Infant chest compressions are a life-saving procedure performed when a baby’s breathing or heartbeat has stopped. This can occur due to various reasons, including choking, drowning, or other injuries. Cardiopulmonary resuscitation (CPR) for infants involves both rescue breathing, which supplies oxygen to the lungs, and chest compressions, which circulate blood throughout the body. The techniques for infant CPR differ from those used for older children or adults due to an infant’s unique physiology and delicate anatomy.
Recognizing the Need for Infant Compressions
An infant needing compressions will typically be unresponsive, exhibiting no normal breathing, or only gasping. If an infant does not respond to gentle stimulation, such as tapping the bottom of their foot, and is not breathing or is breathing abnormally, immediate action is necessary. It is important to check for signs of life, like movement or coughing, within 10 seconds. If there are no such signs, or if you are unsure, emergency services should be called immediately, and CPR initiated without delay.
Performing Infant Chest Compressions
When preparing to perform infant chest compressions, place the infant on a firm, flat surface to ensure effective compressions. For a single rescuer, compressions are performed using two fingers on the lower half of the breastbone, just below the nipple line. If two rescuers are present, the two-thumb encircling method is preferred, where both thumbs are placed side-by-side on the breastbone, with fingers encircling the infant’s chest. The compression depth should be approximately one-third the depth of the chest, which is about 1.5 inches or 4 centimeters for most infants.
The rate of compressions should be between 100 and 120 per minute. It is important to allow the chest to fully recoil after each compression, enabling the heart to refill with blood and pump it effectively. After a set number of compressions, rescue breaths are administered. For a single rescuer, the compression-to-ventilation ratio is 30 compressions followed by 2 breaths. If two rescuers are present, the ratio changes to 15 compressions to 2 breaths.
To provide rescue breaths, ensure the infant’s head is in a neutral position with the chin gently lifted to open the airway. For infants, cover both the mouth and nose with your mouth to create a seal, then gently deliver a breath, observing for a visible chest rise. If the chest does not rise, reposition the head and attempt the breath again. Initial rescue breaths are often recommended before starting chest compressions.
Key Differences in Infant Compression Techniques
Infant compression techniques vary significantly from those for older children or adults, primarily due to differences in body size and the common causes of cardiac arrest. For adults, two hands are typically used for chest compressions, whereas for infants, two fingers or the two-thumb encircling method are employed. The compression depth for infants is shallower, approximately 1.5 inches (4 cm), compared to 2 inches (5 cm) for children and adults. This reduced depth accounts for the infant’s smaller body and softer bones, requiring less force.
While compression-only CPR can be effective for adult cardiac arrest, which often stems from heart issues, infant cardiac arrest is more frequently caused by respiratory problems. Providing rescue breaths in conjunction with compressions is important for infants to deliver much-needed oxygen. The two-thumb encircling method has been shown to provide more consistent and adequate compression depth compared to the two-finger technique.
Critical Steps After Compressions Begin
Once chest compressions begin, it is important to continue them without significant interruption until emergency medical services (EMS) arrive or the infant shows clear signs of recovery. If multiple rescuers are present, they should switch roles every two minutes to prevent fatigue.
Compressions should only be stopped if the infant begins to show signs of life, such as normal breathing or movement, or if trained medical personnel take over. Another reason to cease compressions is if the rescuer becomes too exhausted to continue safely, or if the scene becomes unsafe. Even if the infant recovers and appears stable, seeking professional medical evaluation is important to address any underlying issues and ensure ongoing well-being.