Infant / Pediatric CPR Study Guide

If there are 2 rescuers available:

1. Rescuer 1– Assess the child for responsiveness by tapping the soles of the feet and calling to him/her loudly. Check for breathing- if the infant is not breathing or is breathing abnormally or only gasping, send Rescuer 2 to activate EMS and bring the AED (if one is available).
2. Rescuer 1– Check the infant’s brachial pulse for at least 5, but not more than 10, seconds. Place 2 or 3 fingers on the inside of the upper arm between the shoulder and elbow. Press the fingers down gently for 5 to 10 seconds to feel for a pulse. Remember: pushing too firmly may occlude the infant’s pulse.
3. Rescuer 1– If you are not sure you can feel the pulse, the pulse is absent or the infant’s heart rate is below 60 beats per minute with signs of poor perfusion (pale or bluish discoloration in the face, extremities or nail beds), start CPR, beginning with 30 compressions followed by two breaths.
   1. Place the infant on his back on the ground or on a firm surface.
   2. b. Place 2 fingers in the center of the infant’s chest just below the nipple line; do not press on the end of the breastbone.
   3. Provide 100-120 chest compressions per minute to a depth of 1/3 the depth of the chest or approximately 1 ½ inches.
   4. The principles of providing breaths for infants are the same as for children and adults. Use the correct sized face mask for the infant (the mask should cover the mouth and nose without extending past the chin or covering the eyes). Each breath should go in over 1 second and should cause visible chest rise. A breath should require only a small puff of air into the mouthpiece of the device to cause chest rise- avoid excessive ventilations. When the second person returns, change the ratio of compressions to ventilations to 15:2.
4. Rescuer 2 should place the thumbs of both hands on the lower half of the infant’s breastbone, while being careful not to press on the end of the breastbone (xiphoid process). Put the fingers of both hands around the infant’s back to provide support. Use the thumbs to depress the sternum approximately 1/3 the depth of the chest, or approximately 1 ½ inches. Compress at a rate of 100-120 compressions per minute.
5. Rescuer 1 should provide breaths as described above.
6. Continue CPR at a ratio of 15 compressions to 2 breaths and switch roles every 2 minutes to avoid fatigue.
7. Use the AED when available.

Mouth-to-Mouth-and Nose Breathing

To provide breaths to an infant when there is no face mask available:

1. Use a head tilt-chin lift to maintain an open airway (sniffing position), being careful not to hyperextend the neck, which could block the airway.
2. Place your mouth over the victim’s mouth AND NOSE to create a tight seal.
3. Blow into the infant’s nose and mouth over 1 second, with just enough volume and force to cause the chest to rise with each breath. Be careful not to ventilate too forcefully, as doing so may cause lung damage.
4. If the chest does not rise, repeat the head tilt-chin lift and try to ventilate the victim again. You may need to try to provide breaths at a few different positions before you achieve airway patency (airway is in an open position).
5. If the infant is older and you cannot cover both the infant’s mouth and nose, pinch the nostrils closed and place your mouth over the victim’s to form a tight seal- just the same as you would do for a child.

You may wonder how mouth-to-mouth or mouth-to-mouth-and-nose breathing can sustain the victim. In actual fact, your expired air contains about 17% oxygen- this is just enough oxygen to meet the victim’s needs for a brief period of time.

When providing mouth-to-mouth or mouth-to-mouth-and-nose breathing, it is important not to provide breaths that are too forceful or too rapid. Doing so may cause air to enter the stomach rather than the lungs, which can cause gastric inflation. Gastric inflation may result in vomiting, and an unconscious victim may develop pneumonia if vomitus makes its way to the lungs. To avoid gastric inflation, give each breath slowly over 1 second and deliver just enough air to make the chest rise.