Apnea in a child refers to the cessation of breathing, which is a life-threatening medical emergency. For infants, an apneic episode is defined as a pause in breathing lasting 20 seconds or longer, or a shorter pause accompanied by a change in color or heart rate. This cessation of airflow prevents oxygen from reaching the brain and vital organs, making the situation time-sensitive. Recognizing the signs and activating professional medical help is the primary step.
Recognizing Apnea and Activating Emergency Response
When a child is found unresponsive, assess the situation immediately. An apneic child will show no signs of chest movement, may be limp, and often displays a change in skin color, such as turning pale or blue (cyanosis). After ensuring the environment is safe, gently tap the child and shout to check for a response.
If the child does not respond, immediately activate the emergency response system by calling 911 or your local emergency number. Clearly state that you have an unresponsive child who is not breathing. The emergency dispatcher can provide guidance while help is on the way.
While waiting for help, quickly check the child’s airway, breathing, and circulation. Look closely at the chest and abdomen for movement for no more than 10 seconds to confirm the absence of breathing and check for a pulse.
If the child is unresponsive but has a pulse, provide simple, non-invasive stimulation, such as briskly rubbing the chest or gently thumping the soles of their feet. If the child remains unresponsive, position the head correctly to open the airway. For an infant, this means a neutral position; an older child may need a slight head-tilt, chin-lift maneuver. If the child has a pulse but is not breathing, initiate rescue breathing at a rate of approximately one breath every two to three seconds.
Hands-On Interventions: Rescue Breathing and Compressions
If the child is not breathing and no pulse is felt within the 10-second check, or if the heart rate is less than 60 beats per minute with signs of poor perfusion, cardiopulmonary resuscitation (CPR) must be started immediately. Lay rescuers should only perform CPR if they have formal training in pediatric life support or are receiving instructions from the emergency dispatcher. CPR involves a sequence of chest compressions and rescue breaths.
Compression Ratios
For a single rescuer, the ratio is 30 compressions followed by 2 rescue breaths (30:2). If a second trained rescuer is present, the ratio is adjusted to 15 compressions to 2 breaths (15:2). Compressions should be delivered at a consistent rate of 100 to 120 per minute for all ages.
Compression Technique
The depth of compressions should be about one-third of the anterior-posterior diameter of the chest, translating to approximately 1.5 inches for an infant and 2 inches for a child. Proper technique requires the rescuer to allow the chest to recoil fully after each compression to permit the heart to refill with blood. Rescue breaths should be delivered over about one second, providing enough air to make the child’s chest visibly rise.
For infants, compressions are performed using two fingers on the breastbone just below the nipple line. For older children, one or two hands may be used, depending on the child’s size, with the heel of the hand placed on the lower half of the breastbone. Intervention continues until the child shows signs of life, such as purposeful movement or normal breathing, or until emergency medical personnel take over care.
Hospital Care and Identifying the Source of Apnea
Once the child arrives at the hospital, medical staff focus on stabilization, including continuous cardiac and respiratory monitoring. The child may require respiratory support, such as supplemental oxygen, and interventions like fluid resuscitation. After stabilization, the medical team begins a diagnostic workup to determine the underlying cause of the apneic episode, as resuscitation alone does not prevent recurrence.
Diagnosis involves obtaining a medical history and conducting specialized testing, with a sleep study (polysomnography) being the standard for many breathing disorders. Apnea can stem from various sources, including central causes, where the brain fails to send the correct signals to the breathing muscles. Obstructive causes, such as enlarged tonsils and adenoids blocking the airway, are also common in children.
Other potential medical causes investigated include underlying infections, cardiac issues, or neurological problems. Treatment is individualized based on the diagnosis; for example, obstructive sleep apnea may be treated with adenotonsillectomy to remove the blockage or with a Continuous Positive Airway Pressure (CPAP) machine. Specialized follow-up care is then arranged to monitor the child and prevent future episodes.