Medical knowledge, Patient Education
CPR, Pediatric
Cardiopulmonary resuscitation (CPR) is an emergency procedure that is done to help a person whose breathing or heartbeat has stopped (cardiac arrest). When the heart stops beating, blood flow to the brain and other vital organs also stops. Brain damage or death can occur if this is not treated within minutes. CPR squeezes the heart and moves blood and oxygen to the brain and lungs. CPR can save a life.
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C – Chest compressions.
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A – Airway.
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B – Breathing.
If an automated external defibrillator (AED) is available, use it during CPR. An AED is a portable electrical device that can deliver an electric shock (if necessary) to restart the heart or to return the heartbeat to normal. This process is called defibrillation. If an AED becomes available at any time, use it immediately.
The best way to learn CPR is to take a certified training class. Look for a class in your community. Almost anyone can learn how to do CPR and use an AED.
What should I do first?
If you see a child who seems to be unconscious and has no pulse, is not breathing, or is only gasping, take the following steps:
1. Make sure the area is safe
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Quickly look around the area where the child is located. Go to help the child only if the area seems safe to enter.
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If the child is in immediate danger, carefully take the child with you and leave the area, if you can do this safely.
2. Check for a response
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Gently tap the child on a shoulder and ask if they are okay.
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If you are by yourself, shout for help to see if someone is nearby.
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Watch the child’s face and chest for no more than 10 seconds to see if they are breathing.
3. Call emergency services
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If the child does not respond, and they are not breathing or are only gasping, start CPR right away.
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If another person is nearby, have that person call emergency services (911 in the U.S.) and look for an AED while you start CPR.
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If you are alone and do not have immediate access to a phone, do CPR for 2 minutes. Then, shout for help, call emergency services, and get an AED if one is available. If calling from a mobile phone, use the speakerphone function to keep your hands free. Return to CPR as quickly as possible.
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If the child responds and is breathing normally but is ill or injured, call emergency services and wait for help. Follow the operator’s instructions over the phone. While you wait, check the child frequently.
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If another person is nearby, have that person call emergency services and look for an AED while you wait with the child.
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4. Begin CPR
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Start chest compressions immediately if the child does not respond to you, and:
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The child is not breathing.
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You are not sure if the child is breathing.
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The child is gasping.
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Remember the C-A-B sequence: chest compressions, airway, and breathing.
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If you have an AED, use it right away by turning it on and following its directions.
How do I perform CPR?
Position the child
The child should be lying on a firm, flat surface facing up. You may need to carefully roll the child into this position.
C – Chest compressions
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Kneel next to the child’s chest.
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Place the heel of one of your hands in the middle of the child’s chest, over the lower half of the breastbone.
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Place the heel of your other hand on top of the first hand so that your hands overlap, or use just one hand if the child is small.
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Push down until the chest moves down about 2 inches (5 cm), or one-third the depth of the chest.
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Let the chest rise up completely to its normal position before the next compression. Do not lean on the chest, especially between compressions.
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Do the compressions very quickly, at a rate of 100–120 per minute. Count the compressions while you do them. Focus on doing compressions “hard and fast.”
Do the compressions at a consistent rhythm, with no interruptions, until the emergency services operator provides other instructions. If you have an AED, follow its instructions.
A – Airway
Opening the airway prepares the child to receive rescue breaths. Be careful when moving the child’s head and neck, especially if you think the child is injured. If you believe the child has injured their neck, perform a jaw thrust maneuver rather than a “head tilt, chin lift.”
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Kneel behind the child’s head.
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Place the palms of your hands on the child’s temples and your fingertips gripping under the jaw.
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Gently lift the jaw to open the airway. Do not tilt the neck.
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Place one hand on the child’s forehead and push slightly with your palm to tilt the head back.
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Place the fingers of your other hand under the bony part of the child’s lower jaw and gently lift the chin.
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Pinch the child’s nose closed.
B – Breathing
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Put your mouth over the child’s mouth. Make a good seal with your mouth so that all of the air that you exhale goes into the child’s mouth.
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Exhale 2 breaths into the child’s mouth. Each breath should take about 1 second.
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Make sure the child’s chest rises when you exhale. If the chest does not rise, reposition the head and try again.
If you are by yourself, open the airway and give 2 rescue breaths after every 30 chest compressions. If you cannot give rescue breaths, you may do chest compressions only (compression-only CPR or hands-only CPR).
Perform defibrillation with an AED
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Turn on the AED and follow its directions. If the AED has a child setting, choose this. If the AED does not have a child setting, use the regular setting.
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Follow directions on the AED showing where to attach the pads to the child’s chest. There may be special child-sized pads in the defibrillator case.
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If the child has been lying in water or snow, or the chest is covered with water or sweat, move the child to a dry area. Quickly wipe the chest dry before applying the pads.
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If the child has an implanted defibrillator or pacemaker, do not place the pad directly over the device.
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If the child is wearing a medicine patch where the pad needs to be placed, do not place the pad over the patch. Put on gloves, remove the patch, and wipe the area clean before applying the pad.
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If pediatric pads are not available, use adult pads. Make sure the adult pads do not touch each other or overlap.
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The AED will automatically determine whether you need to give the child a shock and will provide directions. If a shock is needed:
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Make sure that no one is touching the child before you give the shock. Right before the shock, loudly say, “clear” and look to be sure that no one is touching the child.
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The AED will deliver a shock once you complete the steps it tells you to do. You may have to press the shock button on the machine.
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After one shock is delivered, continue to perform CPR. The AED will instruct you when to give another shock or when to check the child’s heart rhythm.
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Continue CPR and defibrillation until the child starts breathing normally or until medical personnel take over.
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If it is not possible or necessary to deliver a shock, continue CPR until medical help arrives.
Should I wait to perform CPR until a trained professional is available?
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Do not wait until medical professionals arrive. You have a better chance of saving a life if you attempt CPR while waiting for medical help to arrive.
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When trained medical professionals arrive, tell them what happened. This is an important part of the overall care provided to the child.
Where to find more information
To find a CPR course near you, visit the website of the American Heart Association: www.heart.org
Summary
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CPR can save a life by moving blood and oxygen to the brain and lungs.
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The best way to learn CPR is to take a training class. Look for a class in your community. Almost anyone can learn to do CPR.
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Do CPR using the C-A-B method. This stands for chest compressions, airway, and breathing.
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If an AED becomes available at any time, use it immediately. An AED delivers an electric shock to try to restart the heart or return the heartbeat to normal.
This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.
