Becoming a mother or father encompasses a tremendous responsibility, and that involves keeping your children safe from harm. This is why I decided to write a post about CPR and the use of the AED for infants (newborn to one year old) in hopes of raising awareness of this important life saving skill (that hopefully, you never have to use).
This is a in-depth step by step guide on how to perform CPR and use the AED on your infant if a situation ever arises.
It is important to note that this post does not replace courses with licensed first aid & CPR instructors. Instead, this post is meant to encourage you to enroll in a licensed class and supplement your learning. I have taken classes with the Red Cross and St. John Ambulance and their instructors are passionate and informative. I highly recommend them.
What is CPR?
CPR stands for cardiopulmonary resuscitation. CPR is needed when the heart, circulation, and respiration cease. The goal of CPR is to provide adequate blood perfusion to the brain, the heart, and vital organs by manually compressing the heart to pump blood. In doing so, you will decrease the likelihood of organ damage due to lack of oxygen.
Steps on How to Perform CPR on an Infant
Note: An infant is considered a newborn to one year old.
Scene: You find your baby unconscious in the play room.
Step 1: Assess the scene and make sure it is safe to approach.
As you approach your infant, you need to make sure the scene is safe to enter. Of course, in this situation, you are at home and your infant is in the playroom.
Take note of their environment and the objects around them.
Assessing the scene and looking for cues will help you figure out what has happened, and guide you in your next steps of action.
Step 2: Try to stimulate the infant to wake up.
Elicit a response by trying the following:
– Flick the bottom of their feet
– Gently stroking the infant
Note: Never shake an infant due to the risk of shaken baby syndrome which can result in severe brain damage.
Step 3: If the infant does not respond, call for help.
If you are alone, call 911 for help and if possible, do not leave the infant’s side.
If someone is with you, get them to call 911 and find an AED (Automated External Defibrillator) while you provide care. In a home setting, finding an AED may be very difficult!
Step 4: Assess for breathing and pulse simultaneously for no more than 10 seconds.
Put your ear to the infants mouth and nose and listen for breathing sounds.
Watch their chest for up and down breathing movement.
At the same time, place your index finger and middle finger together and feel for the brachial or femoral pulse.
The brachial pulse is felt at the inner part of the infant’s arm, just above the elbow.
The femoral pulse can be felt in the inner and upper thigh.
You should be listening for breathing, watching the chest for rise and fall, and feeling for a pulse all at the same time and as quickly as possible.
Step 5: If there is no breathing, give a rescue breath.
Cover the infants mouth and nose entirely with your mouth and deliver one breath to see if the infant’s chest rises.
If it does not rise, the infant may have an obstructed airway (such as chocking). If that is the case, you will give 2 back thrusts with the palm of your hand after delivering compressions using the 2 finger technique (more detail below). Make sure to tilt the infant head downwards to allow gravity to help dislodge the foreign object out of their airway.
If the chest rises, their airway is clear. Deliver a second breath.
Note: Each rescue breath should last 1 second long, and make the chest rise.
Step 6: If the infant remains unresponsive, begin compressions.
Two Types of Compression Techniques for Infants:
1. 2-Finger Compression
Place your index and middle finger of one hand on the lower part of the sternum (in the middle of the chest, just below the nipple line) while your other hand supports the infant’s back. Use this technique when you are delivering back thrusts.
When to use this technique: When you are the only rescuer on site or if your hands are too small to encircle the chest of the infant
2. 2-Thumb Encircling Hands Technique
Preferred compression technique because it results in improved cardiac perfusion
Place both your thumbs on the middle third of the infant’s sternum (just below the nipple line) while encircling and supporting the infant’s back with both hands.
When to use this technique: This is the preferred compression technique. Use this technique if you can encircle the infant’s chest with both your hands. If the infant is very small, or your hands and thumbs are too large, you can put your thumbs on top of each other and compress that way.
Note: Avoid compression of the xyphoid portion of the sternum – compression here can damage the infant’s liver
How to Compress and Ventilate
If you are by yourself, compress 30 times and follow with 2 breaths (compression – ventilation ratio: 30:2)
Compress about 1/3 deep or 1 1/2 inches deep of the infant’s chest at a rate of 100-120 per minute.
If you are with another rescuer, they can help you. Instead of 30 compressions, deliver 15 compressions, and provide 2 breaths. Then you and the other rescuer can take turns compressing and giving rescue breaths at a ratio of 15:2. Also, while one person is performing CPR, the other can find and set up an AED.
Having another rescuer allows you to take turns and rotate. Compressions can get tiring, especially if you are the only rescuer waiting for help. As you get tired, your compressions may become sloppy and ineffective. It is shown that high quality compressions along with the AED are the two most critical interventions in saving a life so make sure you are doing them right. Always use the help whenever it is available.
Step 7: Continue CPR if infant remains unresponsive, and until help or the AED arrives
As you continue compressing and giving 2 breaths, make sure to reassess the infant every 2 minutes (after 5 cycles of CPR) or until help arrives. Which ever comes first.
If you are alone and performing CPR, reassess the infant every 2 minutes. If the infant is still not responsive, try to find an AED. Of course, if you are at home, continue CPR until help arrives.
When the AED arrives, apply the pads and wait for the automated instructions while you continue performing CPR.
How to use an AED on an Infant
AED stands for automated external defibrillator and can be found in public spaces for emergency use. It is a user-friendly and smart portable electronic device. It analyzes the person’s heart rhythm and determines if the heart rhythm is irregular (aka dysrhythmia). If the AED senses that the heart rhythm is irregular, it will deliver an electrical shock to restore the heart’s dysrhythmia to its normal rhythm. AEDs will only shock and correct a dysrhythmia. It will not start one that has already stopped such as in asystole.
In cases where the AED does not sense an irregular rhythm that it can shock, you should resume manual compressions and rescue breaths until the AED senses a shockable rhythm. Then reassess the infant every 2 minutes of CPR until the AED delivers a shock or until you see any spontaneous movement from the infant.
It is important to use the AED immediately when it arrives, even in the middle of performing CPR, and even if the AED that you have is not intended for children. Research has shown that survival rates increase when CPR and defibrillation occurs within 3-5 minutes of cardiac arrest.
When the AED is turned on, it will automatically instruct you. Listen to its instructions as it tries to sense a shockable rhythm. If there is a shockable rhythm, it will notify you to stay clear before shocking. “Clear” means do not touch the infant while the AED is delivering a shock.
AED Pad Placement on an Infant (Newborn to 1 Year old)
If there are pediatric AED pads or a pediatric dose attentuator on the AED you have on hand, it can be used for newborn babies and up to 8 years old.
Adults pads can also be used on children if that is all you have. But it is important to ensure that the AED pads do not overlap or touch each other during placement on the infant or child’s chest. This is due to the way the AED delivers the shock. If the pads overlap or touch, the shock delivered will not pass through the heart as it was intended to. Instead, the shock will just transfer from one pad to the other.
Sandwich the Heart
If all you have is an adult AED, place one adult pad in the middle of the infant’s chest and then place the other pad in the middle of their back, as if you are “sandwiching” the heart.
Cardiac Arrest in Children
Children often go into respiratory distress and bradycardia (heart rate drops to 60 or less beats per minute; normal for an infant is 80-160 beats per minute) before going into cardiac arrest. Even with a pulse, health care professionals will initiate compressions right away in preparation for a potential cardiac arrest. They will treat an infant with respiratory distress and a low heart rate as if they were “pulseless“, despite the presence of a pulse.
Signs & Symptoms of Respiratory Distress in Children
If your child is experiencing any or a combination of the following signs and symptoms, they may be experiencing respiratory distress:
- Nasal Flaring
- Noisy breathing
- Rapid and/or shallow breathing
- Shortness of breath
- Brief periods of not breathing (also known as apnea)
- Bluish colour of the skin and mucous membranes (gums and mouth, eyelids, hands and feet, nail beds) (also known as cyanosis)
- Clammy skin (cool and sweaty skin)
- Chest wall retractions (when the infant’s chest pulls in with each breath)
- Mood Changes (difficult to arouse or keep awake, or fussier than usual)
- Change in body position (positioning themselves in a way that makes it easier for them to breathe)
What to do if you notice the above signs and symptoms in your infant:
Stay calm, stay with your child, and reassure them.
Call for help (911) or take your child to the nearest emergency department if they are in distress.
Be ready to perform CPR if your infant becomes unconscious.
And my best advice to parents is to trust your instincts! If you feel like something just isn’t right, get help.
I hope you never have to use any of these skills in real life on an infant, especially your own, but these things do happen. Babies can choke on their food or toys, accidentally fall into a pool or slip under the water during bath time… And it can all happen so fast and so suddenly. As a new mom who has taken the CPR course many times, I can sincerely say that I have piece of mind knowing that I am definitely prepared when and if the time ever comes. And you should too.
As always, thanks for reading.