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Pediatric CPR: How to Perform CPR on Pediatric Patients?

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July 25, 2022

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Pediatric CPR applies to infants less than one year of age and children up to puberty or children weighing less than 121 pounds. Rescuers who need to respond to pediatric emergencies should be fully competent in pediatric resuscitation and must follow the American Heart Association Guidelines. If you are a parent, guardian, child care provider, or an ordinary person who wants to save a life in an emergency, this article will discuss everything you need to know about pediatric CPR. 

What is Pediatric CPR?

Pediatric CPR or resuscitation is a lifesaving procedure done when the child’s breathing or heartbeat has stopped. This may happen after drowning, poisoning, suffocation, choking, or an injury. Pediatric CPR involves rescue breathing, which provides oxygen to a child’s lungs, and chest compressions, which keep the child’s blood circulating. If a child’s blood flow stops, permanent brain damage or death can occur within minutes. Therefore, you must continue doing CPR until the heartbeat and breathing return or until emergency medical services help arrive.

Survival to discharge in children with an out-of-hospital cardiac arrest varies by age: 13% in children, 4. 9% in infants, and 17% in adolescents.

What’s the difference between Pediatric and Standard CPR?

Pediatric patients differ anatomically and physiologically from adults in many aspects that can affect resuscitation. For example, a child’s jaw is shorter than adults’, reducing the available room to maneuver. Although Pediatric CPR is very similar to adult CPR, rescuers should start CPR before calling 911. According to the American Heart Association (AHA) guidelines, if you’re the only person around and need to choose between starting the resuscitation and calling 911, go for the CPR. Why? Because children are more resilient, and their chances of survival are much higher if you begin CPR immediately. After two minutes of CPR with rescue breathing, call 911.  

pediatric cpr

How to Perform Pediatric CPR?

Before you give CPR to a pediatric patient, it’s essential to check the scene first for safety and form an initial impression. Then, obtain consent from the parent or guardian, and use personal protective equipment (PPE). If the child or baby appears unresponsive, perform cardiopulmonary resuscitation by following these steps:

Step 1: Check for Responsiveness

Check if the pediatric patient will respond. To do this, just tap the heel of the baby’s foot and call his or her name to see if he responds.

Step 2: Call 911

If the pediatric patient does not respond, ask someone to call 911 or the emergency medical services team. If you are alone, use your phone to call 911 and put it on speakerphone while you start CPR.

Step 3: Turn the baby flat on his back on a hard surface

For a child, kneel beside the victim. For a baby, stand or kneel to the victim’s side with your hips at a slight angle. Look at the patient’s face and check if the baby is breathing. Check for at least 5 seconds, but no more than 10 seconds.

Step 4: Give 30 Chest Compressions

If the pediatric patient is not breathing, find the proper position for compressions. To do this, draw an imaginary line between the nipples to find the middle of the breastbone. Then place the heel of one hand (for a small child) in the center of the victim’s chest. Push down hard and fast, about 2 inches deep at a rate of 100 to 120 compressions per minute.

For a baby, place both thumbs on the center of the chest. Use the other fingers to encircle the victim’s chest toward the back, providing support. Then push down and fast about 1 ½ inch at a rate of 100 to 120 compressions per minute, using both thumbs simultaneously. Allow chest recoil after each compression.

 Step 5: Give 2 Rescue Breaths

After you give 30 chest compressions, open the baby’s airway for mouth-to-mouth breathing using the head lift-chin lift method. Then blow into the child or baby’s mouth for about 1 second. Give one rescue breath every 3-5 seconds (12-20 rescue breaths per minute) and ensure that each breath makes the chest rise. Since the lungs of the babies are small, only small puffs of air are needed to fill them. If the first breath does not cause chest rise, tilt the head again and ensure a proper seal before giving the second breath.

Step 6: Repeat the cycle

Continue CPR by giving sets of 30 chest compressions and 2 breaths until you notice obvious signs of life, if an AED is ready to use, or if EMS personnel arrive and begin their care. 

pediatric cpr aed

Can You Use AED on Pediatric Patients?

Yes. If an Automated External Defibrillator is available, apply pediatric pads and use them after five cycles of CPR. A first aid responder can use an Automated External Defibrillator on children and infants as early as possible for the best chance of survival. In addition, pediatric pads should be used if the victim is under eight years old or weigh under 55 pounds. 

For infants less than one-year-old, a manual defibrillator should be used. If a manual defibrillator is not available, an Automated External Defibrillator may be used. Some AEDs have a switch that can be set to deliver a pediatric shock. An adult shock should be given if the AED cannot deliver a pediatric shock. It is crucial to remember an electric shock may be the treatment for a fatal heart rhythm.

pediatric cpr training

Pediatric CPR Training

Substantial advancements have been made in pediatric CPR training in the United States since the 1980s. In 1988, the American Heart Association offered the first course in Pediatric Advanced Life Support (PALS). It was designed for pediatric healthcare providers at all levels and taught basic approaches to pediatric cardiopulmonary arrest. In 1984, the American Academy of Pediatrics and the American College of Emergency Physicians offered the first Advanced Pediatric Life Support (APLS) course. It was designed to be more comprehensive and covered a spectrum of pediatric emergencies and basic resuscitation. Over the last 20 years, these two courses have become the predominant programs hospitals across the United States require for pediatric healthcare providers. 

Key Takeaway

Pediatric CPR is best done by a trained rescuer in an accredited CPR and AED certification course following the American Heart Association guidelines. In addition, parents, guardians, child care providers, and those who care for children and infants should learn Pediatric CPR if they have not already. 

  • In 1988, the American Heart Association offered the first course in Pediatric Advanced Life Support (PALS).
  • Survival to discharge in pediatric patients with an out-of-hospital cardiac arrest varies by age.
  • When giving chest compressions, use one or two hands, depending on the child’s size.
  • The compressions depth should be only one and a half inches at a rate of 100 to 120 compressions per minute.
  • Give one breath every 3-5 seconds (12-20 breaths per minute) and ensure that each breath makes the chest recoil.
  • If an Automated External Defibrillator is available, apply pediatric pads and use them after five cycles of CPR.
  • Continue CPR until the child’s heartbeat and breathing return, if you see signs of life,  or until emergency medical services help arrive.
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