Infant Cardiopulmonary Resuscitation (CPR) is an emergency procedure performed on a baby under one year of age whose heart or breathing has stopped. This technique combines chest compressions and rescue breathing to manually circulate oxygenated blood to the brain and other organs until professional help arrives. Unlike adults, where cardiac arrest is often caused by a sudden heart event, an infant’s heart stops due to respiratory failure, such as from choking, drowning, or severe illness. Immediate action is necessary since permanent brain damage can begin within minutes of blood flow stopping.
Recognizing the Need for Infant CPR
The decision to begin Infant CPR relies on recognizing specific signs of life-threatening distress, starting with an assessment of responsiveness. To check for a response, gently tap the bottom of the infant’s foot or lightly squeeze their shoulder while calling their name loudly. If the baby is limp, does not wake up, move, or make any sound, they are considered unresponsive.
After confirming unresponsiveness, check for normal breathing and signs of circulation for no more than 10 seconds. Look for the chest to rise and fall, listen for breath sounds, and feel for air movement. If the infant is not breathing, or is only exhibiting agonal gasps (irregular, noisy, and ineffective breaths), start resuscitation immediately. Signs of poor circulation, such as pale or bluish skin and a heart rate below 60 beats per minute, also indicate an immediate need for CPR.
Essential Components of the Procedure
Infant CPR requires specific modifications for the infant’s smaller body size. To deliver chest compressions, the infant must be placed on a firm, flat surface. The rescuer uses two fingers—the index and middle fingers—placed in the center of the chest, just below the nipple line on the breastbone.
Compressions must be delivered at a steady rate of 100 to 120 per minute, which is the same pace recommended for adults. The compression depth should be approximately 1.5 inches, or about one-third the front-to-back depth of the infant’s chest. Allowing the chest to fully recoil after each compression is necessary to ensure adequate blood flow returns to the heart. For two rescuers, an alternative technique involves encircling the infant’s chest with both hands and using the two thumbs for compressions, which may be more effective for maintaining depth and consistency.
Rescue breaths require gently opening the infant’s airway by tilting the head only slightly past a neutral position. Because an infant’s airway is fragile, hyperextension of the neck must be avoided. The rescuer’s mouth should cover both the infant’s nose and mouth simultaneously to create a seal, then deliver a gentle puff of air over one second. The volume of air should be just enough to make the infant’s chest visibly rise, indicating a successful breath.
The ratio of compressions to breaths depends on the number of rescuers present. For a single rescuer, the recommended ratio is 30 compressions followed by 2 rescue breaths. If two trained rescuers are present, the ratio changes to 15 compressions followed by 2 rescue breaths.
The Critical Sequence of Action
The procedural flow of a pediatric emergency begins with ensuring the scene is safe before approaching the infant. After determining the infant is unresponsive and not breathing normally, the next step is to activate the emergency response system. The flow of action for infants differs from adults based on whether the collapse was witnessed or unwitnessed.
In an unwitnessed collapse, the rescuer should perform 2 minutes of CPR first before calling emergency services. This is because the cause is likely a breathing problem that requires immediate ventilations and compressions to oxygenate the blood. After the two minutes of care, the rescuer should then call for help and retrieve an Automated External Defibrillator (AED) if one is available.
Conversely, if the collapse was witnessed, the rescuer should immediately call emergency services first, then begin CPR. This “Call First” approach is used when a primary cardiac issue is suspected.
If there are two rescuers, one should begin CPR immediately while the second rescuer calls for help and retrieves the AED. Rescuers should switch roles approximately every two minutes to prevent fatigue, ensuring that compressions are paused for no more than 10 seconds during the transition.
Formal Training and Medical Follow-Up
Reading about Infant CPR is not a substitute for hands-on, certified training from organizations like the American Heart Association or the Red Cross. Formal courses provide practice on manikins, allowing a rescuer to develop the muscle memory needed for proper compression depth, rate, and rescue breath technique.
Once emergency medical services arrive, the rescuer transfers care to the professionals, providing a history of the event. An AED may be used on an infant, but it requires specialized pediatric pads or a dose-attenuator cable to deliver a lower level of electrical energy. If the infant revives and begins breathing normally, they should be carefully placed in the recovery position—on their side—to help keep the airway open and prevent aspiration. Continue monitoring their breathing until medical personnel take over.