Child Cardiopulmonary Resuscitation (CPR) is a life-saving procedure performed on children who are unresponsive and not breathing normally. The guidelines for Child CPR apply to individuals from one year of age up to the onset of puberty, which is generally marked by breast development in females or the presence of armpit hair in males. Unlike adult resuscitation, where cardiac arrest is most often the result of a primary heart problem, cardiac arrest in children is typically caused by a respiratory issue, such as choking, drowning, or severe illness. This leads to a lack of oxygen and subsequent heart failure. Because of this difference, the inclusion of rescue breaths is particularly important for Child CPR, unlike the “hands-only” method often suggested for adult bystanders. The core of the procedure involves a combination of chest compressions to circulate blood and rescue breaths to deliver oxygen.
The Foundation: Compression-to-Breath Ratio
The most common scenario encountered by a lay rescuer is providing assistance alone, which follows a specific compression-to-breath ratio. For a single rescuer, the standard is 30 chest compressions followed by 2 rescue breaths, known as the 30:2 ratio. This ratio is identical to the one used for adult CPR, simplifying the initial steps for a bystander who may be under stress.
The goal is to maintain a continuous cycle of activity, minimizing interruptions to blood flow. Chest compressions must be delivered at a rate of 100 to 120 compressions per minute. High-quality compressions are achieved by pushing down on the center of the child’s chest to a depth of approximately one-third of the chest’s front-to-back diameter, which is about 2 inches for most children.
Following the 30 compressions, the rescuer must pause briefly to deliver the 2 rescue breaths before immediately returning to compressions. This 30:2 cycle is repeated continuously until emergency medical services arrive or the child shows signs of life. The focus remains on rapid, forceful compressions that allow the chest to fully recoil between each push, ensuring effective blood circulation during the process.
Delivering Effective Rescue Breaths
The specific question of how many breaths to deliver per minute is directly related to the ventilation component of CPR. When rescue breathing is performed independently of compressions, such as for a child who has a pulse but is not breathing adequately, the recommended rate is approximately 20 to 30 breaths per minute. This translates to delivering one breath every two to three seconds.
However, when breaths are integrated into the 30:2 compression cycle, the number of breaths per minute is determined by the overall rhythm. The two breaths are delivered during a short pause after every set of 30 compressions. Each individual breath should last about one second and must be gentle, only introducing enough air to make the chest visibly rise.
To deliver an effective breath, the rescuer must first ensure the airway is open by performing a slight head-tilt and chin-lift maneuver. The rescuer then creates a seal over the child’s mouth, pinching the nose closed to prevent air leakage. It is important to avoid excessive ventilation, which means not blowing too hard or too quickly, as this can cause air to enter the stomach and lead to complications.
Two-Rescuer CPR: Adjusted Ratios
When a second trained rescuer is available, the standard protocol shifts to the 15 compressions to 2 breaths (15:2) ratio. This change is designed to enhance the effectiveness of CPR by increasing the frequency of ventilations. The presence of a second rescuer allows for a more coordinated approach, minimizing the time compressions are paused for breathing.
In this coordinated setting, one rescuer focuses primarily on delivering the chest compressions at the same rate of 100 to 120 per minute. The second rescuer prepares to deliver the two rescue breaths after every 15th compression. The two rescuers should swap roles approximately every two minutes, or after five cycles of 15:2, to prevent physical fatigue and maintain the quality of the compressions.
If the second person is untrained or cannot effectively coordinate with the primary rescuer, the single-rescuer 30:2 ratio should be maintained to avoid confusion and poor-quality care. The 15:2 ratio is a professional adjustment focused on teamwork and maximizing the delivery of both circulation and oxygenation.
Transitioning Care: When to Stop and What Happens Next
A lay rescuer should continue the cycles of CPR until one of several specific conditions is met:
- The child shows an obvious sign of life, such as purposeful movement or breathing normally.
- Trained emergency medical services (EMS) personnel arrive and take over care.
- The scene becomes unsafe for the rescuer to continue.
- The rescuer is alone and becomes too exhausted to perform high-quality compressions.
If an Automated External Defibrillator (AED) becomes available, it should be applied to the child as soon as possible. The AED is a device that can analyze the heart’s rhythm and deliver an electrical shock if needed. Pediatric pads and a dose attenuator should be used for children if available. The rescuer should follow the AED’s prompts, delivering a shock if advised, and immediately resuming the compression-to-breath cycle for two minutes after the shock is given or if no shock is advised.