Life Saving Skills Every Parent Should Know: CPR & AED for Infants

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.

Photo by Piotr Janus on Unsplash

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.

Photo by Shitota Yuri on Unsplash

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.

The Truth About Eating Raw Fish During Pregnancy

When I was pregnant, all of my friends and family warned me to avoid eating sushi because sushi was one of my favourite foods! Though devastated, I knew I had to make those sacrifices when I got pregnant – raw fish being one of them. And for the sake of my unborn child, I never bothered to question it.

Literally 2 minutes after I had delivered my baby girl, I joked to my doctor and said, “God, I can’t wait to eat sushi again!” My doctor looked at me and said, “…who said you couldn’t before?” I looked back at her puzzled and realized, I never actually asked my doctor if I had to avoid raw fish during pregnancy! I just assumed that it was the obvious thing to do! 

Photo by Valeria Boltneva from Pexels

So if you didn’t know, now you know. To all my sushi loving friends, it’s generally safe to eat sushi and raw fish when you’re pregnant and when you’re breastfeeding! Hooray!

The FDA does state that pregnant women and young children should stay away from raw fish as they have weaker immune systems and are at more risk for food borne illnesses but raw fish served in sushi and sashimi is not included in this recommendation!

In fact, the FDA states that eating a variety of fish when pregnant or breast feeding can provide health benefits for mom and baby! (Keyword: variety! Don’t just eat the same type of fish every time you do!)

Eating fish provides:

  • Protein
  • Omega 3 fats (aka DHA and EPA)
  • Very high in Vitamin B12 and vitamin D
  • Iron
  • Minerals such as selenium, zinc, iodine

And these nutrients contribute to healthy growth and development of your baby. They even provide heart health benefits and lowers the risk of obesity.

Photo by Sebastian Pena Lambarri on Unsplash

2 Things to look out for when eating raw fish

1. Parasitic worms

It’s the parasitic worms found in raw fish that actually make you sick. Ingesting and getting infected with the worms (aka anisakis) results in a painful condition called anisakidosis. These worms invade and penetrate your stomach lining. Some common signs and symptoms include:

  • Severe abdominal pain
  • Nausea and vomiting
  • Diarrhea
  • Allergic reaction
  • Death in very rare cases!

Other parasitic worms present in fish is tapeworm. Fishes potentially infected with tapeworm include:

  • Pike
  • Perch
  • Anadromous fish (fish that migrate up rivers from the sea to spawn such as salmon)

Learn more about parasites from the Seafood Health Facts website!

2. High levels of mercury

Ingesting high levels of mercury can lead to birth defects specifically affecting the brain and nervous system. Mercury is present in streams, lakes and oceans and are either naturally occurring or man made. Mercury turns into methylmercury which is found in nearly all fish but in different amounts. It is this type of mercury that is harmful to us in high amounts.

These fish have the highest mercury level and should be avoided:

  • King mackerel
  • Marlin
  • Orange roughy
  • Shark
  • Swordfish
  • Tilefish
  • Tuna, big eye 

There is no way to prepare or cook fish to lower its mercury level because the mercury is in the tissue of the fish. But that doesn’t mean you should avoid eating fish entirely during pregnancy due to its considerable health benefits. Just consume fish that are low in mercury and avoid fish with high levels.

Photo by Travis Yewell on Unsplash

Fishes low in mercury that you should eat:

  • Anchovy
  • Atlantic croacker
  • Atlantic, and pacific chub mackerel
  • Black sea bass
  • Butterfish
  • Catfish
  • Cod
  • Flounder
  • Haddock
  • Herring
  • Pickerel
  • Pollock
  • Salmon
  • Sardine
  • Sole
  • Tilapia
  • Freshwater trout
  • Canned light tuna
  • White fish
  • Whiting

… and many more! Learn more about which fish is best to eat here on the FDA website.

Remember, a variety of fish in your diet is key!

Photo by chuttersnap on Unsplash

Farmed Fish and Freezing Methods

Some farmed fish used in sushi such as salmon or tuna are very unlikely to be infected with the parasitic worms because of the methods used to farm these fish for mass human consumption.

Also, freezing raw fish kills any worms present which makes it safe to eat. When preparing sushi in your own home, make sure to freeze the raw fish for at least 4-7 days.

Learn more about farmed fish practices here!

Photo by ray rui on Unsplash

What about shellfish?

Shellfish is totally okay to eat when it is cooked. Raw shellfish contains harmful viruses and bacteria that can cause food poisoning so if you’re pregnant, you should probably avoid that scallop ceviche dish!

Shellfish include:

  • Shrimps
  • Prawns
  • Crawfish
  • Crabs
  • Scallops
  • lobster

Keep these tips in mind when you’re at the sushi restaurant and about to enjoy some delicious sushi rolls with you baby bump! But beware of the concerning stares – they don’t know any better…

Thanks for reading everyone!

3 Easy steps to prevent and treat flat head syndrome

What is flat head syndrome?

Flat head syndrome is also known as plagiocephaly. (“plagio-” means slanted or oblique and “-cephaly” means head) It is also known as positional or deformational plagiocephaly.

It is where the back or the side of the baby’s head becomes flat, asymmetrical or slanted. Sometimes, the baby’s head may also widen and the forehead bulges out in more severe cases. This is due to prolonged external pressure on one spot of the newborn’s soft and malleable skull.

It is more common today because of the Safe to Sleep® campaign recommending that babies sleep on their backs in the first few months of life to prevent SIDS (Sudden infant death syndrome).

Other causes of flat head syndrome include the following:

  • Medical problems or delayed development which makes it harder for babies to move and change positions
  • Stiff or tight neck muscles limiting neck movement (Torticollis)
  • Premature babies have softer skulls than full term babies and also move their heads less
  • Plagiocephaly can also occur in the womb such as overcrowding with twins or the mothers womb has an unusual shape

SIDS

SIDS (Sudden Infant Death Syndrome) is the death of a healthy baby who is less than a year old during sleep (also known as crib death). The cause of death is unknown even after a complete investigation but is believed to be linked to defects in the baby’s brain that controls breathing and arousal from sleep. It is also said to be a combination of physical and environmental factors in the baby’s sleeping environment such as in the crib, however research is still ongoing.

I highly recommend mothers to visit this website, Safe to Sleep® campaign to learn about SIDS and how to reduce the risks.

Should I be concerned about plagiocephaly?

Experts have dismissed plagiocephaly as an aesthetic issue because not everyone has a perfectly round shaped head. Also, it is also believed that asymmetrical heads should resolve itself over time as the baby grows.

Because flat head syndrome is a fairly new concern, there is limited studies on the matter. There is a 2010 study from Seattle Children’s hospital that has found an association between flat head syndrome and developmental delays, specifically motor, language and cognitive delays. This means there is no actual cause and effect between flat heads and child development but there is some link between the two.  In fact, the study suggests that a flat head may be a marker to identify children who are at risk for developmental delays, not that flat heads actually cause such delays. Unfortunately, there is no clear answer at this time and research is still ongoing…

Learn more about this study at Seattle Children’s Hospital website here.

Plagiocephaly may also be mistaken with craniocynostosis which is very different! Craniocyntosis  is where the baby’s skull fuses too early preventing normal development of brain growth. Babies with craniocyntosis will have uneven head shapes and this may also look like flat head syndrome. Check with your doctor to make sure!

Treatment & Management

Treatment depends on your health care provider, the age of your baby, the potential cause and so forth. It is very important that you seek professional medical help if you are concerned!

Your baby’s soft skull will start to fuse together and harden at about 9 to 18 months.

If the cause of your baby’s flat head syndrome is due to how they sleep, nap and lay, treatment may include positioning your baby’s head in different ways and avoiding pressure on the flat spot. It is also important to limit the time your baby spends in their bouncers, car seat or anything that applies pressure to certain parts of their head.

If your baby is diagnosed with stiff neck muscles (torticollis), your doctor may recommend special exercises or refer you to a physiotherapist.

If after 6 months, there is no improvement after trying to reposition your baby’s head first, your doctor may recommend helmet therapy. The plastic helmet, lined with foam fits snugly on the round parts of your baby’s head, and loosely on the flat spots to allow the flat spot to expand and even out as your baby grows. Generally they are worn for about 23 hours every day from about 1 to 6 months but it depends on your child’s age and case. Also, helmets can be very pricey!…

Learn more about plagiocephaly at Seattle children’s hospital website here.

How we fixed our baby’s flat spot with 3 easy steps

A few months ago my baby started to develop a flat spot on the back of her head and I freaked out! I always put her down on her back for naps and at night (especially after reading about SIDS!) And I will admit that I put her in her bouncer when I’m busy around the house, and I let her finish her nap when she falls asleep in the car seat on our way home. I realized that all of these habits had contributed to her flat head syndrome!

I had spoken to my doctor about her flat spot and she said that I shouldn’t be too concerned because naturally, no one has a perfectly round head. Also, preventing SIDS far outweighs the concerns that comes with flat head syndrome. I mentioned that I had done some research about flat head syndrome and developmental delays but she assured me that more research is needed to conclude this hypothesis. After much discussion, she provided me with simple, at home measures that I could take to gradually mold my baby’s head naturally without a pricey helmet.

Today she is 6 months old and her head is as “naturally” round as can be.

With 3 simple steps, this is how we did it.
 

1. Repositioning

The first tip to try is to reposition your baby when he or she sleeps and naps. There are a couple of ways to reposition your baby without having to put them on their sides or stomach. Remember to always place your baby on their backs and for peace of mind, turn on that baby camera when your not in the room!

First, use interesting objects or toys that catch your baby’s attention such as a baby mobile. Position the mobile where you want your baby to turn his or her head when they lay on their backs.

Check out our post about the Top 5 Reasons why You Need a Crib Mobile.

Another tip is to place your baby the other way in the crib. For example, if your baby’s feet is towards to door of the room, instead place your baby’s head towards the door.

Lastly, you can also try rearranging your nursery in the room. Moving the crib to a different area in the room can help to move your baby’s head in a different direction.

2. Lots of Supervised Tummy Time

Tummy time is vital, not only for relieving the pressure off of baby’s head but also to help strengthen neck and shoulder muscles for crawling and sitting up. It also improves your baby’s motor skills.

Babies should be on their tummies for at least 2-3 times per day for short periods of time right from birth. As they get older, allow them to spend more time on their tummies with each session. Try not to leave your baby unsupervised when on tummy time! Also, never leave your baby on tummy time (or in any position) on a high area such as the bed or changing table. They may roll over and fall!

Tips for tummy time:

Lay out a blanket on the floor

Place their favourite toy within baby’s reach and help them learn to play and interact with their surroundings

Tummy time after a nap and diaper change is ideal

Avoid tummy time right after a feed, they may spit it all up!

Never leave baby unattended during tummy time

3. Head Molding Pillows

Right now, I’m using Babymoov Lovenest baby head support pillow when my baby sleeps or naps. She sleeps through the night for about 9 hours straight which applies a lot of pressure on the back of her head!

It is so important to put your baby down on their backs but this is probably one of the reasons why my baby developed a flat spot on the back of her head. So I did some research and found the Babymoov Lovenest pillow on Amazon for $19.99 CDN and had to give it a try. This pillow significantly relieve the pressure off of my baby’s head and I truly recommend it. I use this pillow every time I lay her down. It comes in a variety of colors. The fabric is soft, breathable and machine washable. If you don’t believe me, check out their reviews on amazon!

With these 3 simple tips, we saw a difference in just one month! Today, our baby is 6 months old and we continue to implement these steps when she sleeps. Her flat spot has evened out and we are very happy with the results!

Does you baby have a flat spot? Share your story in the comments below! We love to hear from you.