Cardiac arrest in children is less common than in adults, but the cause is different. In adults it is usually a heart problem; in children it is most often the end result of breathing failure or shock, from causes such as pneumonia, bronchiolitis, choking, drowning, sepsis or severe dehydration. That’s why paediatric BLS puts oxygen and breathing first. This guide follows European and UK resuscitation council principles; follow the guideline you are trained in.
Age definitions
- Infant: under 1 year.
- Child: 1 year to puberty.
- After puberty, use adult BLS.
The sequence
- Safety: make sure the area is safe.
- Stimulate and check response: speak loudly; gently stimulate. Don’t shake an infant.
- Shout for help.
- Open the airway: head tilt and chin lift. For an infant, keep the head in a neutral position (a small roll under the shoulders can help); for a child, a little more tilt (“sniffing” position).
- Check breathing for no more than 10 seconds.
- If not breathing normally, give 5 initial rescue breaths. Watch for chest rise.
- Check for signs of life (movement, coughing, normal breathing) and, if trained, a pulse, for no more than 10 seconds.
- If no signs of life, start chest compressions, then continue at 15 compressions to 2 breaths (for healthcare staff).
- Call the resuscitation team or emergency services. A lone rescuer without a phone should perform about 1 minute of CPR before leaving to get help.
Rescue breaths
- Infant: cover the infant’s mouth and nose with your mouth (or use a bag-valve-mask of the right size).
- Child: pinch the nose and cover the mouth.
- Breathe steadily over about 1 second, enough to make the chest rise. Avoid excessive force.
- In hospital, use a bag-valve-mask with oxygen as soon as possible.
Chest compressions
| Infant | Child | |
|---|---|---|
| Position | Lower half of the breastbone | Lower half of the breastbone |
| Technique | Two thumbs with hands encircling the chest (two rescuers), or two fingers | Heel of one hand (or two hands for larger children) |
| Depth | At least one third of the chest depth (about 4 cm) | At least one third of the chest depth (about 5 cm) |
| Rate | 100–120 per minute | 100–120 per minute |
| Ratio (healthcare staff) | 15:2 | 15:2 |
Allow full recoil, minimise interruptions, and swap compressors every 2 minutes. Lay rescuers trained only in adult CPR can use 30:2 with 5 initial breaths, which is better than doing nothing.
Using an AED
Use an AED as soon as it is available. Use paediatric pads or a paediatric setting for children under about 8 years if available; if not, use adult pads. For small children and infants, place pads front and back (one on the centre of the chest, one between the shoulder blades) so they don’t touch.
Choking
- Effective cough: encourage coughing and watch closely.
- Ineffective cough, conscious: give up to 5 back blows, then up to 5 thrusts: chest thrusts for infants, abdominal thrusts for children over 1 year. Repeat.
- Unconscious: open the airway, remove any obvious object (no blind finger sweeps), give 5 rescue breaths and start CPR.
Prevention is the real priority
Most paediatric arrests are preceded by signs of deterioration: fast breathing, recession, falling saturations, fast heart rate, poor perfusion and drowsiness. Recognising and treating these early, using a paediatric early warning score and the IMCI danger signs, saves more children than CPR.
Related: Adult BLS · Newborn resuscitation · Normal vital signs in children
Based on European Resuscitation Council and Resuscitation Council UK paediatric basic life support guidelines. Not a substitute for certified hands-on training.