This lesson focuses on how to perform rescue breathing on an unconscious infant for the healthcare provider. And there are a few differences between adult/child rescue breathing and delivering rescue breaths to an infant that we'll highlight below.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your infant-sized rescue mask with a one-way valve handy and begin calling out to the infant to assess whether or not he or she is responsive.
Are you OK? Can you hear me? (With infants, shouting their name, if you know it, may help.)
If you don't get an initial response and you can see that the infant still isn't breathing normally, place your hand on his or her forehead and tap on the bottom of the baby's feet, shoulder, or rub their belly. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc.
- Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse.
- Look one more time for signs the infant is breathing normally.
- If you've determined at this point that the infant is unresponsive, not breathing normally but does have a pulse above 60 beats per minute, continue immediately with rescue breathing.
Pro Tip #1: Notice that with infants, we check for a pulse using the brachial artery rather than the carotid artery. Also, keep in mind that a weak pulse can be considered the same as no pulse in infants. The dividing line is 60 beats per minute. If lower, begin CPR immediately. If above, establish that the infant isn't breathing normally, then begin rescue breathing.
Rescue Breathing Technique for Infants
- Grab a small-sized rescue mask and seal it over the infant's face and nose.
- Place something firm under the infant's shoulders (if possible) to lengthen the neck a little and create a neutral or slightly sniffing head position.
- Breathe into the rescue mask and count out loud – one one-thousand, two one-thousand …
- On three one-thousand, breathe into the rescue mask again.
Pro Tip #2: What does slightly sniffing look like? Imagine you've just walked into a kitchen and caught the whiff of a freshly baked apple pie. You turn your head upward ever so slightly to catch a better smell. Ever so slightly, or neutral, is our goal when delivering rescue breaths to infants.
The sequence for infants is the same as the sequence for children – one rescue breath every two to three seconds for two minutes. At that time, reassess the patient. If you still detect a pulse but the patient isn't breathing normally, continue with one rescue breath every two to three seconds for two more minutes. And so on.
Warning: As an infant's lungs are considerably smaller than the lungs of adults and even children, be careful not to force air in beyond the full point. To do this, watch closely as you deliver rescue breaths and stop when the chest reaches its apex.
Continue using the rescue breathing technique until help arrives or the patient revives. If you have an AED, consider preparing it for use just in case the patient loses his or her pulse.
Pro Tip #3: As adults don't normally breathe one breath every two to three seconds, there's a chance you may become hyperventilated while doing rescue breathing. To combat this, take in a deep breath, hold it, and use that air to deliver a few rescue breaths. This is especially important if you feel like you're about to begin hyperventilating.
Remember, if at any point you discover that the patient's pulse has disappeared, go immediately into full CPR and use an AED if you have one available.
A Word About Pediatric Considerations and Respiratory Emergencies
It's really important to quickly recognize breathing emergencies in children and infants and to provide treatment before their hearts stop beating. In adults, when their hearts stop beating, it's typically because of a disease.
However, in children and infants, their hearts are usually healthy. Which is why when a child's or an infant's heart stops beating, it's usually the result of a breathing emergency.
When helping a child with respiratory problems, keep in mind that a lower airway disease may be caused by birth problems or infections such as bronchiolitis, bronchospasms, pneumonia, or croup.
Several of the illnesses and diseases that affect respiratory systems in infants and children are preventable through vaccines. These include:
- Diphtheria
- Measles, mumps, and rubella
- Whooping cough
- Pneumococcal disease
- Mycoplasma pneumonia
- Chickenpox
Some diseases that may not have respiratory symptoms might still be spread through respiratory transmissions, such as mumps and severe diarrhea.