Differences Between Adult, Infant and Child CPR
Differences Between Adult, Infant and Child CPR
by Greta Kviklyte
Life Saver, AMC
Co-authored by Kim Murray, RN, M.S.
posted on May 7, 2021, at 1:19 am
If you know how to give adult CPR, then you’re well on your way to being able to give child CPR or infant CPR. But you’ll find some clear differences in through procedures and those differences can greatly impact the effectiveness of CPR on a child or infant.
This is not a complete guide to CPR for infants, children, or adults. It’s an in-depth look at differences. So please consider the many reasons to get a CPR certification to be confident you know how to correctly perform CPR for all ages.
What Is Considered an Infant, Child, Adult When Giving CPR?
People grow and develop at their own rates, so understanding how CPR experts define each of these is critical to that child receiving the correct care.
When to Use Infant CPR
In the world of CPR, an infant is a child that is less than one year old. If you know a child is 12 months or younger, then infant CPR is the best course of action.
But what if you don’t know the age of the infant/child? Use your best judgment. Generally speaking, most one-year-olds are just beginning to walk. So if the child isn’t doing at least some unsteady walking, and the child that looks like an infant, you could assume they’re under one, if you don’t know and have no way to find out.
When to Use Child CPR
A child is a person that is no longer an infant but has not yet reached the age of puberty. According to DukeHealth.org, in the US, the average age of puberty for a girl is 8-13 and 9 to 14 for a boy.
In either case, if you don’t know the age of the child/infant, you shouldn’t hesitate to provide CPR. CPR saves lives.
When to Use Adult CPR
That leaves adults. Adult CPR is for anyone over the age of puberty. In other words, most teenagers and some “tweens” (10-12) will receive adult CPR.
Common Reasons for Infant/Child Cardiac Event
The reasons for cardiac arrest in children, infants, and adults differ. This impacts how CPR is given to these different groups.
Reasons for Infant Cardiac Events
For an infant up to about 6 months, the most common cause is SIDS (Sudden Infant Death Syndrome). According to ChildrensHospital.org, the cause of SIDS is unknown. But doctors believe children who suffer from SIDS may lack the ability to wake up when they are unable to breathe. Children can roll over or become tangled in bedding, leading to these events. While this condition has the word “Death” in it, an infant who has experienced a SIDS-causing cardiac arrest may be resuscitated if found soon after the event.
As for infants 6-12 months, the most likely cause would be any kind of respiratory failure or airway obstruction. According to CDC.gov, 2/3 of infant injuries are related to suffocation.
However, medical conditions like hypertrophic cardiomyopathy, coronary artery abnormalities, or arrhythmias can occur. And trauma is another likely possibility, so be aware of this when performing infant CPR.
Reasons for Children Cardiac Events
A child is most likely to experience a cardiac event caused by:
- Choking. Around 12,000 children visit the ER after a food-choking incident in the US.
- Suffocation. Including choking, this is the fourth leading cause of death in children in the US, according to The New England Journal of Medicine.
- Drowning. Around 1000 children die of drowning each year. According to CDC.gov, drowning is the most common cause of death in infants/children 0-4 YO.
- Trauma. Vehicle and bike crashes account for most traumatic events in children. Around 600 children die in car accidents each year. 33% were not properly restrained. In the case of bike accidents, studies have shown that wearing a helmet can protect a child from 85% of head injuries and 89% from brain damage.
Common Reasons for Cardiac Events in Adults
While the children’s cardiac event statistics may seem alarming, adult rates are much higher.
According to CDC.gov, heart disease is the leading cause of death in adults in the US. Nearly 700,000 people die each year from it. In the US, someone has a heart attack every 40 seconds.
The most common causes in adults are related to heart disease:
- Scarring from a previous heart attack
- Thickened heart muscle, which results from poorly managed high blood pressure and other causes
- Medication dosing issues or side effects
- Recreational drug use
- Other heart disease-related conditions
In these events, CPR can save lives.
Survival Rates with CPR for Adult vs. Child
If a child receives CPR out-of-hospital, they have a 17-40% chance of surviving to discharge. This rate may seem low, but it has significantly improved from around 2.6%, thanks to more people knowing CPR and improvement in pediatric intensive care after an event.
We will also note that when a child or infant is found quickly (within a few minutes), their chances of survival are higher.
The survival rate to discharge for adults is typically much lower at around 7% if they didn’t get bystander CPR. This rate goes up significantly to 11% when a bystander initiates CPR.
In adult and child CPR, you use the palm of your hand to give compression. However, with infant CPR, this could apply too much force over too much other their chest. So instead, use two fingers of one hand. Place them in the middle right below the nipple line. Press straight down with your fingers lowering the breastbone about 1.5 inches (4 cm). Allow the chest to come back up before doing another compression, which will happen immediately. Your goal is 100 to 120 beats per minute.
For a child, the recommended depth is about 2 inches (5cm) or roughly 1/3 the depth of the chest at 100 to 120 beats a minute.
In adults, the recommended depth for compressions is 2 to 2.4 inches (5 to 6cm), also at 100 to 120 beats per minute. Today Show compiled a list of other popular songs like “I Will Survive” (Gloria Gaynor) and “Sweet Home Alabama” (Lynyrd Skynyrd, Alabama) that can help you keep tempo.
Compression-only CPR: Yes or No?
According to NIH.gov research, if you need CPR, there’s a 45% chance you’ll receive it from a stranger rather than family, friend, or coworker (15%). Even though giving breath has been shown to be a low-risk activity, some people may hesitate to give breaths to a stranger if they don’t have a mask. Strangers may choose to give compression-only (also called hands-only) CPR based on this concern.
Those who get full CPR are 2.6 times as likely to survive versus no CPR. Those who get hands-only CPR are twice as likely to survive versus no CPR. So even though not ideal, something is better than nothing.
However, with both infants and children, the CDC recommends that you always give full infant or child CPR, which includes checking airways, giving breaths, and compressions, among other steps.
The CDC discourages hands-only for children for a good reason. Brain damage begins at 4 minutes of oxygen deprivation. So if CPR is done for an extended period without restoring breathing, it increases the risk of loss of neurological function. This may impair learning and significantly alter long-term potential for a quality life.
As mentioned above, infants and children are more likely to experience an event because of breathing problems, not heart problems. Because of this, you can usually make some basic assumptions and handle the situation differently. They may have airway obstruction.
Checking the Airway & Relieving Choking
In infants, choking is categorized as a “mild obstruction” or “severe”. In a mild obstruction, a child can still breathe a little, but they’re coughing or wheezing. If you see the object, try to remove it with your fingers being careful not to push it in further.
In these cases, try a chest thrust and back slap (while supporting the head and neck). With a “mild” or “partial” obstruction, it may be hard to dislodge the object with a chest thrust and back slap because air is getting around it. So try to calm the infant and dislodge the obstruction. If you can’t dislodge it quickly, call 911.
If the infant has a severe obstruction, then little to no air is getting through. Use back slaps and chest thrusts. If the infant stops responding, place them on a firm, flat surface, yell for help, then start CPR..
When a child or adult has a possible airway obstruction, they may be able to respond to your instructions. Encourage them to cough. If they can’t cough, or it doesn’t work, you’ll do the Heimlich Maneuver.
- While standing to the side of them, support the individual’s front and bend them over at a 90-degree angle. Then slap their back five firm times. If not dislodged, continue to the Heimlich Maneuver (2).
- Put your arms around them from behind and grasp your fist with your other slightly above their belly button. Pull hard toward yourself in a firm upward thrust, like you’re trying to pick the person up. Do this six to 10 times. This is also called an abdominal thrust.
According to Mayo Clinic, to save lives, you can also teach a child or adult to cough and then perform a modified “Heimlich” on themselves by leaning over the back of the chair or on a table if they are choking when no one is around.
You can find step-by-step infant CPR instructions here.
Mouth-Nose Seal for Infant
When giving breath to an adult, you hold the nose and breath through the mouth. But since your mouth is much larger than the infants, you’ll place your mouth over both the mouth and nose to give breath. If the infant’s breathing is obstructed, depending on where it is, this will also give air two possible entry points if one is blocked.
If you have a mask, it will go over the nose and mouth in adults, children, and infants.
Using an AED on a Child, Infant, Adult
AEDs are easy to use and can improve survival rates when used with CPR. Because they’re automated, they determine the best time to deliver the shock and will tell you it’s time to stop touching the person (Clear!).
You can use an Automated External Defibrillator (AED) on adults, children, and infants. However, the application of the pads is different.
For child CPR, place one pad on the upper right chest about the breast. Place the second pad on the lower left chest below the armpit. For infant CPR, apply one pad in the center of the chest and the other to the back.
Preserving Brain Function
According to MedlinePlus.gov, an adult, child, or infant will begin to develop potentially permanent brain damage after only 4 minutes without oxygen. Time is of the essence.
Call 911 First OR Not
With adults, the typical recommendation is that you call 911 first if you’re the only rescuer and no one else is coming. You then begin the steps to perform CPR while you wait for them to pick up. However, with children and infants, you should yell for someone to “call 911” and begin CPR immediately.
Who Needs a Child/Infant CPR Certification, etc.
Anyone from teen to adult could benefit from taking a CPR course. Researchers have found a strong correlation between the number of people who are CPR certified in a certain community and how likely a person in that community is to survive an event.
Some people who should certainly consider CPR certification include:
- Teachers and Day Care Professionals
- Nurses, EMT, Orderlies
- Senior living and nursing home employees
- Addiction treatment center employees
- People who work in recreation or events
- Police Officers
- Parents, grandparents, uncles, and aunts
- Caregivers for an aging family member
To save a life, you must know what to do during an emergency. Getting a CPR certification can give you the confidence to act quickly to prevent a worsening event or keep a person’s brain supplied while you await emergency support. Over 100,000 health care professionals trust Advanced Medical Certification when it’s time to get certified or recertified in CPR or more advanced life-saving techniques. You can get the skills and the confidence by signing up for an online CPR and First Aid Course today.
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