An unresponsive infant or child presents a serious and time-sensitive situation. Unresponsiveness means the child does not move, respond to touch or sound, or appears limp. Calm, immediate action can significantly influence the outcome. This article provides guidance on the initial steps to take before contacting emergency services, ensuring you can provide immediate care.
Initial Assessment and Scene Safety
Before approaching an unresponsive infant or child, ensure the surrounding area is safe for both yourself and the child. Once the scene is safe, gently check for responsiveness. For an infant, this involves lightly tapping or flicking the sole of their foot while speaking loudly. For a child, gently tap their shoulder and shout, asking if they are alright.
Opening the Airway and Checking Breathing
If the child remains unresponsive, the next step involves opening their airway to ensure clear passage for air. The head-tilt, chin-lift maneuver is the standard technique, provided there is no suspicion of a spinal injury. For an infant, gently tilt the head back to a neutral position and lift the chin. For a child, place one hand on their forehead and gently tilt their head back, while using the fingertips of the other hand to lift their chin, ensuring not to press on the soft tissues under the chin. Over-extending an infant’s neck can obstruct their airway due to their flexible anatomy.
After opening the airway, quickly check for breathing for no more than 10 seconds. Look for chest movement, listen for breath sounds, and feel for air on your cheek. Distinguish between normal breathing and agonal breathing, which appears as gasping, irregular, or noisy breaths. Agonal breathing is ineffective and requires immediate intervention, similar to no breathing. If there is any doubt about whether breathing is normal, proceed as if it is not.
Initiating Rescue Breaths or Chest Compressions
If the child is not breathing normally, or only gasping, but has a pulse, begin rescue breaths. For a child, after opening the airway, pinch their nostrils shut and cover their mouth with yours to create a seal. Deliver two breaths, each lasting about one second, watching for the chest to visibly rise with each breath. If the chest does not rise, reposition the head and attempt the breath again.
For an infant, cover both their mouth and nose with your mouth, or just the mouth or nose if a seal cannot be made over both, and deliver gentle breaths, ensuring the chest rises.
If the child is not breathing normally and has no pulse, or a very slow or weak pulse, begin chest compressions, also known as cardiopulmonary resuscitation (CPR). For a child, place the heel of one hand, or both hands if needed for larger children, on the lower half of the breastbone, just below the nipples. Compress the chest about 2 inches (5 centimeters) deep, or approximately one-third the depth of the chest, at a rate of 100 to 120 compressions per minute.
For an infant, use two fingers placed just below the nipple line in the center of the chest. Compress the infant’s chest about 1.5 inches (4 centimeters) deep, or one-third the chest depth, at the same rate. Ensure the chest fully recoils after each compression to allow the heart to refill with blood. The recommended compression-to-breath ratio for a single rescuer is 30 compressions followed by 2 rescue breaths. Continue this cycle without significant interruption.
Determining When to Call 911
The timing for calling emergency services varies depending on the number of rescuers present. If you are the only rescuer, it is recommended to perform approximately 2 minutes of CPR before calling 911. This typically amounts to about five cycles of 30 compressions and 2 breaths. Respiratory arrest is a common cause of cardiac arrest in children, so immediate oxygenation through CPR is highly beneficial.
If another person is present, one rescuer should immediately call 911 while the other begins CPR without delay. This ensures emergency medical services are en route quickly while life-sustaining measures are performed. Stay on the phone with the dispatcher for further guidance, and continue providing care until emergency personnel arrive and take over.