Child CPR, AED, and Choking

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Actual heart problems are less common than breathing difficulties in children. Because of this, it is important to quickly begin CPR and then to perform five sets of CPR before going to get additional help. Each set of CPR consists of 30 compressions and two breaths.

If available, make a second rescuer call 911 and find an AED. Upon their return, work as a team and have them follow the AED prompts, apply the pads, and help you with CPR.

Provide CPR if the child is unresponsive and having trouble breathing.

Do the following when giving CPR to a child:

  1. Assess the safety of the scene and make sure the child is safe.
  2. Tap the child and ask loudly, “Are you okay?”
  3. Yell for help.
  4. Check the child’s breathing.
  5. Give five sets of 30 compressions and two breaths if the child is not responding and having trouble breathing.
  6. Get an AED and call 911.
  7. Resume CPR and give compressions and breaths.

Child CPR (1 year to puberty)

CPR is similar in adults and in children. Giving breaths, pushing fast and hard on the chest, and early administration of CPR are the main goals. Children are those older than one year of age but who have not yet reached puberty. For the purposes of CPR, adult-sized children can be treated as adults.

Children who do not blink, speak, move, make a sound, or make any reaction to your efforts in awakening them are considered “unresponsive” or “not responding.”

Take Note

Only use the “hands-only” CPR if you are an untrained rescuer. This means no breaths and only continuous compressions.

Child CPR Chest Compressions
Child CPR Chest Compressions
Child CPR Chest Compressions

Figure 19

Compressions

It is common to be afraid of hurting the affected child when considering whether or not to do chest compressions. However, remember that the child will die without CPR.

Do the following to perform CPR on a child:

  1. Find a firm, flat surface to position the child on his or her back.
  2. Clothing at the neck and chest area must be opened or removed.
  3. On the lower half of the breastbone, place the heel of one hand (Figure 19).
  4. For at least one third the depth of the chest (about 2 inches or 5 cm in most children), push straight down. Deliver compressions at a rate of 100 to 120 beats per minute.
  5. After each compression, allow the chest to fully recoil.

In child CPR, you may consider using one-handed or two-handed compressions (Figures 19b & 19c). As CPR can become tiring, change roles with another person (if available) every two minutes. The pause between compressions must be minimized.

Giving Breaths

Breathing problems—not heart problems—are the most common cause of unresponsiveness in children. The most effective treatment is the prevention of choking or severe breathing problems due to untreated illness. The child can be helped with breaths during CPR. Cardiac arrest in children can be a result of severe breathing problems from a respiratory illness. The heart will beat irregularly or stop beating altogether due to a breathing problem in children who require CPR.

Absence of any breaths altogether, very shallow or sporadic breathing, and slow breathing are all signs of ineffective breathing. Children who are seemingly struggling to breathe must be given rescue breaths. The child’s chest will rise after a successful breath.

Do the following to open the child’s airway:

  1. Place a hand on their forehead (Figure 20a).
  2. On the bony part of their chin, place your fingers (Figure 20b).
  3. Lift their chin and tilt their head back gently (Figure 20c).

Do the following to give breaths:

  1. Pinch the child’s nose shut and hold their airway open (Figure 20d).
  2. Breathe deeply, then secure your mouth around the child’s mouth (Figure 20e).
  3. Watch their chest rise as you blow for one second into their mouth.
  4. Repeat with a second breath.
CPR - Giving Breaths
CPR - Giving Breaths
CPR - Giving Breaths
CPR - Giving Breaths
CPR - Giving Breaths

Figure 20

Reposition the airway if the chest does not rise. Let the child’s head go back to a normal position before repeating the head-tilt/chin-lift maneuver. Give another breath and look for the chest to rise.

Perform chest compressions without interruption. Do not allow any more than 10 seconds to give two breaths. Begin chest compressions again if the child’s chest fails to rise within 10 seconds.

CPR Mask Children A
CPR Mask Children B
CPR Mask Children C

Figure 21

Mask Use

Generally, including the act of giving breaths, CPR is safe. However, use a mask whenever it is available. Fit the mask over the child’s nose and mouth. The pointed end of the mask should be fitted over the bridge of the child’s nose. The mask must fit properly; efforts to deliver breaths will be ineffective if the mask is too large because no proper seal is achieved.

Do the following when using a mask to give breaths to a child:

  1. Secure the mask over the child’s nose and mouth (Figure 21a).
  2. Perform the head-tilt/chin-lift maneuver to open the airway.
  3. Ensure that there is a secure seal between the mask and the child’s face.
  4. Watch the chest rise as you give a breath for one second (Figure 21b).
  5. Deliver a second breath.
AED - Children A
AED - Children B
AED - Children C
AED - Children D
AED - Children E
AED - Children F

Figure 22

AED for Children

An AED can be used on children, and it should be administered as early as possible while not interfering with CPR. Using an AED on a child generally involves the same steps as using an AED in an adult. When the AED arrives on the scene, check it. Use pediatric pads if the child is younger than eight years of age. However, if no pediatric pads are available, standard (adult) pads are acceptable. Do not let the pads touch or overlap when using standard pads. Because of this, if the child is small, one pad may have to be placed on the child’s back.

A pediatric shock can be delivered with some AEDs that have the appropriate switch or setting. For children younger than eight years of age, turn this switch on (if available). An adult shock can be given if the available AED has no option for pediatric shocks. Start CPR immediately. Make sure that pads do not touch when using adult pads on a child.

Do the following to use an AED on a child:

  1. Turn it on.
  2. Reveal the child’s chest (Figure 22b).
  3. Apply the pads properly while ensuring that they do not touch (Figure 22c, Figure 22d ).
  4. Connect the pads (Figure 22e).
  5. Clear the child; ensure that no one, including yourself, is touching the child.
  6. Check the rhythm.
  7. Follow the prompts: Shock Advised, No Shock Advised, Check Connection, etc. (Figure 22e).
  8. Begin compression again.
Activating EMS A
Activating EMS B
Activating EMS C

Figure 23

Activating EMS (Calling 911)

When approaching a child, be certain that the scene is safe. It will make the situation much worse if you become disabled or injured.

The child is considered unresponsive if he or she fails to respond to a tap and a loud question, like “Are you okay?”
(Figure 23a). Get an AED if possible and send another person to call 911 after yelling for help (Figure 23b).

Check the child’s breathing after you have determined that he or she is unresponsive. Begin CPR immediately if the child is having trouble breathing or is only gasping, as gasping is generally ineffective, and often occurs in cardiac arrest (it is an abnormal sign).

Give five sets of compressions and breaths (about two minutes of CPR cycles) before leaving the child—and you should only leave the child if you are alone and cannot activate EMS using a cell phone at the scene. You can call 911 without leaving the child in most cases, as most rescuers have cell phones on hand with speakerphones (Figure 23c).

Choking in Children

Choking can be either mild or severe. The airway is mildly blocked when the child can still cough and make sounds. Encourage them to cough and stand near them. If you are still worried about their breathing, call 911 immediately.

The universal choking sign of clutching the throat, inability to speak, coughing without making a sound, and the inability to breathe are signs of severe blockage. Immediate action is required in cases such as these.

Determining whether choking is mild or severed is better understood with Table 2.

Yell for help and lay the child down if they stop responding. Begin CPR if there is no breathing. Open the airway and search for the foreign object after 30 compressions. Attempt to remove it and give a breath if the object is visible. Until more advanced help arrives or until the child recovers, continue applying CPR.

Degree of ObstructionResponsivenessRescuers Actions
Mild Obstruction
  • Breathing but may also be wheezing
  • Coughing and making noise
  • Stay with the child, try to keep them calm
  • Call 911 if the obstruction is not cleared quickly
Severe Obstruction
  • Weak or no cough
  • Unable to make noise or makes high-pitched noises
  • Little or no breathing
  • Appears cyanotic (blue around lips and fingertips)
  • Act fast
  • Follow the steps for relief of choking for child

Table 2

Relief of Choking - Heimlich Maneuver - A
Relief of Choking - Heimlich Maneuver - B
Relief of Choking - Heimlich Maneuver - C

Figure 24:
Heimlich Maneuver

Relief of Choking

For children who are choking, use abdominal thrusts as discussed in the adult section.

Do the following to relieve choking in a child:

  1. Ask if they are choking.
  2. Inform them that you are here to help.
  3. Wrap your arms around their body below the rib cage as you stand behind them (Figure 24a).
  4. Make a fist with your first hand and place it just above the navel (Figure 24b).
  5. With your other hand, grab your fist, then deliver quick upward thrusts (Figure 24c).
  6. Keep this up until the child stops responding, speaking or coughing is restored, or until the obstruction comes out and breathing is possible again.

Remove any foreign object that you may see in the child’s mouth. However, you risk pushing the object deeper into the airway if you blindly sweep the child’s mouth with your finger. Carefully observe their breathing by watching and feeling. Begin CPR and continue applying it until additional help comes if the child does not respond or begin breathing.

In cases of large children where your arms cannot wrap around their waist, perform chest thrusts, or perform abdominal thrusts with your fist on the breastbone.

A doctor should be consulted regarding any child who has experienced a severe choking event.

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