Cardiopulmonary Resuscitation (CPR) is an emergency procedure designed to sustain life when breathing or heart function has stopped. It involves chest compressions and rescue breaths to maintain blood flow and oxygen delivery to vital organs. Understanding the distinctions in CPR techniques for adults versus children is important for effective intervention, as improper application can reduce its life-saving potential.
Defining Adult and Pediatric Patients
For CPR purposes, individuals are categorized by age to guide the appropriate technique and specific adjustments needed for effective delivery. An adult is generally considered someone who has reached puberty or is 12 years of age or older. A child typically ranges from one year old to the onset of puberty. An infant is defined as a person under one year of age.
Core CPR Techniques
Initial assessment for responsiveness involves tapping and shouting for adults and children, and a gentle tap on the foot for infants. If there is no response and no normal breathing, or only gasping, emergency services should be called. For an adult, calling for help immediately is the first step if alone. If alone with a child or infant, two minutes of CPR should be performed before calling emergency services.
Chest compressions vary across age groups. For adults, compressions are performed using two hands, placed in the center of the chest on the lower half of the breastbone. The compression depth should be at least 2 inches (5 cm), but no more than 2.4 inches (6 cm). For children, one or two hands can be used, depending on the child’s size, with placement in the center of the chest. The compression depth for a child is approximately 2 inches (5 cm) or about one-third the depth of the chest. For infants, two fingers are placed just below the nipple line in the center of the chest, or the two-thumb encircling method can be used by two rescuers. The compression depth for an infant is about 1.5 inches (4 cm) or one-third the depth of the chest. The compression rate for all age groups remains consistent, at 100 to 120 compressions per minute. Complete chest recoil must be allowed after each compression.
Rescue breaths also vary in technique. For adults, after opening the airway using a head-tilt/chin-lift maneuver, the rescuer pinches the person’s nostrils shut and covers their mouth with their own, making a seal. Two breaths, each lasting about one second and causing the chest to rise, are delivered after every 30 compressions. For children, the head-tilt/chin-lift maneuver is performed with gentle pressure. The rescuer seals their mouth over the child’s mouth, delivering two breaths that make the chest visibly rise. For infants, the head is tilted to a neutral position, and the rescuer covers both the infant’s mouth and nose with their own to form an airtight seal. Gentle puffs of air are delivered, just enough to make the chest rise, as an infant’s lungs are small. The compression-to-breath ratio is typically 30:2 for a single rescuer across all age groups, but for two rescuers performing CPR on an infant or child, a 15:2 ratio may be used.
Automated External Defibrillator Use
Automated External Defibrillators (AEDs) are important devices that deliver an electrical shock to restore a normal heart rhythm. Adult AED pads are designed for individuals aged eight years and older or those weighing more than 55 pounds, delivering a higher energy shock.
Pediatric AED pads are specifically designed for children under eight years old or weighing less than 55 pounds. These pads, also known as attenuated pads, deliver a reduced energy shock appropriate for a child’s smaller and more delicate heart. Some AEDs may have a key or switch to adjust the shock level for pediatric use without changing the pads. If pediatric pads are unavailable for a child, adult pads can be used, but care should be taken to ensure they do not touch each other by placing one on the front of the chest and the other on the back.
Underlying Reasons for Variation
The differences in CPR techniques are rooted in the distinct physiological and anatomical characteristics of adults, children, and infants. Children and infants have smaller, more delicate bodies with softer, more flexible bones, particularly in their rib cages, making them more susceptible to injury from excessive force. Their airways are narrower and their tongues are relatively larger in proportion to their mouths, increasing the likelihood of airway obstruction. These anatomical differences necessitate gentler compressions and careful airway management.
A significant reason for varied CPR approaches is the common cause of cardiac arrest in different age groups. In adults, cardiac arrest is most frequently caused by primary cardiac events, such as a heart attack. However, in children and infants, cardiac arrest is more often a result of respiratory failure or shock, often due to conditions like airway obstruction, drowning, or severe infections. This difference emphasizes the importance of timely rescue breaths in pediatric CPR, as providing oxygen is crucial for reversing the underlying cause of arrest in many cases.