When an infant (typically under one year of age) is found unresponsive, immediate, decisive action is required. This article outlines the sequence of life-saving steps to take until trained emergency medical personnel arrive. It is not a substitute for professional medical advice or formal cardiopulmonary resuscitation (CPR) training.
Immediate Assessment and Activating Emergency Services
The first step is to ensure the environment is safe for both you and the infant. After confirming the scene is safe, gently attempt to stimulate the infant by tapping the soles of their feet to check for any response. Never shake an infant, as this can cause further injury.
Next, check for breathing and signs of life, which should take no more than 10 seconds. If the infant is unresponsive and not breathing or is only gasping, immediately activate the emergency response system.
A lone rescuer who did not witness the collapse should follow the “Care First” protocol. This means providing life support for approximately two minutes (five cycles of CPR) before pausing to call 911 or the local emergency number. If another person is present, one individual should call emergency services immediately while the other begins care. When calling, clearly state your location and that an infant is unresponsive and not breathing, then follow the dispatcher’s instructions.
Performing Rescue Breathing and Chest Compressions
Initiating CPR is necessary if the infant is unresponsive and not breathing normally. Begin by placing the infant on their back on a firm, flat surface. Open the airway using the head-tilt/chin-lift maneuver, ensuring the neck is not overextended.
Deliver two rescue breaths after opening the airway by sealing your mouth over the infant’s mouth and nose simultaneously. Each breath should be a gentle puff lasting about one second, just enough to make the chest visibly rise. Following the breaths, immediately begin chest compressions, aiming for a rate of 100 to 120 compressions per minute.
Position two fingers—typically the index and middle fingers—on the center of the infant’s chest, just below the nipple line. Push hard and fast, compressing the chest about 1.5 inches deep, or approximately one-third of the chest’s depth. The compression-to-ventilation ratio for a lone rescuer is 30 compressions followed by 2 breaths, which should be continued in repeating cycles.
Specific Steps for Airway Obstruction (Choking)
The procedure changes if an infant is conscious but cannot cry, cough, or breathe due to a complete airway obstruction. For a conscious, choking infant, the focus is on a sequence of back blows and chest thrusts to dislodge the foreign object.
Lay the infant face-down along your forearm, using your thigh for support, ensuring the infant’s head is lower than their chest. Deliver up to five firm back blows between the shoulder blades using the heel of your hand.
If the back blows are unsuccessful, turn the infant face-up, supporting the head and neck, and keep the head lower than the chest. Deliver up to five quick chest thrusts with two fingers positioned as they would be for CPR. This sequence of five back blows and five chest thrusts should be repeated until the obstruction is cleared or the infant becomes unresponsive.
If the infant becomes unresponsive while choking, the procedure transitions immediately to CPR. Begin with chest compressions. Before delivering rescue breaths, look inside the infant’s mouth only if you can see the object. If the object is visible, attempt to remove it with a finger sweep; otherwise, do not perform a blind finger sweep, as this may push the object further down the airway.
Monitoring and Handing Over Care
Once CPR has begun, it must be continued without interruption until one of three outcomes occurs: emergency medical services (EMS) personnel arrive and take over care, an Automated External Defibrillator (AED) is available and ready for use, or the infant shows definitive signs of life. Signs of life include purposeful movement, crying, or normal breathing. Do not stop CPR simply because you are tired, unless you are physically unable to continue.
If the infant revives and begins breathing normally, place them in a recovery position. This involves positioning the infant on their side, supporting the head and neck, to help keep the airway open and prevent aspiration. The infant must be continuously monitored until professional help arrives, watching for any changes in their breathing or responsiveness.