Cardiopulmonary resuscitation, or CPR, consists of rescue breathing and chest compressions. CPR may be required in cases of cardiac arrest, choking, drowning, head trauma, lung disease, suffocation or stopped heartbeat and breathing. Effective bystander CPR can double a victim's chance for survival, says the American Heart Association. While the ABCs of CPR--airway, breathing, and circulation--are similar for everyone, CPR technique must be adjusted to accommodate children ages 1 to 8 and babies.
Assess the Situation
First, be sure it is safe to approach the child. Then, ascertain whether the child is conscious or unconscious by calling to him in a loud voice and gently tapping or shaking his shoulder. Never shake a baby, though. Instead stroke him and watch for a response. If the child is unresponsive, proceed to the ABCs of CPR.
Calling for Help and the CPR Cycle
Shout for help if you are alone, or have someone else go for help or call 911 while you attend to the child. If you have had no response from the child and she is not breathing, begin CPR. If you are alone, complete five cycles of compressions and breaths before you call 911 or go for help. A cycle is 30 compressions followed by two breaths. Five cycles should take about two minutes.
Chest Compressions vs. Rescue Breathing
In adult cardiac arrest situations, compression-only CPR is preferred. But for children in cardiac arrest, both compression-only or compressions combined with rescue breathing are similarly effective, according to a 2010 study from Kyoto University Health Service in Japan. However, if the child is in cardiac arrest due to lack of oxygen--in the case of drowning, for instance--you must use both chest compressions and rescue breathing so that oxygen can begin circulating through the bloodstream again. If you are performing CPR on an infant, compressions-only CPR will not be effective--you must use only the combined method.
Airway
Carefully lay the child on his back on a firm surface, being aware of the possibility of spinal injury. Gently tilt his head back with a hand on his forehead and with the other hand, lift his chin to open the airway. Check for breathing by watching for the rise and fall of the chest and by putting your face close to the child's to hear the sound of breathing or to feel his breath on your skin. Take no more than 10 seconds to check for breathing.
Breathing
If there is no breath, you must breathe for the child. With the head tilted back and the chin up, pinch the child's nostrils closed and cover her mouth with yours, forming a tight seal. Give two rescue breaths, lasting about one second each. Check to be sure the chest rises after each breath. If it doesn't rise, tilt the head and lift the chin again and give the second breath. For a baby, cover both her mouth and nose with your mouth and give gentler rescue breaths.
Circulation
Perform chest compressions to begin circulating the blood. Where you would use two hands to do chest compression for an adult, for a child you will use one hand only and for a baby just two fingers of one hand. Put the heel of your hand, or your index and middle fingers, on the breastbone, just below the nipples. Make sure the edge of your hand or fingers is not at the edge of the breastbone. Keep your other hand on the child's forehead to keep it tilted back.
Keep your elbow straight and , using your upper body weight, press down rapidly on the chest about one-third to one-half the depth of the chest. Be more gentle with a baby. The rate of compression should be about 100 per minute. After 30 compressions, which should take about 18 seconds, give two rescue breaths and begin again.
Automatic External Defibrillator
If you have access to an automatic external defibrillator, or AED, apply it to the child if she has not responded after five cycles of CPR. Follow the AED prompts, using pediatric pads if available. Administer one shock; then return to CPR for five cycles, or two minutes. Continue this pattern until the child responds or emergency medical personnel arrive.
References
- American Heart Association: CPR Facts and Statistics
- Mayo Clinic: Cardiopulmonary Resuscitation
- National Institutes of Health: PubMed Study Abstract
- "Circulation"; New Concepts of Cardiopulmonary Resuscitation for the Lay Public; Gordon A. Ewy, M.D.,
- National Institutes of Health: CPR--Child (1 to 8 years old)
