Cardiopulmonary resuscitation (CPR), or Basic Life Support (BLS), is a sequence of actions adapted for pediatric patients, including a 7-year-old child. The goal of BLS is to circulate oxygenated blood to the brain and other organs until advanced medical help arrives. Guidelines for a child (ages one year until puberty) focus on minimizing interruptions to chest compressions while providing adequate rescue breaths. Permanent brain damage can begin after only four minutes without oxygen, making rapid intervention necessary.
Recognizing the Need for CPR and Initial Steps
The first step involves verifying that the scene is safe for the rescuer and the child. Check for responsiveness by gently tapping the child’s shoulder and shouting. If the child does not respond, immediately shout for nearby help and activate the emergency response system (e.g., calling 911).
Quickly assess the child’s breathing and check for a pulse simultaneously, taking no more than ten seconds. CPR should begin immediately if the child is not breathing, is only gasping, or has no pulse. A heart rate below 60 beats per minute is also an indication to start chest compressions.
The sequence for activating the emergency system depends on whether the collapse was witnessed. If a single rescuer witnesses the collapse, they should activate the emergency response system and retrieve an Automated External Defibrillator (AED) immediately before starting CPR. If the collapse was not witnessed, the rescuer should perform two minutes of CPR first. This is because unwitnessed collapses in children are often due to respiratory issues, making ventilations initially more beneficial.
Determining the Correct Compression to Ventilation Ratio
The correct compression to ventilation (C:V) ratio for a 7-year-old depends on the number of trained rescuers present. This ratio determines the cycle of chest compressions followed by rescue breaths. Pediatric guidelines acknowledge that cardiac arrest in this age group (one year to puberty) is frequently caused by respiratory failure.
Single Rescuer Ratio
When only a single rescuer is present, the recommended C:V ratio for a child is 30 compressions followed by 2 breaths (30:2). This ratio matches the adult standard, ensuring simplicity for lay rescuers. The rescuer should aim to complete approximately five cycles within a two-minute period before pausing to call for help or retrieve an AED.
This ratio balances delivering blood flow through compressions and re-oxygenating the blood through ventilations. Maintain a compression rate between 100 and 120 compressions per minute, minimizing interruptions for breaths.
Two-Rescuer Ratio
When two or more trained rescuers are present, the C:V ratio changes to 15 compressions followed by 2 breaths (15:2). This ratio is adapted for pediatric BLS and allows for increased frequency of rescue breaths. The lower compression count per cycle is beneficial when the cause of cardiac arrest is likely respiratory.
In this scenario, one rescuer focuses on high-quality chest compressions, while the other manages the airway and provides ventilations. Rescuers should coordinate switching roles about every two minutes (or after five cycles) to prevent fatigue and maintain compression quality. The switch must be executed quickly to ensure interruptions to chest compressions do not exceed 10 seconds.
Delivering Effective Compressions and Rescue Breaths
Delivering effective compressions and breaths requires attention to the correct physical technique, depth, rate, and volume. For chest compressions on a 7-year-old, the child must be placed on a firm, flat surface. The rescuer should use the heel of one or two hands, depending on the child’s size, pressing down on the lower half of the breastbone, just below the nipple line.
The depth of each compression should be approximately two inches, or roughly one-third of the total chest depth. A consistent rate of 100 to 120 compressions per minute must be maintained. Allowing the chest to fully recoil after each compression is fundamental to high-quality CPR, as this allows the heart to refill with blood.
To deliver rescue breaths, first open the child’s airway using the head-tilt/chin-lift maneuver. Place one hand on the forehead to tilt the head back gently, while the fingers of the other hand lift the chin. If a neck injury is suspected, use a jaw-thrust maneuver without tilting the head.
The rescuer seals their mouth over the child’s mouth, pinching the nose closed to prevent air leakage. Each breath should be delivered over approximately one second, providing only enough air to make the child’s chest visibly rise. Over-ventilation (breaths that are too forceful or too large) can cause complications by forcing air into the stomach.
Integrating the Automated External Defibrillator (AED)
The Automated External Defibrillator (AED) analyzes the heart’s rhythm and delivers an electrical shock if needed to restore a normal heartbeat. The AED should be applied as soon as it is available, with CPR continuing until the pads are attached and the device is ready to analyze. The AED is recommended for a 7-year-old and provides spoken prompts to guide the rescuer.
For children under eight years old or those weighing less than 55 pounds, pediatric pads or a pediatric attenuator key should be used if available. These special pads reduce the energy dose delivered, making the shock safer for a smaller body. If pediatric equipment is unavailable, standard adult pads should be used, as delivering a higher-energy shock is preferable to delaying defibrillation.
When applying the pads, ensure they do not touch each other. Standard placement involves placing one pad on the upper right chest and the second pad on the lower left side, beneath the armpit. If the pads risk touching, use an alternative anterior-posterior placement: one pad on the front of the chest and the other on the back, between the shoulder blades.