Infant Cardiopulmonary Resuscitation (CPR) requires precise technique due to anatomical differences and the common causes of cardiac arrest in this age group. Unlike adults, an infant’s heart typically stops because of a respiratory problem, such as choking or severe illness. Effective CPR involves standardized guidelines that balance generating sufficient blood flow with avoiding injury to the small, fragile body. Understanding the specific measurements for chest compressions is necessary for intervention in an emergency.
Defining the Infant and Compression Depth
For CPR guidelines, an infant is defined as a child from birth up to one year of age. This age bracket has distinct requirements separate from both children and adults. The primary numerical specification for this group is the depth of chest compression. Current guidelines recommend that compressions should be approximately 1.5 inches deep. This measurement corresponds to compressing the chest by about one-third of its total anterior-posterior depth, which is necessary for circulating oxygenated blood to the brain and other organs.
Proper Technique and Hand Placement
The technique used to achieve the target depth varies depending on the number of rescuers present.
Single Rescuer Technique
For a single rescuer, the most widely taught method involves using two fingers. These fingers are placed on the center of the infant’s chest, specifically on the breastbone just below the nipple line. The compression force should be directed straight down onto the sternum, without leaning on the chest between compressions. The infant must be placed on a firm, flat surface to ensure the force translates directly into chest depression.
Two Rescuer Technique
When two rescuers are available, the preferred method is the two-thumb encircling technique. One rescuer wraps both hands around the infant’s chest, placing their thumbs side-by-side on the lower half of the breastbone. The fingers support the infant’s back, providing a firm base. This two-thumb technique is generally considered more effective at achieving optimal depth and generating higher blood pressure.
Compression Rate and Ratio
The speed and rhythm of compressions are important components of high-quality infant CPR. The compression rate should be delivered at a pace of 100 to 120 compressions per minute. This rapid rate ensures a continuous flow of blood to the body’s vital systems.
The number of compressions must be coordinated with rescue breaths, forming a compression-to-ventilation ratio. When only one rescuer is present, the ratio is 30 compressions followed by 2 breaths (30:2). If two trained rescuers are present, the ratio changes to 15 compressions followed by 2 breaths (15:2). The 15:2 ratio acknowledges that respiratory failure is the most likely cause of the cardiac event in infants. Rescuers should switch roles every two minutes to prevent fatigue.
Why Accurate Depth Matters
The 1.5-inch compression depth requirement is based on the physiological need to pump blood effectively without causing injury. Compressions that are too shallow (less than one-third of the chest depth) fail to create adequate pressure to circulate blood to the brain and heart. Insufficient blood flow reduces the chances of survival because the organs are starved of oxygen.
Conversely, pushing too deeply can be dangerous for an infant’s delicate internal structure. Compressing the chest beyond half its depth increases the risk of serious complications, including rib fractures or internal trauma to the liver and lungs. Finding the precise middle ground ensures that CPR is both effective and safe for the infant patient.
Allowing the chest to fully recoil after each compression is another factor in effective blood circulation. Full recoil permits the heart to fully refill with blood between compressions, maximizing the volume of blood pumped out. Without this complete release, the heart cannot adequately prepare for the next compression, and the overall blood flow generated is reduced.