An Automated External Defibrillator (AED) analyzes a person’s heart rhythm and delivers an electrical shock to restore a normal heartbeat during sudden cardiac arrest. This condition occurs when the heart’s electrical activity becomes chaotic, preventing it from effectively pumping blood. Immediate action with an AED is important, as survival decreases by about 10% every minute without defibrillation. While AEDs are built for use by bystanders with minimal training, specific considerations apply when treating a small body, such as an infant or young child.
Equipment Considerations for Pediatric AED Use
The primary concern when using an AED on a small child is ensuring the electrical dose is appropriate for their body size. Standard adult AEDs deliver a high-energy shock, typically ranging from 120 to over 200 joules. Pediatric pads or a child key system reduce this energy to a safer level (often 50 to 70 joules), suitable for children generally under eight years old or weighing less than 55 pounds (25 kg).
If a pediatric system is unavailable, adult pads should be used as a last resort, since any attempt at defibrillation is better than none. Adult pads will deliver the full, unattenuated shock, making careful placement even more important to ensure the current passes effectively through the heart.
Why Standard Pad Placement Fails on Small Bodies
The standard placement for AED pads on an adult or large child is known as the anterior-lateral position. This involves placing one pad on the upper right side of the chest, just below the collarbone, and the other pad on the lower left side of the rib cage, below the armpit. This configuration creates a current pathway that effectively runs directly through the heart muscle.
This standard technique is inappropriate for infants and small children because the size of the pads can lead to them touching or overlapping on a tiny chest. If the conductive surfaces of the pads make contact, the electrical current will follow the path of least resistance. This results in the current arcing between the pads outside the body, rather than passing through the heart. When this happens, the shock is ineffective at correcting the cardiac rhythm and may also cause burns to the skin where the pads meet.
The Anterior-Posterior Placement Technique
To eliminate the risk of the pads touching and ensure the electrical current crosses the heart, the recommended technique for infants and small children is the Anterior-Posterior placement. This method maximizes the distance between the pads, creating a clear pathway for the energy to travel directly through the center of the chest.
To apply this technique, the first pad is placed on the center of the child’s bare chest. The second pad is then placed on the child’s back, positioned between the shoulder blades. This front-and-back positioning ensures the heart is situated directly between the two electrodes, regardless of the pad size.
Applying the back pad requires briefly and carefully rolling the child onto their side. Once the back pad is firmly in place, the child must be immediately returned to their back to continue CPR and allow the AED to analyze the rhythm and deliver the shock. This alternative placement guarantees separation and optimizes the delivery of the electrical current.