How to Perform CPR for Children

Although CPR (Cardiopulmonary Resuscitation) should be performed by individuals who have undergone certified first aid training, even untrained people can make a life-saving difference when a child experiences cardiac arrest. For infants under one year old, specific CPR steps for newborns must be followed. For adults, distinct CPR steps are necessary as well. Basic CPR involves chest compressions, airway opening, and rescue breaths (mouth-to-mouth resuscitation). If you haven't been formally trained in CPR, performing chest compressions alone is advised.

Assess the surroundings for potential dangers. If you find a child unconscious, you must quickly evaluate the scene and ensure your own safety before assisting them. Is there smoke coming from a vehicle? A gas leak? Are there fires or falling wires? If there are any hazards that could endanger you or the victim, think about what steps you can take to mitigate them, such as opening windows, turning off stoves, or extinguishing a fire if possible.

• However, if there is nothing you can do to reduce the danger, move the victim. The safest way to do this is by placing a blanket or coat under their back and pulling them away.
• If spinal injuries are suspected, the victim should be moved by two people to avoid any twisting of the head or neck.

Check the child's responsiveness. Gently shake or tap their shoulder and ask loudly and clearly: "Are you okay? Are you alright?" If they respond, they are still conscious. The child might just be asleep or could be in a coma. If it's an emergency, such as difficulty breathing or the child seems to be slipping in and out of consciousness, call for help and begin first aid along with shock prevention and treatment methods.

Check the victim's pulse. If the child does not respond, the first thing to do is check their pulse. In this case, CPR must be performed immediately. Don’t spend more than 10 seconds checking the pulse. If the child has no pulse, their heart has stopped, and chest compressions are necessary.

• To check the carotid pulse, feel for the pulse on one side of the neck, closest to you, by placing your index and middle fingers on the side of the throat (note that the Adam's apple is often less visible in females and may not be clearly visible in prepubescent boys).
• To check the radial pulse, place your index and middle fingers on the wrist, near the thumb side.
• Other pulse points include the groin and ankle. To check the femoral pulse, place your index and middle fingers into the groin area. To check the posterior tibial pulse, place your fingers on the inside of the ankle.

Perform CPR for two minutes. After quickly assessing the situation and checking the child's responsiveness and circulation, you must act fast. If there's no pulse, begin CPR immediately and continue for two minutes (about 5 cycles of CPR) before calling Emergency Medical Services. If you're alone, performing CPR before calling for help is essential.

• If someone else is present, ask them to call for help. If you're alone, do not call for help until you’ve completed the two minutes of CPR.
• Dial the local emergency number. Call 115 in Vietnam, 911 in the USA, 000 in Australia, 111 in New Zealand, 112 on mobile in Europe (including the UK), and 999 in the UK.
• If available, have someone retrieve an AED (Automated External Defibrillator) from the building or nearby location.

Remember the CAB principle. CAB is the fundamental procedure for CPR. It stands for Chest Compressions, Airway, and Breathing. In 2010, this updated sequence was recommended, where chest compressions come before airway management and rescue breaths. Chest compressions play a crucial role in correcting abnormal heart rhythms (such as ventricular fibrillation or pulseless ventricular tachycardia), and since it takes only 18 seconds to perform 30 chest compressions, airway management and breaths will not be delayed too long.

• Hands-only CPR is recommended if you are not trained or feel uncomfortable giving mouth-to-mouth to a stranger.

Position your hands for chest compressions. When performing CPR on children, hand placement is crucial since they are more fragile than adults. Locate the child’s breastbone by placing your fingers at the bottom of their chest. Identify the point where the lower ribs meet in the middle. Then, place the heel of your other hand on top of your fingers. Only use the heel of your hand for compressions.

Perform 30 chest compressions. With your elbows locked, press down straight into the chest with a depth of approximately 5 cm. Children require less pressure than adults. If you hear or feel a cracking sound, it could be a sign of excessive force. In that case, decrease the pressure for the following compressions. Perform 30 compressions at a rate of at least 100 compressions per minute if you're the only one administering first aid.

• Let the chest fully recoil after each compression.
• Minimize interruptions for things like changing positions or preparing for defibrillation. Try to keep breaks under 10 seconds.
• If two people are assisting, each should complete 15 compressions in a round.

Ensure the airway is open. Place one hand on the victim's forehead and two fingers under their chin. Gently lift the victim’s chin while pressing their forehead down with your other hand. If you suspect neck injury, lift the jaw instead of the chin. Afterward, look, listen, and feel for breathing.

• Place your ear near the victim's mouth and nose, listening carefully for signs of life.
• Watch the chest for movement and feel for breath on your cheek.
• If there are no signs of life, place a protective mask (if available) over the victim’s mouth.

Perform two rescue breaths. Maintain the open airway, using your fingers on the forehead to pinch the victim's nose. Seal their mouth with yours and exhale for about one second. Breathe slowly to allow air to enter the lungs instead of the stomach. Also, watch for the victim's chest rising.

• If the chest rises, you’ll see a slight inflation and feel air exiting. If successful, repeat the rescue breath.
• If air doesn’t enter, adjust the victim’s head and try again. If it still doesn’t go in, the victim may be choking. In that case, perform chest compressions. Remember that abdominal thrusts (Heimlich maneuver) should only be done when the victim is conscious.

Repeat the cycle of 30 chest compressions and two rescue breaths. Perform CPR for two minutes (five cycles of compressions and breaths) before checking for signs of life, pulse, or breathing. Continue CPR until someone takes over, emergency personnel arrive, you’re too tired to continue, an AED is attached and powered on, or the victim regains a pulse or breath.

• Remember to call emergency services after the first two minutes of CPR.
• Once you’ve called for help, keep performing CPR until they arrive.

Use the AED. If an AED is available, power on the device and follow the instructions for pad placement (one on the upper right chest and one on the left side of the ribcage). Allow the AED to analyze the heart rhythm, and if instructed, once everyone has cleared the victim (shout: "CLEAR!"), administer a shock. Perform 5 rounds of chest compressions immediately following each shock, before reassessing the situation.

• If the victim begins to breathe, gently move them into the recovery position.