Single-person Basic Life Support (BLS) for a child or infant is a time-sensitive sequence of actions designed to provide oxygen and circulate blood until professional help arrives. Pediatric BLS differs from adult resuscitation because children most often experience cardiac arrest due to respiratory failure, not a primary heart problem. The “seven steps” refer to a progression of assessment and intervention that prioritizes immediate care when a single rescuer is present. This sequential intervention maximizes the chance of survival for infants (under 1 year) and children (1 year to puberty).
Initial Assessment and Activating Emergency Services
The first action in any emergency is ensuring the safety of the scene for both the rescuer and the patient. Scene safety must be verified before approaching the child.
Once the environment is safe, the rescuer checks responsiveness by tapping the shoulder and shouting, “Are you okay?” If the child does not respond, the rescuer should immediately shout for nearby help, but remain with the child. The rescuer must simultaneously check for breathing and a pulse, which should take no longer than 10 seconds. For infants, the pulse is checked at the brachial artery, while for children, the carotid artery or femoral artery is used.
A distinguishing feature of single-rescuer pediatric BLS is the “Care First” principle for an unwitnessed collapse. Since children often suffer from oxygen deprivation, immediate intervention is the priority. If the collapse was unwitnessed, the rescuer performs five cycles of CPR (about two minutes) before leaving the child to call 911 and retrieve an Automated External Defibrillator (AED). If the collapse was witnessed, the rescuer should activate the emergency response system immediately (“Call First”) before starting CPR.
The Core Single-Rescuer CPR Cycle
If no pulse is felt, or if the pulse rate is less than 60 beats per minute with signs of poor perfusion, the rescuer must begin high-quality cardiopulmonary resuscitation (CPR). High-quality CPR involves maintaining adequate depth and rate, minimizing interruptions, and ensuring full chest recoil.
The core single-rescuer pediatric cycle uses a 30-to-2 compression-to-ventilation ratio. The rescuer delivers 30 chest compressions followed by two rescue breaths. This 30:2 ratio is used for both infants and children when only one rescuer is present.
The rate of chest compressions must be between 100 and 120 compressions per minute. The rescuer repeats the 30:2 cycle five times before pausing to re-assess or activate EMS if necessary. Interruptions in chest compressions should be kept to a minimum, ideally less than 10 seconds, to maintain continuous blood flow.
Age-Specific Technique Variations
The physical execution of compressions and ventilations differs based on the patient’s size and age.
Infant Techniques (Under 1 Year)
For infants, the rescuer uses the two-finger technique, placing the fingers on the breastbone just below the nipple line. The compression depth should be approximately 1.5 inches, or about one-third the anterior-posterior diameter of the chest. For ventilations, the rescuer’s mouth covers both the infant’s mouth and nose to form a seal, delivering a small puff of air.
Child Techniques (1 Year to Puberty)
For children, the rescuer can use the heel of one hand or two hands, depending on the child’s size, to achieve the proper depth. The compression depth should be approximately 2 inches, or about one-third the diameter of the chest.
For both age groups, the head-tilt/chin-lift maneuver is performed to open the airway. This maneuver requires a less aggressive tilt than in adults to avoid hyperextension, which can close a child’s flexible airway.
When and How to Discontinue BLS
The decision to stop single-person BLS is based on specific criteria. The rescuer should continue the 30:2 cycle until one of four conditions is met:
- The arrival of trained emergency medical services (EMS) personnel who can take over care with advanced life support equipment.
- The child exhibits clear signs of life, such as spontaneous breathing, movement, or responsiveness.
- The rescuer becomes physically exhausted and can no longer continue high-quality compressions.
- A valid Do Not Resuscitate (DNR) order is presented.
If the child becomes responsive and is breathing normally, the rescuer should turn them onto their side into the recovery position. This ensures the airway remains open while monitoring them continuously until EMS arrives. If the child has a pulse but is not breathing normally, the rescuer should continue rescue breathing at a rate of one breath every 2 to 3 seconds (20 to 30 breaths per minute), checking the pulse every two minutes.