CPR for an infant is a distinct skill that differs significantly from performing CPR on a child or an adult. The fragile nature of an infant’s body requires a precise technique to ensure compressions are effective without causing harm. In infants, cardiac arrest is most often the result of a breathing problem, which means that proper and immediate intervention is essential for blood oxygenation and survival. Knowing the specific standards for infant chest compressions prepares a lay rescuer to provide effective care during a life-threatening emergency.
Defining the Infant Compression Standard
The recommended depth for chest compressions on an infant is defined by major resuscitation organizations. The chest should be compressed to a depth of at least one-third of the total anterior-posterior (front-to-back) diameter of the infant’s chest. This measurement typically translates to approximately 1.5 inches, or about 4 centimeters, for most infants under one year old.
Achieving this specific depth is necessary because it allows the heart, situated between the breastbone and the spine, to be adequately squeezed. This mechanical pressure generates enough force to circulate oxygenated blood to the brain and other vital organs. Compressing the chest too shallowly will not create enough blood flow, while pushing too deep risks internal injury.
Proper Technique for Infant Chest Compressions
The execution of compressions requires a specific technique to achieve the correct depth and rate while minimizing the risk of injury. For a single rescuer, the two-finger technique is commonly taught, placing the tips of the index and middle fingers on the breastbone just below the imaginary line connecting the infant’s nipples. This method allows the rescuer to focus the force precisely on the center of the chest.
An alternative technique, preferred when two rescuers are present, is the two-thumb encircling hands technique. The rescuer wraps their hands around the infant’s chest, placing both thumbs side-by-side on the breastbone. This approach often results in a greater and more consistent compression depth. Whether using two fingers or two thumbs, compressions must be delivered at a consistent rate of 100 to 120 per minute.
A successful compression sequence requires allowing the chest to fully return to its normal position after each push, known as complete chest recoil. Full recoil permits the heart to refill with blood between compressions, maximizing the amount of blood circulated. The compressions are integrated with rescue breaths, following a ratio of 30 compressions to 2 breaths for a single rescuer, or 15 compressions to 2 breaths when two rescuers are performing CPR.
Context: When to Initiate Infant CPR
Before beginning chest compressions, a rescuer must confirm that the infant is unresponsive and is not breathing normally. Responsiveness is checked by gently tapping the sole of the infant’s foot or shoulder and shouting, avoiding any forceful shaking. If the infant is unresponsive and not breathing, or only gasping, emergency services must be activated immediately.
For a lone rescuer who did not witness the collapse, the recommended protocol is to provide two minutes of CPR (approximately five cycles) before pausing to call 911. This “Care First” approach is used because the cause of cardiac arrest in infants is typically respiratory, making immediate oxygenation and circulation a priority. The current sequence for lay rescuers prioritizes compressions first, following the C-A-B (Compressions, Airway, Breathing) protocol.
The rescuer must ensure the infant is placed on a firm, flat surface to effectively deliver the required compression depth. The airway is opened with a very slight head tilt and chin lift, being careful not to over-extend the neck due to the infant’s delicate anatomy. These preparatory steps ensure compressions are delivered on a stable surface with the airway ready for rescue breaths.