Why is Infant CPR important?
Cardiac arrest in infants is typically what occurs when an airway is blocked from receiving breath, such as when an infant chokes, has experienced drowning, or a serious breathing issue. The heart can unfortunately not continue pumping without oxygen, and when this occurs, an infant may seem to be experiencing cardiac arrest. Prompt CPR with successful rescue breathing could be the only form of treatment necessary to arouse the heart and stop a serious cardiac arrest from taking place. However, in some cases ventricular fibrillation may take place and for that an infant may need defibrillation.
Are you in need of CPR Certification for Adults, Children, an Infants?
When rescue breathing for an infant who is thought to be experiencing cardiac arrest, be sure that their airway is open and that you are effectively giving rescue breaths when performing CPR. Always connect an AED when it is accessible.
It is imperative to be aware of the steps to perform CPR (or cardiopulmonary resuscitation) on an infant, in the event that a breathing or cardiac emergency takes place. For purposes of these instructions, an infant refers to a child less than one year old. It is important to perform CPR differently to an infant than it would be done to children or adults.
The following steps can be accessed anywhere if you print them and keep them close by. Reading over the steps again can further solidify them in your memory to help keep your skills polished.
Infant CPR Steps
Adults nearby or those who are alone with the baby and witnessed the collapse of the infant should perform two minutes of CPR prior to calling the emergency hotline (911). Those who do not witness the collapse should immediately call 911, as it is unknown how long the baby could have been struggling to breathe.
Step 1. Assess the scene
First, check the infant and the area that the accident took place. Ensure that the scene is safe for you and the victim. Once this has been established, the well-being of the victim may be assessed. If you discover that a victim is not responding or breathing at all, once you have determined that there are no additional dangers at the scene, it is okay to begin performing infant CPR. To ensure that an infant actually is in need of help, tap the bottom of their foot to stimulate a reaction.
While the administration of CPR could potentially have a risk of spreading infectious disease, there is an extremely low risk for the rescuer. A device may be used as a barrier if the rescuer is hesitant to offer rescue breathing by mouth. The minuscule risk of spreading an infection has not shown to be reduced by a barrier device, however, and these devices could act as an inhibitor for air to flow as it should. For individuals using barrier devices, it is imperative that rescue breathing is not delayed. If a delay takes place when seeking to obtain a device to use as a barrier, it is most important to forgo the barrier. The rescuer should opt to give rescue breathing by mouth, if they are able and willing. Although if the rescuer is not willing, chest compressions may be continued in lieu of rescue breathing.
Step 2. Determine whether or not the infant needs CPR
Gently tap on the baby’s shoulder while you shout loudly enough for them to hear, but also be mindful of an infant’s hearing capabilities. If the infant is responsive, you will hear a moan, or the baby may move. Quickly look to see if the infant needs medical care or has injuries. If the child begins to breathe and you are by yourself, briefly leave the side of the child if you must to call the emergency phone number, but quickly return and monitor the condition of the child again. Frequently check the child’s condition, as it can change from moment to moment in a cardiac arrest situation.
Kids who have respiratory anguish may be able to lie in a position that allows for their airways to be more open to allow for as much ventilation as possible. Be sure to let the infant lay however they are most comfortable.
If you do not receive any response, breathing does not appear normal, or they are not breathing at all; lay the baby on their back. Begin to yell for help to come. CPR should only be performed if cardiac arrest is thought to be taking place. CPR needs to be administered if the victim is not responding.
Step 3. Perform a breathing check
Normal breathing will indicate that the baby will not require CPR. If trauma does not appear to have taken place, the child must be turned on their side (in the recovery position). This position will decrease the likelihood of aspiration taking place and will allow the airway to stay open.
If the infant is not breathing and is unresponsive (or can only gasp for breath), it is time to begin CPR. If you are not certain if the infant is breathing, you may check for a pulse in the following step. Occasionally, a baby that needs CPR will only be able to gasp, which should not be misjudged as active breathing. The victim should be treated as if there is not any breathing taking place, and CPR should begin.
Formal training will be able to further illustrate the difference between a normal breath and a gasp. CPR should always take place even when occasional gasping is taking place by the victim who is unresponsive.
If you discover the infant is not breathing and is unresponsive, 10 seconds may be allotted to try and find a pulse (for an infant, the brachial pulse). If a pulse is not discovered within a period of no more than 10 seconds, or if you are not sure, begin to perform chest compressions.
A pulse can be hard to find, especially during the stress of an emergency situation, and it has been revealed that rescuers and healthcare professionals may not be able to detect a pulse reliably.
Pulse with insufficient breathing
If a pulse can be identified (60 beats for every minute) but insufficient breathing is taking place, rescue breaths should be given (follow a rate of 12-20 breaths for every minute, or give one breath for every 3-5 seconds) until breathing returns. Check the pulse again once every two minutes, but do not spend more than 10 seconds reevaluating the pulse.
Step 4. Open the infant’s airway
Ensure the infant is lying down on their back, and move the head back slowly by raising the chin gently.
Step 5. Monitor for breathing
Listen cautiously for signs of breathing, for a period no longer than 10 seconds. Intermittent gasps are not breathing. Changes in breathing repetition are normal for infants as they can have periodic patterns of breathing.
Step 6. Perform rescue breaths
If the infant is still not breathing, pinch the nose of the child closed, and tilt the head of the baby backward slowly and carefully by lifting the chin. Complete the seal by putting your mouth over the mouth of the baby. Blow into the baby’s mouth for one second to be sure the chest will rise. Next, breathe two rescue breaths into the infant’s mouth.
Step 7. Begin CPR: Perform a Set of 30 Compressions
In instance of cardiac arrest, chest compressions that are of high quality should encourage blood flow to move to the vital organs. If the infant does not respond to the rescue breathing, CPR may begin.
Gentle compressions on the chest should be given at the speed of 100-120 every minute according to the 30:2 compression to breathing ratio. Two or three fingers should be used in the middle of the chest when there is only one rescuer present, in the area located immediately under the nipples. Push into the depth of the chest one-third of a distance down (roughly 1 ½ inches). Push hard and push quickly.
Step 8. Open the Infant’s Airway
Tilt the baby’s chin gently to open up the airway. Do not push too far, tilting the head back too much. Ensure your rescue breaths are entering the airway of the victim, as an unresponsive baby could inadvertently cover their own airway with their tongue.
Step 9. Offer two Soft Breaths
Two minutes or about five repetitions of breathing and compressions should be given, and then the rescuer should contact 911 (or instruct another person to call 911). CPR should be sustained until breathing returns or until help comes. Compressions should be thrust in 1/3 of the circumference of the chest (roughly 1 ½ inches, or four cm).
If the infant or baby is still not breathing as they should normally, or if they are not breathing at all, offer two breaths into their mouth after you cover the nose and mouth of the baby. Ensure that the breaths you give are one second long. The chest of the baby should rise every time you give them a breath.
Continue performing 30 pumps followed by two breaths until additional help has arrived, until the infant is obviously breathing, an AED has become available to use, or the scene is no longer safe.
Defibrillation Series with an AED
When an AED becomes available, if help still has not arrived, have the AED monitor or analyze the rhythm of the victim’s heart.
If the heart of the victim reads as shockable, one shock may be given. CPR should be resumed right away for a duration of two minutes, or until the AED alerts the rescuer that it is time for another heart rhythm check. This process should be continued until the infant begins to move, or until rescue professionals have arrived to the scene and can take over.
If the heart of the victim reads as non-shockable, resume CPR right away for two more minutes. After two minutes, the AED should prompt for an additional heart rhythm check. This process should be continued until rescue professionals can continue, or the victim begins to move.
Most modern AEDs are able to identify shockable rhythms in pediatric patients, and certain machines are equipped to reduce the energy sent to the patient to make the machines suitable for infants. Pediatric attenuators are other options that are recommended for use in children. When required, shocks should take place following compressions as soon as possible.
Infant CPR Ratio
One rescuer should follow a 30:2 compression-to-ventilation ratio; the individual must complete both the chest compressions while maintaining an open airway for the infant. This means that two ventilations should be given for each set of 30 compressions when one rescuer is present.
Two rescuers should follow a 15:2 compression-to-ventilation ratio; with one rescuer completing the chest compressions and the other rescuer ensuring that the airway stays open. When two rescuers are able to provide care, two ventilations should be given for each set of 15 compressions.
Infant CPR Compression Rate
For infants, compressions should continue at a frequency of 100-120 per minute with one breath given every six seconds (a rate of 10 breaths per minute). The rate is the same as the beat in the song, “Stayin’ Alive”, which is fairly quick. Infants will need to be resuscitated quickly as their bodies are much smaller.
1 Rescuer Infant CPR
The steps to perform one rescuer infant CPR are outlined above, in the section titled “Infant CPR Steps”. One person performing infant rescue CPR should compress the chest with the 2-finger technique. As most babies who have cardiac arrest are experiencing an asphyxia instead of a VF arrest, an alone rescuer should first perform two minutes of CPR prior to notifying an emergency response team or getting an AED, if available.
Below the center horizontal line in the middle of the chest (below the nipples of the baby), place two fingers to begin compressions. 100-120 compressions per minute should be given according to the 30:2 compression to breathing ratio. Two minutes or around five repetitions of breathing and compressions should be performed, and then contact 911 (or instruct another person to call 911). CPR should be continued until breathing resumes or until help arrives. Compressions should be pushed in 1/3 of the circumference of the chest (roughly 1 ½ inches, or four cm).
2 Rescuer Infant CPR
When there are two people performing infant rescue CPR, it is suggested that the 2-thumb surrounding hands method be used. The first rescuer should begin CPR right away and the other should notify an emergency response system (typically calling 911 will suffice) and if available, attain an AED.
One rescuer should be positioned over the head and the other should be able to hold the central portion of the infant’s belly with both hands, thumbs upward. Enclose the chest of the infant with two hands; place your fingers across the thorax (on the back of the body), and the thumbs should be together over the bottom third of the area of the sternum (on the front of the body). The rescuer should then squeeze the sternum powerfully with the thumbs. Previously, the thorax was recommended to be compressed while chest compression is taking place, but there was no data supporting any benefit from a squeeze during the compression.
The technique with 2-thumbs surrounding the hands is suggested and preferred over the 2-finger method because additional pressure is placed on the coronary artery perfusion. The rescuer is able to offer the assistance in a more direct manner, which aids with the likelihood of recovery. This technique is able to reach the appropriate compression depth on a more consistent basis, and could generate greater systolic and diastolic pressures. If it is not possible to encircle the chest of the victim, the chest can also be effectively compressed with two fingers. See the portion of this article entitled, “1 Rescuer Infant CPR”.
Infant CPR Warnings
As infants are much smaller than adults, rescuers must take additional caution when they are attempting to perform CPR on a baby.
As a rescuer, be sure to never:
- Lean or push unnecessarily on the chest of the victim while giving compressions
- Deliver too much breath, too many breaths, or too much force
- Compress at a speed lower than 100 per minute or quicker than 120 per minute
- Permit interruptions while compressions are taking place of longer than 10 seconds
- Compress at a depth lower than 1 ½ inches (or 4 cm)
Infant CPR video
For a video demonstration of baby CPR, the following links may be beneficial for reference. It is important to abide by proper techniques prior to performing infant CPR. However, if there is no time, rescue breaths should begin as soon as possible if the baby is not breathing.
Once the process of CPR has begun, it is important that you do your best. An infant who cannot breathe or who does not have proper circulation cannot live. There is almost nothing that could be done to make the situation worse.