Giving CPR to Children

Although we all hope never to need it, learning to give CPR to children is essential if you are working with children, volunteering with children, or even if you have children in your household. CPR stands for cardiopulmonary resuscitation and can help to save a child’s life in the event of a cardiac or breathing emergency. In most circumstances, you are advised to take a class on giving CPR to children or babies, but it is also helpful to have the steps involved written down so that the information stays fresh in your memory, and you’ll know what to do if the need to provide CPR arises. For this reason, here’s everything you need to know about giving CPR to children:

When is CPR Needed for Children?

You should provide CPR on a child that is unresponsive and not breathing normally. At the same time as beginning CPR, you should also call 999 for emergency help and support. Administering CPR to an individual whose heart has stopped beating will as much as double or triple their chances of survival. CPR works by keeping a person’s blood flowing until a healthcare professional, usually, a first responder can help them. People without first aid training can still save a life by using the CPR steps listed below, although CPR should always be provided by a professional or trained individual in the first instance if someone suitable is available.

Some of the circumstances in which CPR may be needed for a child include:

• If the child has experienced a heart attack or sudden cardiac arrest
• If the child has choked on a foreign body
• If the child has been involved in a road traffic accident
• If a child has drowned
• If the child has been suffocated or poisoned, including with an accidental drug or alcohol overdose
• If the child has been in a fire and suffered from smoke inhalation
• If the child has been electrocuted
• In cases of suspected sudden infant death syndrome

Keeping children safe and healthy is everyone’s responsibility, and for this reason, there is a significant list of people who it is suggested are trained to provide CPR for children. According to the NHS, it’s highly recommended that every parent goes on a first aid course which includes learning CPR, as it makes this process much easier to understand and remember. It is also recommended that educators, administrators and other staff members within schools undertake CPR training, ensuring that they are all able to adopt a hands-on approach to CPR. If you work in healthcare then you should also ensure that your CPR training is regularly updated, to ensure you are able to support children when emergencies arise.

Before Giving CPR

Before you administer CPR to anyone, regardless of their age, it’s important to ensure that the area around the person in need of CPR is safe and free from hazards. Common hazards to look for include traffic in the case of a road traffic accident, electrical cables that may be live if you suspect the child has been electrocuted, as well as general debris and other hazards that could negatively impact your own safety.

If you are not alone when you discover the child in need of CPR then you should also ensure that someone seeks medical assistance as soon as possible by calling 999 or calling for help/running for help if no phone is available. If you are alone then you should immediately begin assessing the child and performing CPR before you seek assistance, as time is of the essence.

Performing CPR on Children

The following steps are those you should follow if you are performing CPR on a child over one year of age:

• Check if the child is responsive by shaking them gently or asking if they’re alright
• If the child is able to move or answer, leave them in the position that you found them in and seek help. If the child is not responsive, turn them onto their back and call for help
• Open the child’s airway by lifting their chin and tilting their head forward. You can do this by gently placing your hand on the child’s forehead and using your fingertips to lift the child’s chin at the same time. Do not push on the soft tissues under the chin as this may block the airway
• Once the airway is open, place your face close to the child’s face to listen and feel for normal breathing. You should look for chest movements, try to feel air movement on your cheek and listen for breathing sounds. Listen for around 10 seconds to determine if the child is breathing
• If the child is breathing normally then turn them on their side and continue to call or wait for help
• If the child is not breathing normally then remove any obvious obstructions from their mouth and begin to provide rescue breaths, also known as mouth-to-mouth resuscitation

How to Provide Rescue Breaths to a Child

• If you have determined that mouth-to-mouth resuscitation is needed, tilt the head of the child and lift the chin in the way that has been outlined above
• Open their mouth slightly if it is closed, but keep the child’s chin pointing upwards
• Take a breath and then create a seal around the child’s mouth using your lips
• Blow your breath into the child’s mouth at a steady rate for around one second, watching the child’s chest rise to ensure that you are completing the breath correctly
• Keeping their head tilted and chin lifted, take your mouth away and watch for the chest to fall as air comes out
• Repeat this sequence four more times, ensuring that the child’s chest rises and then falls in the same way throughout the sequence
• If you cannot achieve an effective breath for the child, their airway may be obstructed. Open the child’s mouth to look for and remove any visible obstructions. Ensure the chin is properly lifted, but don’t overextend the neck. Make up to 5 attempts to achieve effective breaths (enough to make the chest visibly rise). If this is still unsuccessful, move on to chest compressions combined with rescue breaths
• It is important to assess the child for signs of life including any movement, coughing, or normal breathing, but not abnormal gasps or infrequent, irregular breaths
• If there are definite signs of life then you should continue administering rescue breaths until the child is breathing for themselves, at which point you should put them in the recovery position

How to Provide Chest Compressions to a Child 

• Place the heel of 1 hand over the lower third of the breastbone, which is around one finger’s width above where the lowest ribs join in the middle
• Lift your fingers to ensure the pressure is not applied over the rib, and you are only using the heel of your hand to complete the compressions
• Position yourself vertically above the chest and, with your arm straight, compress the breastbone so you push it down 5cm, which is approximately one-third of the chest diameter. The quality (depth) of chest compressions is very important if they are to be successful
• In larger children or if you’re small, you may find it easier to complete chest compressions by using both hands with the fingers interlocked, avoiding applying pressure on the ribs
• You should continue providing CPR until the child recovers and shows signs of life, further qualified help arrives, or you become exhausted. If you are alone and no one has responded to your shouts for help then follow these steps for at least one minute before you stop to dial 999

Performing CPR on Babies

The following steps are those you should follow if you are performing CPR on an infant under one year of age. Whilst many of these steps will be identical to those for performing CPR on a child over the age of one, many are also different, so it is important to ensure you follow the steps closely:

• Check that the area is safe for you to approach and that there are no hazards around the child (examples of these would be traffic, debris or electrical equipment)
• Check if the child is responsive by shaking them gently and speaking to them loudly to alert them to your presence
• If the child is able to move or answer, leave them in the position that you found them in and seek help. If the child is unresponsive, turn them onto their back and call for help
• Ensure the head is in a neutral position, with the head and neck in line with each other, then lift the infant’s chin using your fingertips. Do not push on the soft tissues under the chin as this may block the airway
• Once the airway is open, place your face close to the child’s face to listen and feel for normal breathing. You should look for chest movements, try to feel air movement on your cheek and listen for breathing sounds. Listen for around 10 seconds to determine if the child is breathing
• If the child is breathing normally then turn them on their side and continue to call or wait for help
• If the child is not breathing normally then remove any obvious obstructions from their mouth and begin to provide rescue breaths, also known as mouth-to-mouth resuscitation

How to Provide Rescue Breaths to an Infant

• Ensure the head is in a neutral position and lift the chin
• Take a breath and then place your mouth around the baby’s nose and mouth to create a seal. If the infant is too large to cover both the mouth and the nose then just seal around the mouth, as you would with an older child
• Blow steadily into the baby’s mouth and nose for over 1 second at a consistent rate. You should watch the infant’s chest rise as you give them your breath
• Keeping their head tilted and chin lifted, take your mouth away and watch for the chest to fall as air comes out
• Take another breath and repeat this sequence 4 more times, ensuring that the chest rises and falls as it would normally with each breath
• If there are definite signs of life then you should continue administering rescue breaths until the child is breathing for themselves, at which point you should put them in the recovery position, and stay with them as you wait for professional help to arrive

How to Provide Chest Compressions to a Child 

• Place the heel of 1 hand over the lower third of the breastbone, which is around one finger’s width above where the lowest ribs join in the middle
• You should only complete chest compressions with just two fingers on a child of this age. Don’t use the whole of your hand or two hands
• Position yourself vertically above the chest and, with your arm straight, compress the breastbone so you push it down 4cm, which is approximately one-third of the chest diameter. The quality (depth) of chest compressions is very important if they are to be successful

Next Steps

Once you have performed CPR on a child, it is important to keep administering the CPR until the child recovers and shows signs of life, further qualified help arrives, or you become exhausted. If you are alone and no one has responded to your shouts for help, then follow these steps for at least one minute before you stop to dial 999. CPR is a life-saving first aid procedure. It can significantly improve someone’s chances of surviving if they suffer a heart attack or stop breathing following an accident or trauma, and if you are confronted with a child that has stopped breathing or is unresponsive then you should start the CPR cycle by providing chest compressions and rescue breaths as soon as possible to improve their chance of survival. Check the person to see whether they respond to verbal or physical stimuli before starting CPR: performing CPR on a child or infant who does not need it can be very dangerous.

To ensure that your CPR skills are as competent as possible, you are strongly advised to undertake a CPR training course. The British Red Cross provides first aid training courses that include CPR training for both adults and children. First aid courses for babies and children cost as little as £37.50 and can be undertaken during the daytime or in the evenings. They cover a range of life-saving skills such as unresponsiveness, heart attack, choking and seizures, and are available to anyone aged 16 plus.