This article is a quick overview. It is recommended all parents and caregivers take an AHA approved CPR/AED course which includes rescue practices for adults, children, and infants.
When your child becomes unresponsive and is not breathing it is a heart-stopping moment – possibly for both of you. Infant and child sudden cardiac arrest does happen. Knowing what to do quickly when it strikes is crucial to their survival.
If you are alone, provide 1-2 minutes of care before calling 911 unless you suspect the child is having an allergic reaction, in which case you will want to call 911 immediately. If you are with someone else – instruct them to call 911 while you begin care.
First – do you suspect they have an obstructed airway? Were they seen playing with a small toy or eating something they may have choked on? If so, and you can see the object, you can try to remove it gently, but you must be careful NOT to push the object further into the child’s throat. If in doubt, or if you cannot see the obstruction, lay the infant across your lap face down with their head slightly lower than the chest, supporting the head and being sure you are not covering their airway. Give 5 short, sharp blows to the back with the heel of your hand. Alternate this maneuver with infant chest compressions (discussed below), until help arrives or child becomes responsive. If the object dislodges, but the infant is still not breathing and is unresponsive, begin CPR.
Determining responsiveness in infants can be difficult. For an older child, you can use the “shake and shout” method (in the absence of any noticeable trauma), but an infant presents a unique challenge, as anyone who has tried to wake a soundly sleeping baby will agree. One way to try and get a response is to flick or run your fingernail up the bottom of their foot. Even if sound asleep, a responsive infant will flinch or pull their foot upward involuntarily.
If the airway is clear and the child is unresponsive and not breathing, you will need to perform CPR. Child and Infant CPR is different than adult CPR – taking an AHA approved CPR/AED certification class which includes infant/child and choking first aid will give you hands-on practice with appropriately sized and calibrated manikins so you will have the confidence to act quickly when needed. While there has been a big push for “hands-only” CPR for teens and adults recently, the 2015 American Heart Association CPR guidelines still advise 2 breaths for every 30 compressions in children and infants. Compress the chest about one-third of the child’s torso depth using the heel of your palm for children or your first two fingers for infants.
CPR is critical, but if an AED is available, use of this device is advisable. In children under 55 pounds, it is preferable to use pediatric AED options when available (either special pediatric electrode pads or an infant/child “key”) so the shock administered, if needed, is at the correct energy levels. If no pediatric options are available, adult electrode pads can be used in the pediatric configuration of one electrode pad on the chest between the nipples, and one on the back between the shoulder blades. The important factor is the electrode pads should not be touching one another. Remember – a person, regardless of age, in cardiac arrest has technically died and you cannot hurt them further! An AED will NOT shock unless it determines there is a shockable rhythm present.