Cardiopulmonary Resuscitation (CPR) is an emergency procedure designed to maintain blood flow and oxygen delivery when a person’s heart stops beating. While the fundamental purpose of CPR remains the same across all age groups, the techniques must be significantly adapted based on the victim’s size and underlying physiology. Infants, defined as babies under one year old, have distinct anatomical and physiological needs compared to adults. Using adult-sized force or methods on an infant can cause severe physical harm while being ineffective at circulating blood.
Initial Response Sequence
The initial response sequence differs based on the victim’s age, particularly regarding when to call for emergency medical services (EMS). For an unresponsive adult, the recommended procedure is “Call First.” This means the rescuer immediately calls 911 before starting compressions. This approach is used because adult cardiac arrests are most frequently caused by a primary heart event, making rapid access to a defibrillator the most time-sensitive intervention.
Infants commonly experience cardiac arrest as a secondary result of respiratory failure, often due to conditions like choking or infection. Since the underlying issue is a lack of oxygen, immediate oxygenation and ventilation are the most beneficial first steps. Therefore, the guideline for a lone rescuer of an infant is to provide “Care First,” performing approximately two minutes of CPR before pausing to call EMS. This two-minute period, consisting of five cycles of compressions and breaths, prioritizes getting oxygenated blood circulating immediately.
Compression Technique Variation
The physical mechanics of delivering compressions vary significantly between an adult and an infant due to differences in body size and skeletal fragility.
Hand Placement
For adults, the rescuer uses the heel of two interlocked hands, placed over the center of the chest on the lower half of the breastbone. This technique allows the rescuer to use their body weight to achieve the necessary depth. In contrast, an infant’s small size requires a more controlled and localized force. A single rescuer typically uses the tips of two fingers, placed just below the nipple line on the breastbone. When two rescuers are present, the two-thumb encircling-hands technique is preferred, where the hands wrap around the infant’s chest with both thumbs pressing on the breastbone.
Compression Depth
The required depth of compression is carefully calibrated to the victim’s size. For an adult, compressions should be at least two inches deep (five to six centimeters). For an infant, the compression depth is approximately 1.5 inches (four centimeters), which is roughly one-third of the infant’s chest depth. Applying too much force risks fracturing the infant’s delicate ribs or damaging internal organs.
Rate and Ratio
The rate of compressions remains constant for both adults and infants, falling between 100 to 120 compressions per minute. The compression-to-ventilation ratio varies depending on the number of rescuers present. For a single rescuer, the ratio is 30 compressions followed by two breaths for both adults and infants. If two trained rescuers are present for an infant, the ratio changes to 15 compressions to two breaths.
Airway and Ventilation Differences
Opening the airway and delivering rescue breaths requires modifications to accommodate the infant’s unique anatomy.
Airway Opening
For an adult, the standard technique to open the airway involves the head-tilt, chin-lift maneuver, which tilts the head back past the neutral position. This movement lifts the tongue away from the back of the throat to create a clear passage for air. Applying this same action to an infant can collapse their highly flexible trachea, closing the airway. Therefore, the infant airway is opened using only a slight head-tilt to the “sniffing position,” which is a neutral or slightly extended neck position. This minimal movement aligns the airway structures without risking obstruction.
Rescue Breath Seal
The technique for delivering the rescue breath seal differs due to the infant’s small facial features. While an adult receives a mouth-to-mouth seal, the rescuer performing infant CPR covers both the infant’s mouth and nose with their own mouth to create an effective seal. This dual-coverage technique ensures that the minimal air volume delivered reaches the lungs.
Breath Volume
The volume and force of the breath must be significantly reduced to avoid injury. Adult rescue breaths involve a normal breath delivered over one second until the chest visibly rises. For an infant, the rescuer should use only a small puff of air, delivered gently over one second. The goal is to see only a minimal, gentle rise of the chest, as over-inflation can force air into the stomach or lead to lung damage.