Standardized protocols for cardiopulmonary resuscitation (CPR) require specific definitions for victims to ensure the correct techniques and equipment are used. Emergency care guidelines categorize individuals based on age and physical development because human anatomy changes significantly from infancy to adulthood. These definitions are necessary to tailor the force of compressions, the volume of rescue breaths, and the appropriate use of medical devices to the victim’s body size and physiological state. Applying adult techniques to a small body could cause severe injury, while using child techniques on an adult would be ineffective in circulating blood.
Defining the Boundaries of a Child in CPR
A victim is categorized as a “child” for CPR purposes starting from their first birthday until they show definitive signs of puberty. This definition creates a distinct category between the smaller “infant” and the physically mature “adult,” acknowledging the unique developmental stage. The child category typically encompasses individuals who have not yet reached the size and bone density that characterize an adult body.
While a specific age range, such as age one to approximately eight years, is often used for teaching, physical maturity ultimately determines the proper protocol. Puberty is defined by the appearance of secondary sex characteristics, such as underarm or chest hair in males and breast development in females. If a rescuer cannot determine the victim’s exact age, a quick visual assessment of these physical signs takes precedence.
The distinction is based on the body’s needs during resuscitation. A child’s chest wall is more flexible and their heart is smaller compared to an adult’s, which necessitates a modified approach to chest compressions to prevent trauma and ensure effective blood flow. This definition dictates the selection of equipment, such as pediatric pads for an Automated External Defibrillator (AED), and the specific compression technique employed. The child category ensures a balance between generating adequate circulation and avoiding harm.
The Infant CPR Category
The category that precedes the child classification is the “infant,” defined as a victim from birth up to one year of age. This group requires the most specialized care due to their unique anatomical and physiological characteristics. Infants have a larger head-to-body ratio and relatively smaller, more easily obstructed airways compared to older children and adults.
Their smaller, more pliable rib cages and chests mean that chest compressions must be performed with less force than for a child. An infant’s cardiac arrest is most frequently caused by respiratory failure, making effective rescue breaths particularly important. The protocols for this age group, such as the use of two fingers for compressions, reflect the goal of providing gentle yet effective support.
Technique Differences Between Child and Adult CPR
CPR techniques change when treating a child versus an adult to account for differences in body size and structure. For a child, the recommended chest compression depth is approximately two inches, or about one-third the depth of the chest, which is a slightly shallower target than the two to 2.4 inches recommended for adults. This depth difference accounts for the child’s smaller thoracic cavity and more flexible bones.
The technique for delivering compressions also varies, as a child may only require the heel of one hand, whereas two hands are standard for an adult. For a larger child, two hands may be necessary, but the rescuer must adjust the force to match the one-third depth guideline. For both children and adults, the rate of compressions remains the same, targeting 100 to 120 compressions per minute.
Children require a smaller volume of air during rescue breaths to visibly make the chest rise, avoiding excessive force that could cause harm. The standard compression-to-breath ratio is 30 compressions to 2 breaths for a single rescuer for both adults and children. When two rescuers are present, however, the ratio for a child changes to 15 compressions to 2 breaths, emphasizing the importance of ventilation for pediatric victims.
When using an Automated External Defibrillator (AED), a child requires attenuated pads or a dose attenuation system to deliver a lower electrical energy level. These pediatric pads or settings are generally used for children up to eight years old or until they meet the physical criteria for adult protocols. Using an adult setting on a small child can deliver an unnecessarily high-energy shock, which underscores the need for the child definition.
When to Transition from Child to Adult Protocols
The upper boundary of the child CPR definition is not a strict chronological age but the onset of puberty, which is a physical milestone. Puberty is the definitive transition point because the body has developed sufficiently to require the more forceful techniques and higher energy doses of adult care.
For a rescuer, this means that a 12-year-old showing no signs of puberty should still receive child CPR, while an eight-year-old with clear secondary sex characteristics should be treated using adult protocols. If the rescuer is uncertain (e.g., the victim appears to be a small adult or a large pre-teen), the general guidance is to default to adult techniques and equipment. This preference for the adult protocol in ambiguous cases is based on the principle that under-treating a larger victim is a greater risk than slightly over-treating a smaller one.
Once a victim is assessed as being past the stage of puberty, or weighs more than 55 kilograms, the adult CPR guidelines apply. This includes using a two-handed compression technique, aiming for the full adult compression depth, and utilizing standard AED pads without attenuation. The physiological changes of puberty signal that the victim’s body can withstand the mechanical forces and electrical energy designed for an adult.