Rescue breathing is a time-sensitive intervention used when a child has stopped breathing but still has a palpable heartbeat. The goal is to deliver oxygen to the lungs, ensuring oxygenated blood circulates to the brain and vital organs. When breathing ceases, the lack of oxygen eventually causes the heart muscle to fail, leading to cardiac arrest. Prompt delivery of rescue breaths prevents respiratory failure and the more severe outcome of cardiac arrest.
Immediate Safety and Assessment
Before initiating care, a rescuer must verify that the environment is safe for both themselves and the child. Once the scene is secure, the rescuer should tap the child and loudly ask if they are okay to determine unresponsiveness. If the child does not respond, the rescuer must immediately call for help and then quickly assess the child’s breathing and circulation.
Breathing should be assessed by looking for chest movement, listening for breath sounds, and feeling for air movement against the cheek for no more than ten seconds. Simultaneously, the rescuer must check for a pulse, most reliably located using the carotid artery in the neck or the femoral artery. If the child is unresponsive, not breathing normally (no breathing or only gasping), but has a definite pulse of at least 60 beats per minute, rescue breaths are required without chest compressions. If the rescuer is alone and the collapse was unwitnessed, provide two minutes of rescue breathing before pausing to activate emergency services and retrieve an Automated External Defibrillator (AED).
The child should be positioned on a firm, flat surface to prepare for effective airway opening or the possibility of needing chest compressions. Any obvious obstruction in the mouth should be removed. A blind finger sweep is not recommended, as it could push the item further into the airway.
Performing the Breath Delivery Technique
To open the airway, perform the gentle Head-Tilt/Chin-Lift maneuver. Place one hand on the child’s forehead and two fingers of the other hand under the bony part of the chin. The head is gently tilted back, and the chin is lifted to move the tongue away from the back of the throat, which commonly causes airway obstruction. Unlike with an adult, the head must not be tilted too far back, which could inadvertently close the child’s more flexible airway.
With the airway open, the rescuer must create a tight seal to deliver the breath effectively. For a child (approximately one year old to the onset of puberty), the rescuer should pinch the child’s nose closed using the hand on the forehead. The rescuer then covers the child’s mouth completely with their own to form an airtight connection.
Each rescue breath must be delivered slowly and deliberately over approximately one second. The volume of air delivered should be only enough to cause the child’s chest to visibly rise. Over-inflating the lungs can force air into the stomach, causing vomiting. The rescuer should remove their mouth after the breath to allow the chest to fall and air to exit passively before preparing for the next breath. If the chest does not visibly rise after the first attempt, the rescuer must immediately reposition the head using the Head-Tilt/Chin-Lift and attempt the breath again, ensuring a better seal.
Maintaining Ventilation and Emergency Transition
Once the initial breaths are delivered and the airway is confirmed to be open, the rescuer must continue providing ventilation at a specific rate to maintain adequate oxygenation. Current guidelines recommend delivering one rescue breath every two to three seconds, which translates to a rate of 20 to 30 breaths per minute. This higher rate is based on recent evidence.
Continuous monitoring of the child’s condition is necessary during this time, watching for any return of spontaneous breathing or a change in the pulse. The rescuer should re-assess the child’s pulse approximately every two minutes.
If the child’s pulse rate drops below 60 beats per minute with signs of poor circulation, or if the pulse is lost entirely, the rescuer must immediately transition to Cardiopulmonary Resuscitation (CPR). For a single rescuer, this involves starting chest compressions combined with rescue breaths at a ratio of 30 compressions to 2 breaths. If the child begins breathing normally but remains unconscious, they should be carefully placed into a recovery position while waiting for emergency medical services to arrive.