Child CPR

Much of what was covered in the last section – Adult CPR – will apply in this section – Child CPR. There will, however, be some subtle but crucial differences that will be highlighted. But first, let's recap the five links in the Child Cardiac Chain of Survival:

1. Injury prevention and safety
2. Early CPR
3. Early Emergency Care
4. Pediatric advanced life support
5. Integrated post-cardiac arrest care

Child-related cardiac arrests are typically the result of a hypoxic event, such as:

• Drowning
• Choking/airway obstruction
• Exacerbation of asthma

Due to the nature of these occurrences, providing proper ventilation and oxygenation will be vital for a successful resuscitation.

How to Provide Care

After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin calling out to the victim to assess whether or not the child is responsive.

Are you OK? Can you hear me?

If you don't get an initial response, place your hand on the child's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.

1. 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. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions.
2. Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc.
3. Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse.
4. If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR.

CPR Technique for Children

1. Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum.
2. Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them.
   • Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart.
3. Conduct compressions that go roughly 2 inches deep, or 1/3 the depth of the child's chest, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
4. Perform 30 chest compressions.
   • To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm.
5. Grab the appropriately-sized rescue mask and seal it over the victim's face and nose.
6. Lift the victim's chin and tilt his or her head back slightly – just past perpendicular.
7. Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath.
8. Continue to perform 30 chest compressions to two rescue breaths until help arrives, an AED arrives, or the victim is responding positively and breathing normally.

Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression.

A Word About the Differences Between Child CPR and Adult CPR

This section began by mentioning a few subtle differences between adult CPR and child CPR. There are four distinct differences to be aware of.

Opening the Airway

While the same head tilt maneuver is applied to children as it is for adults, make sure there is less hypertension in a child's neck compared to adults. To do that, simply tilt the head back only slightly past neutral. Your goal is a chin angle that's less pronounced and more perpendicular to the ground.

Performing Compressions

The compressions you perform on a child are very similar to those you would perform on an adult. The only difference is in the compression depth. While adult CPR has a depth of 2-2.4 inches, when administering CPR on a child, two inches will usually be the maximum depth. And in very small children, it's better to perform compressions using just one hand.

Compressions to Ventilations Ratio

If there is only a single responder, continue using the 30 compressions to two ventilations ratio. However, if there are two responders, that ratio changes to 15 compressions to two ventilations.

Using AEDs

AEDs work the same regardless of age. However, the pads themselves, as well as pad placement, will vary based on the size of the child.

If the child weighs more than 55 pounds, continue using the adult AED pads. If the child weighs less than 55 pounds, use pediatric AED pads if available.