The U.S. National Library of Medicine Encyclopedia describes cardio pulmonary resuscitation (CPR) as a lifesaving procedure performed when a child or infant's heart beat or breathing stops. Rescue breaths replace breathing by supplying the lungs with oxygen and chest compressions maintain blood circulation around the body. The method and sequence for child and infant CPR is slightly different compared to adult CPR. In an article published in Circulation in 2005 about Pediatric Basic Life Support, an infant is defined as a less than one year of age and a child between one and eight years of age.
Safety
The article published in Circulation in 2005 details the CPR procedure for children and infants. The first step in CPR is to ensure the area surrounding the child or infant is safe for the first aider to attempt CPR. If the child or infant is in further danger, it is necessary to move them before beginning CPR.
Ascertaining Consciousness
If a child appears unconscious, the child's name should be called loudly and the child should be touched gently to elicit a response. If the child or infant is responsive, further emergency care may still be required if they are struggling to breathe or have other injuries.
If the child or infant is unresponsive, the aid provider should shout for assistance and ask someone else to call an ambulance and if possible obtain an AED (defibrillator) whilst he begins CPR. If the aid provider is alone, he should begin CPR without calling for an ambulance. Five cycles of CPR must be completed before the aid provider calls an ambulance. If unresponsive, the child or infant must be placed on a hard surface in a face up position. Twisting the head and neck must be kept to a minimum.
Rescue Breaths
A cycle of CPR begins by tilting the head and pressing the chin down to open the mouth and airway. If the tongue is obstructing the airway it must be moved and the mouth must be emptied of any substance that may be in it. Having opened the mouth, up to ten seconds should be taken to determine whether the child or infant is breathing. It is best for the aid provider to look for chest movements, feel breaths on his cheek and listen to breath sounds from the nose and mouth.
If the child is breathing, ideally they should be placed in the recovery position. If the child is not breathing, the nose should be pinched and two rescue breaths given. If the breaths are successful, the chest will rise and enough oxygen has been delivered. Excessive inflation of the lungs will rupture them. If the breath is unsuccessful, it should be given again.
For an infant, the aid provider's mouth should cover the infant's nose and mouth and light breaths should be given.
Compressions
Following rescue breaths, compressions should be performed. The site for compressions is on the lower half of the sternum (the flat bone in the middle of the chest descending between the ribs). Care should be taken not to press on the xiphoid, the small extension at the bottom of the sternum. The spot for compressions is usually in the middle of the chest in line with the nipples.
The chest should descend one third of the body depth. Compressions should be performed at a rate of one hundred compressions per minute. After each compression the chest should be released to allow it to fully recoil before the next compression. Depending on the size of the child, compressions can be performed with the heel of one hand or with two hands. When performing compressions on infants, the sternum should be pressed with two fingers. Thirty compressions are performed in each CPR cycle.
Further Procedure
Following the two rescue breaths and thirty compressions, the CPR cycle must be re-started immediately by giving a further two rescue breaths. It is important to maintain the force of the chest compressions despite fatigue and so those capable of performing emergency aid should rotate regularly. If an emergency aider is alone he should perform five sets of CPR before calling an ambulance since it is vital to restore circulation at the earliest opportunity. If a defibrillator is available it should be used on children by following the automatic prompts. CPR should be continued until the child or infant begins to move or an ambulance arrives. Immediately performing CPR significantly increases a child or infants chances of survival.
