Cardiopulmonary resuscitation (CPR) for infants is a specific procedure that differs significantly from adult protocols due to anatomical differences. An infant is defined as a child younger than one year of age. Their survival depends on immediate, high-quality intervention. These instructions reflect current standard guidelines, but they are not a replacement for certified training. Prompt initiation of chest compressions and rescue breaths is paramount.
Assessing the Situation and Activating Help
The first step for a single rescuer is to quickly determine if the infant needs help and to activate the emergency response system. To check for responsiveness, gently tap the infant’s foot or shoulder and shout their name, but never shake them. If the infant is unresponsive and is not breathing, or is only gasping, immediate action is required.
Simultaneously with checking for breathing, a single rescuer should check for a pulse. The pulse is typically checked at the brachial artery on the inside of the upper arm, for no more than ten seconds. Since the primary cause of cardiac arrest in infants is often a respiratory issue, the timing of calling for help is crucial when alone.
If the collapse was witnessed, the rescuer should call emergency services immediately before starting CPR. Conversely, if the collapse was unwitnessed, the protocol is to provide two minutes of care first before calling for help. This is because providing immediate oxygenation and circulation is most likely to reverse the respiratory failure that led to the arrest. Before beginning compressions, position the infant on their back on a firm, flat surface to ensure compressions are effective.
The Mechanics of Delivering Infant Compressions
For a single rescuer, the recommended technique for delivering chest compressions utilizes two fingers. The index and middle fingers are placed on the lower half of the breastbone, or sternum, just below an imaginary line connecting the infant’s nipples. Avoid pressing on the very bottom tip of the sternum, known as the xiphoid process, as this can cause internal injury.
The compressions must be delivered at a consistent rate of 100 to 120 compressions per minute. This rate is necessary to maintain adequate blood flow to the infant’s brain and other vital organs. The depth of each compression requires the chest to be depressed by approximately 1.5 inches, or about one-third the total depth of the chest.
Allowing the chest to fully recoil between each push is essential for effective compressions. Complete chest wall release permits the heart to refill with blood, ensuring the next compression is effective at circulating oxygenated blood. Leaning on the chest between compressions prevents this refilling and reduces the overall quality of the CPR being delivered.
Maintaining the 30:2 Cycle
The single-rescuer protocol integrates compressions with rescue breaths using a ratio of 30 compressions followed by 2 breaths. This cycle is performed continuously to ensure the infant receives both mechanical circulation and oxygenation. The goal is to minimize the interruption between the 30th compression and the first rescue breath to maintain blood flow.
To deliver the two rescue breaths, the rescuer should gently tilt the infant’s head into a neutral or “sniffing” position to open the airway. The rescuer’s mouth must cover both the infant’s mouth and nose to create an effective seal. Each breath should be a gentle puff of air, lasting about one second, with only enough volume to make the chest visibly rise.
After the two breaths are delivered, the rescuer must immediately return to compressions to begin the next cycle of thirty. Maintain this 30:2 cycle without interruption for two minutes before calling emergency services, if they have not already done so. The cycles should continue until professional help arrives, an automated external defibrillator (AED) is ready to use, or the infant shows definitive signs of life.