Pediatric Basic Life Support (BLS) involves a systematic sequence of actions to save a child or infant experiencing a life-threatening emergency. Cardiac arrest in children often results from respiratory failure, making the immediate delivery of compressions and rescue breaths essential for survival. A one-person rescue requires standardized interventions that differ from adult protocols, accounting for the child’s smaller size and the underlying cause of collapse.
Scene Safety and Activating Emergency Response
The first action upon encountering a collapsed child or infant is to confirm the safety of the surrounding environment. Once safe, check for responsiveness by gently tapping the child’s shoulder or the soles of an infant’s feet. If the child is unresponsive, shout for nearby help and assess for normal breathing and a pulse simultaneously. This check must take 5 to 10 seconds. Check the brachial artery for an infant or the carotid or femoral artery for a child. If no pulse is felt, or if the pulse is less than 60 beats per minute with signs of poor circulation, initiate cardiopulmonary resuscitation (CPR) immediately.
The lone rescuer must decide between “Call First vs. Care First” for emergency activation. For an unwitnessed collapse, which suggests a primary respiratory problem, provide two minutes of CPR (Care First). This ensures the child receives immediate oxygenation before the rescuer leaves to activate EMS and retrieve an AED. If the collapse was witnessed and sudden, suggesting a primary cardiac cause, the rescuer should immediately activate the emergency response system (Call First) before beginning CPR.
The Circulation Focus: Starting Chest Compressions
If the assessment reveals no pulse or abnormal breathing, the rescuer must begin high-quality chest compressions immediately, following the Circulation-Airway-Breathing (C-A-B) sequence. Compressions circulate oxygenated blood to the brain and vital organs. Proper hand placement and compression depth vary significantly between an infant and a child.
Infant Compressions
For an infant (younger than one year), the lone rescuer uses the two-finger technique on the lower half of the breastbone, just below the nipple line. The chest must be compressed to a depth of approximately 1.5 inches (4 centimeters), or about one-third of the chest depth. Avoid pressing on the xiphoid process.
Child Compressions
For a child (one year old up to puberty), the rescuer should use the heel of one or two hands, depending on the child’s size, placed on the lower half of the breastbone. The compression depth is about two inches (5 centimeters), or approximately one-third of the chest depth. For both age groups, maintain a rate of 100 to 120 compressions per minute. Allow complete chest recoil after each compression to permit the heart to refill with blood.
Airway Management and Rescue Breaths
After delivering the initial 30 compressions, the lone rescuer must open the airway and provide two rescue breaths, maintaining the 30:2 compression-to-ventilation ratio. Open the airway using the head tilt–chin lift maneuver, which moves the tongue away from the back of the throat. In infants, avoid over-tilting the head, as hyperextension can close off the airway due to the soft trachea.
The two rescue breaths should be delivered over approximately one second each, ensuring the chest visibly rises. For infants, the rescuer may cover both the mouth and nose to create a tight seal, while the mouth-to-mouth technique is used for a child. Avoid overly forceful ventilation, as this can lead to air entering the stomach and risks complications like regurgitation.
Minimize the time compressions are interrupted, aiming for less than ten seconds between the last compression and the delivery of the first rescue breath. This emphasis on ventilation acknowledges that most pediatric cardiac arrests stem from a lack of oxygen.
Sustaining CPR and Transitioning to Advanced Support
The rescuer must continue the cycle of 30 compressions and two breaths for two minutes (approximately five cycles). If EMS was not activated initially (Care First scenario), the rescuer must pause after two minutes to call for emergency services and retrieve an AED. The AED can deliver an electric shock to correct certain heart rhythms.
When an AED becomes available, attach the appropriate-sized pads, using pediatric attenuator pads for children up to eight years old if possible. After the AED analyzes the heart rhythm, follow its instructions, immediately resuming CPR for two minutes after any shock delivery.
The resuscitation effort should continue without interruption until one of the following occurs:
- The child shows clear signs of life.
- The scene becomes unsafe.
- The rescuer is too exhausted to continue.
- Trained advanced life support (ALS) providers take over care.