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A Step-by-Step Guide to Infant CPR

A Step-by-Step Guide to Infant CPR

Photo of Greta

by Greta Kviklyte

Life Saver, AMC
Co-authored by Kim Murray, RN, M.S.

posted on May 30, 2023, at 12:26 am


Out-of-hospital cardiac arrests affect approximately 300,000 people in the United States each year. The survival rate among these patients is low, typically hovering around 8 percent. In-hospital cardiac arrests are also recorded in many patients Some patients with cardiac arrest present with pulseless electrical activity, or PEA. This type of presentation requires a specific approach in order to maximize survival rates.

People tend to associate cardiac arrest with adults and those with pre-existing health conditions, but it may occur in young children and infants too.

According to CPR.Heart.Org, more than 7,000 children, inclusive of infant cases, suffer an out-of-hospital (OOH) cardiac arrest annually, and survival rates average 6.2% for those less than one year old. As with all cardiac arrest cases, immediate intervention, including the steps listed in the lesson available here, is necessary to reduce risk of death, and health professionals, parents, and anyone involved in lives of infants and children need to understand the basics of infant CPR, how to apply two person CPR to small children, and how to improve your training for such circumstances with a few tips.

Prevalence of Cardiac Arrest in Infants and Children


Cardiac arrest rarely occurs in children as a result of pre-existing
conditions. IN most cases, unintentional choking and suffocation typically precipitate cardiac arrest in infants under age one. In fact, choking is the fourth leading cause of death in children under age five, and toys, household items, and food present possible choking hazards. Sadly, mortality rates are grim; a child under the age of one dies every five days due to choking, reports the New York State Department of Health.

Causes of Infant Cardiac or Respiratory Arrest

The causes of infant cardiac or respiratory arrest mirror the H’s and T’s of reversible causes of arrest, which are explained in further detail here. For reference, these include:

  • Hypovolemia
  • Hypoxia
  • Hydrogen ion buildup or acidosis
  • Hypo/hyperkalemia
  • Hypoglycemia
  • Hypothermia
  • Tension pneumothorax
  • Tamponade, cardiac
  • Toxins
  • Thrombosis of the coronary of pulmonary vessels
  • Trauma that’s unrecognized

While these are the most widely known causes of cardiac arrest, it is important to think of how each cause may be the result of another event. For instance, choking is a trauma, or electrocution could lead to a cardiac tamponade. Moreover, ruling out each cause of arrest does not necessarily mean that the same cause is addressed permanently. In other words, the body may re-enter cardiac or respiratory arrest if the underlying cause is not found quickly after a return of spontaneous circulation (ROSC).

The Fundamentals of Performing Life-Saving CPR and Emergency Care for Infants and Small Toddlers

infant-cprThe fundamentals of CPR and life-saving measures for infants are not necessarily different from adults, but due to the smaller stature of children and infants, time is even more vital than usual. Moreover, an infant is unable to voice his or her pain or complaints, so it is up to the informed responder to act.

If the infant does not respond to stimuli or if the child is only gasping for air, begin CPR immediately.

The infant CPR and Basic Life Support (BLS) algorithm includes the following steps:

  1. Check the scene for safety. Remember that aside from choking, the next likely cause of cardiac or respiratory arrest is trauma.
  2. Get someone’s attention to contact emergency medical services (EMS).
  3. Determine if the infant is responsive by shouting at the child and tapping the feet.
  4. If a second person is available, have that person obtain the automated external defibrillator (AED) and contact EMS.
  5. If you are alone and unable to get help, begin providing care to the small infant, taking the baby with you and getting help as quickly as possible. Prior guidelines advised against moving the child, but in this case, it is the best way to get high-quality, advanced care as quickly as possible. Of course, if you suspect a fall or other head injury, avoid moving the child until EMS arrives, performing care.
  6. Check for signs of respiration, looking at the baby’s chest for rise and fall, listening to the baby’s mouth for the sound of air movement, and feeling for air movement with your check near the child’s mouth as well.
    Check for signs of a pulse on the carotid artery. Additionally, checking for a pulse should not be longer than 10 seconds. If it is difficult to feel a pulse, err on the side of caution by initiating infant CPR.
  7. If the baby is not responding, appears to have stopped breathing, or is gasping, give chest compressions at a rate of 100-120 per minute and allow for adequate chest recoil between compressions. The compression depth should be approximately 1.5 inches. For children age one through adolescence, chest compression depth should be two inches.
  8. Before administering rescue breaths, remember to open the airway. Do this by placing a hand on the forehead, and put the other hand on the bony part of the chin. Lift the chin; then, tilt the head back slightly.
  9. Alternate rescue breaths with compressions at a ratio of 30:2 when alone or 15:2 when able to perform 2 person CPR. Pinch the nose shut and hold the airway open. Breathe deeply and secure your mouth over the infant’s mouth to administer the rescue breaths. Now, it is possible to avoid the issue with pinching the nose by covering the infant’s nose and mouth with your mouth when administering rescue breaths. Take a moment to ensure you have a good seal around the infant’s airway.
  10. For infants that have a pulse with diminished respirations, provide one rescue breath every three to five minutes. For infants, the breath should be enough to cause a rise in the chest, but the general rule of thumb is that the amount of air in your mouth when you puff out your cheeks is the volume needed per rescue breath.
  11. Remember to recheck the infant for a pulse throughout the duration of infant CPR after five cycles of compressions and rescue breaths. If a child that had a pulse begins to exhibit any signs of cyanosis, the bluish tint that appears on the face and lips, start chest compressions.
  12. Assuming an AED is available and arrives, place the AED pads on the child. Remember that each AED is different, so it may have a set of pads uniquely sized for infants and children. If no infant set is available, a child-sized pad may be used.
  13. If AED determines that the rhythm is shockable, administer one shock.
  14. Resume CPR for 2 minutes or until the AED prompts to check for a rhythm. Follow the instructions from the AED throughout the process.
  15. If the AED is unshockable, continue CPR immediately. Continue with following the AED system’s audible instructions until ALS providers take over or the infant regains consciousness.
  16. Common Mistakes During Infant CPR

The biggest mistake made when performing infant CPR is failure to initiate chest compressions properly. It is easy to panic, and time lost increases the risk of poor outcomes.

The other mistake involves the positioning of the infant for chest compressions. There are two acceptable means.

  • Place the infant on his back or a firm surface. Using two fingers in the center of the chest and slightly below the nipple line, press down approximately 1.5 inches.
  • The two-thumb encircling technique is also acceptable for chest compressions in infants. Position yourself at the infant’s feet. Place your thumbs side by side in the center of the infant’s chest and slightly below the nipple line, explains Wrap your fingers around the infant’s chest to support the back. Use the thumbs to administer chest compressions.

For those using the two-thumb encircling technique, only use the force of your thumbs to administer compressions. Squeezing the infant with your fingers will result in insufficient chest recoil and a higher risk for injury.

Another mistake occurs when attempting to determine if a diminished pulse should require the initiation of chest compressions. In children, a pulse of less than 60 beats per minute, which does meet the criteria for bradycardia, is considered pulseless electrical activity. As a result, begin CPR if the infant has a pulse of less than 60.

For those with limited experience or training in infant CPR, follow the hands-only CPR approach. The rate of compressions is still 100-120 per minute, but it is imperative that you follow the guidelines for using two fingers or the two-thumb encircling technique for administering compressions.

If you do prefer to use a mask, it is acceptable if the mask does not cause any undue delay in providing care or otherwise inhibits your ability to obtain a proper seal for administering rescue breaths.

What About Infants That Are Choking

A choking infant carries a few distinctions from performing choking care to toddlers and older children. When the airway is blocked, an infant may be gasping or appear motionless. Infants have the highest risk of choking due to their tendency to put small objects in their mouths, which is explained here. If a mild choking incident appears and the child can still breath, stay with the infant and attempt to keep him calm. If the obstruction is not cleared quickly or leads to additional breathing problems, call EMS.

If a severe obstruction is the cause of choking, such as an inability to make noise, failure to breath, or exhibit cyanotic symptoms, immediate intervention is necessary, which is as follows:

  1. Holding the infant in your lap, rest the chest of the infant on your forearm, keeping the head lower than the chest. Ensure your hand is placed on the chest and not causing distress to the infant’s neck.
  2. Using the heel of the hand, perform five back slaps that are in a downward, firm motion and between the infant’s shoulder blades.
  3. Move the baby to the other arm, placing the baby on his back. Provide five thrusts to the chest, mirroring chest compressions during CPR. If the infant does not clear the obstruction, using both arms, swap the infant back to the other arm, putting the baby face down again.
  4. Between cycles, look in the infant’s mouth for any object. NEVER PERFORM A BLIND FINGER SWEEP UNLESS YOU SEE AN OBJECT THAT CAN BE REMOVED. Blind sweeps run the risk of pushing the object further down into the throat and worsening the situation.
  5. If the baby stops responding and has been unable to clear the object, the situation becomes more urgent. Yell for a bystander to contact EMS. Begin infant CPR. After the first cycle of 30 compressions, or 15 compressions if performing 2 person CPR, check the infant’s mouth for an object. If the object can be seen, remove it. Otherwise, continue CPR. Attempt to perform rescue breaths for the duration of the event.

How to Improve Your Readiness for Infant CPR Training

No one wants to think about how to respond when an infant suffers from choking or cardiac arrest. However, the statistics are clear. Chances are good that an infant in your care will one day at least mildly choke. Even in mild cases, choking can quickly progress to a severe obstruction, which is now a life-threatening emergency. To ensure you remember the skills taught in a life-saving infant CPR and choking course, remember these tips:

    • Ensure infant CPR training uses appropriate-sized mannequins.
    • Take note of variances in speed, depth, and standards in infant CPR compared to adult CPR.
    • Think about the things an infant might choke on, including food and toys; apply that knowledge when looking for an obstruction.
    • Take advantage of interactive modules and experiences, such as videos or pretests, that can help improve your long-term memory of skills.
    • Remember that bradycardia with a pulse under 60 is considered PEA in infants, toddlers, and children until adolescence.
    • Always treat for trauma-induced causes as part of the PALS algorithm or infant CPR and BLS process.
    • Get an AED as soon as possible for any emergency.
    • If cases of severe obstruction that lead to regaining consciousness and return of circulation, remember that the child should be seen by a medical professional to rule out any potential aspiration of contents into the lungs.
    • Never perform a blind finger sweep on an infant.

Know How to Reduce Infant Mortality With the Right CPR Courses Now

The mortality risk for infants that suffer OOH cardiac arrest is significant. The greatest chance of survival depends on immediate intervention when an infant suffers arrest as a result of any reversible cause or choking. Those involved in the care of children in any capacity, ranging from babysitters through everyday staff at retailers, should learn how to perform infant CPR and why its urgency is so important.

Also, remember to enroll in your life-saving skills course, available online here, and share this article, along with your thoughts to social media now. Together, we can make a difference and save lives!

About Greta

Greta is a dedicated life saver and a distinguished expert in the field of medical content creation and editing. Her impressive array of certifications in ACLS, CPR, PALS, and BLS underscores her commitment to excellence in the medical field. With over four years of invaluable experience in medical education, Greta plays an indispensable role within the Advanced Medical Certification team, shaping the way healthcare professionals around the world acquire and apply vital knowledge.

Greta's profound expertise serves as the driving force behind the development and distribution of medical content that has significantly enhanced the capabilities of countless healthcare practitioners across the globe.

In addition to her medical qualifications, Greta holds a prestigious academic distinction in Marketing and Global Business from Vilnius University. Her academic journey has been enriched by immersive studies in Slovakia and Portugal during her time as an exchange student, providing her with a global perspective that complements her medical expertise.

Beyond her professional commitments, Greta possesses a genuine passion for global exploration, with a particular focus on immersing herself in diverse cultures and appreciating the intricacies of the natural world. While residing in Vilnius, Lithuania, she continues to make substantial contributions to the field of medical education, leaving an indelible mark on the sector.

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