When a child is unresponsive and not breathing normally, a quick and accurate pulse assessment is the immediate focus of emergency care. Determining if the heart is circulating blood dictates subsequent actions, especially whether to initiate cardiopulmonary resuscitation (CPR). The method for checking a pulse changes based on the child’s size and age, reflecting distinct anatomical considerations.
Defining Infants and Children in Emergency Care
Emergency medical guidelines categorize pediatric patients using specific age ranges, which determine appropriate resuscitation techniques and pulse check locations. An infant is classified from birth up to approximately one year of age, a period characterized by rapid growth and unique physical vulnerabilities. This classification excludes newborn infants, who are managed under separate neonatal resuscitation protocols.
The designation of a child applies to individuals from one year of age until the onset of puberty. Puberty is identified by the presence of breast development in females or axillary (underarm) hair in males. These cutoffs are applied because the body changes significantly across these stages, affecting the location of major arteries and subcutaneous fat.
Locating the Pulse: Brachial vs. Carotid
The choice between the brachial and carotid arteries depends on the patient’s age category to ensure the most reliable and accessible check. The brachial pulse is the preferred site for assessing circulation in infants younger than one year old. This artery is located on the inside of the upper arm, running between the shoulder and the elbow.
To check the brachial pulse, the rescuer places two or three fingers on the inner arm, midway between the infant’s elbow and shoulder crease. The brachial artery is easily compressed against the underlying bone, making it simpler to locate than the neck vessels. The carotid artery is often more difficult to isolate effectively in an infant, which is why the arm site is preferred.
For children one year old and older, the carotid pulse becomes the primary assessment location, similar to the protocol for adults. The carotid artery is a major vessel supplying blood to the brain and is palpable even when peripheral pulses are weak. This pulse is found on the side of the neck, in the groove between the prominent trachea (windpipe) and the large neck muscle.
The rescuer slides their index and middle fingers into this soft groove, pressing gently to feel the pulse against the spinal column. The carotid site is used in older children because their neck anatomy is more defined, and the brachial pulse becomes a less reliable indicator of central circulation compared to the neck artery.
Pulse Check Protocol in an Emergency
Regardless of whether the brachial or carotid site is used, the technique for palpation must be precise and standardized. The rescuer should use the pads of their index and middle fingers to feel for the pulse. Using the thumb is discouraged because it has its own distinct pulse, which can easily lead to a misinterpretation of the child’s circulatory status.
The duration of this assessment is limited to minimize delay in starting life-saving compressions. The rescuer should check for a pulse for a minimum of five seconds but for no more than ten seconds. If a pulse is not definitively felt within this brief window, or if the rescuer is uncertain, they must proceed immediately to the next step of the protocol.
The assessment determines the immediate course of action: if no pulse is detected, chest compressions must begin right away. If a pulse is present but the heart rate is very slow—less than 60 beats per minute with signs of poor circulation—the child is considered to be in need of CPR, starting with compressions. If a pulse is found, but the child is not breathing or is only gasping, the rescuer must provide rescue breaths at a rate of one breath every three to five seconds.