-quality, "fast-n-hard" CPR for approximately five cycles (two minutes) or until the AED announces new instruction/prompts. Continue the repeating compression/ventilation cycles and following the AED's voice prompts until help arrives.
  Note: If at any time during the resuscitation attempt the rescuer notices any obvious signs of life such as spontaneous victim movements or breathing, all resuscitation efforts should stop immediately and the victim closely monitored in the recovery position until advanced help arrives.

Let's Review Child CPR:

First:

Check the scene and make sure it's safe for you to proceed. Don't become a victim yourself!

Then:

C - Check the child's level of consciousness. Tap a child on the shoulder and ask loudly, "are you okay"?
(Remember; it is no longer recommended to "Look, Listen, and Feel" for a pulse or signs of life if you are not a health care professional; assess for responsiveness/breathing only)

P - Phone for help or ask one specific person nearby to call 911 for you so you can begin care of the child.

R - React by initiating life-saving interventions using the current CPR (CABD) guidelines:

• 100 to 120 chest compressions per minute
• 30 compressions delivered at 2 inches deep (1/3 chest diameter) per cycle
• 2 rescue breaths delivered through a barrier device to cause chest rise (1 sec/breath)

Continue CPR cycles until:

• The victim shows signs of life such as spontaneously breathing or moving
• An AED is preparing to analyze the victim
• EMS arrives and takes over care
• The scene becomes unsafe for you to continue care

Congratulations!

You have completed the child CPR training material. If you are comfortable with this material, please proceed to infant CPR. If you are unclear on any topics, please review them before proceeding to the next section.