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How to Perform Basic CPR: Infants to Preschool-aged Children
Author: Dr. Anna Kaplan
CPR stands for CardioPulmonary Resuscitation. It is a way to help keep someone alive whose heart is not beating effectively, or not beating at all, or someone who has stopped breathing. This is called a cardiopulmonary arrest. There are minutes in between the beginning of a catastrophic event and death. If you can do CPR, you may be able to save someone’s life.
Adults usually need CPR because they have had a heart attack. They need the cardiac portion of CPR more than the breathing portion. People are now being taught to do CPR by following the order CAB – Cardiac, Airway, and Breathing. Children should be given CAB also; but with children, the breathing component is much more important (It is believed that teaching everyone to begin with cardiac compressions will help them remember what to do, should the need arise, and not have to think for a long time about the age of the person, and which to begin with: cardiac or breathing.).
It is recommended that anyone who has young children, or works with them, learn CPR and get certified. It is possible to explain the steps, but it is harder to do without some visual aids. For CPR purposes, one is classified as an infant up to a year of age, and classified as a child from one year of age until puberty.
In 2010, the American Heart Association updated all its recommendations about CPR. The following explanation follows their guidelines for bystander pediatric CPR.
If you come across an infant or child who appears unconscious, you should make sure the area is safe for the victim and yourself before starting to do anything. You should tap the child and use his or her name if you know it, asking “Are you okay?” If a child can respond to you, is in severe distress but breathing, do not move her, but activate the emergency response system by dialing 911 or getting someone else to call. If the child is breathing and you are alone, you can leave briefly to make the call.
If the child is unresponsive, you need to see if she is breathing. If she is breathing, you do not do CPR. Children who are having trouble breathing may often find the best position to sit in; do not move a child in this situation. If the child is breathing regularly, turn her onto her side.
If he is not breathing, or taking irregular, infrequent gasps, you must begin CPR. The first step is chest compressions, compressing the breastbone. Infants and children both need 30 quick compressions. To do this:
- Push fast – the rate should be 100 a minute.
- Push hard – enough to depress the chest approximately 1 ½ inches in infants and 2 inches in children.
- Let the chest rise up again after each compression.
- If possible, do this with the child on a firm surface.
For infants, the sternum, or breastbone, should be compressed with 2 fingers just below an imaginary line connecting the nipples. For a child, use the heel of one or two hands to depress the lower half of the breastbone 2 inches. These techniques are best learned in a class with a manikin, or at least after viewing the proper technique.
After 30 compressions, if you are a single rescuer, you need to give 2 breaths. You must open the child’s airway by tilting back his head and lifting the chin forward. For an infant, mouth to mouth-and-nose is correct. You cover the infant’s mouth and nose with your mouth and deliver 2 breaths. Watch to see the chest rise. Each breath should last about a second. Reposition the child if the chest does not rise.
If you are a single rescuer, you will continue to give 30 compressions followed by 2 breaths until someone else arrives or you cannot physically continue. If there are two people, one should make sure the emergency response system has been activated (by calling 911), and then join you to provide 2-person CPR. If you are both equally comfortable with giving breaths and compressions, you should change roles every two minutes. You should also check for breathing every two minutes.
If you are alone, you should do 2 minutes of CPR before trying to get help. Two minutes of CPR may help a child survive while you get help. If there is an automated external defibrillator (AED), you should get it and use it if you know how. If there is not AED, or you do not know how to use it, or you use it and the child is still not breathing, you should resume CPR until help arrives.
Once paramedics or other trained medical personnel arrive, they should take over CPR.
How much will you have helped by doing CPR? If a child who has had a respiratory arrest gets CPR from a bystander, the rate of survival with good functioning is greater than 70%. Even with some types of cardiac arrest in children, CPR greatly increases the chance of survival.
At the current time, only between a third-and-a-half of all children who suffer a cardiac arrest actually receive CPR from a bystander. There is good evidence that shows bystander CPR can improve the outcome for babies and children. So if you are a parent, or even a babysitter, you should try and get CPR training. Most local hospitals offer CPR courses, as do community colleges. If you do not know where to find a class, you can start with the American Heart Association’s website and look for a class.
**Planning Family does not support using this article as a replacement for actual CPR training.
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