Rescue breathing is a procedure used to supply oxygen to a person who is not breathing but still has a pulse. This intervention is time-sensitive in children because pediatric cardiac arrests frequently stem from respiratory failure rather than a primary heart problem. When a child stops breathing, the lack of oxygen can cause the heart to slow down and eventually stop. Knowing the correct rate for delivering breaths provides the necessary oxygenation to sustain life until professional medical help arrives.
Recognizing When to Begin Rescue Breathing
A child is generally defined in resuscitation guidelines as an individual from the age of one year up to the onset of puberty. Recognizing the need for rescue breathing involves a rapid assessment of their responsiveness and breathing status. The rescuer must look for signs of absent or inadequate breathing, which can include no rise and fall of the chest or only occasional gasping breaths.
It is important to confirm that the child has a pulse, as rescue breathing is only appropriate when the heart is still beating. A pulse check should take no more than ten seconds, feeling for a beat in the carotid artery in the neck or the femoral artery in the groin. If a pulse is present but breathing is absent or inadequate, the priority is to begin rescue breathing immediately.
The decision to call emergency medical services (EMS) depends on the number of rescuers present. If a second rescuer is available, they should activate the emergency response system and retrieve an automated external defibrillator (AED) while the first person begins care. A single rescuer should provide about two minutes of rescue breathing before pausing to call 911. This initial period of ventilation is important because respiratory issues are the most common cause of collapse in children.
Delivering Effective Rescue Breaths to a Child
The technique for delivering rescue breaths must ensure oxygen reaches the child’s lungs without causing injury from excessive force. To establish an open airway, use the head-tilt/chin-lift maneuver, which gently tilts the head back while lifting the chin to move the tongue away from the back of the throat. This action can often clear a blocked airway and is performed unless a neck injury is suspected.
For a child, the recommended rate for rescue breathing is one breath every two to three seconds, which translates to a pace of 20 to 30 breaths per minute. This rate is higher than that for adults because children have a faster normal respiratory rate and metabolic demand. Each individual breath should be delivered over approximately one second, providing enough time for the air to enter the lungs.
The rescuer must form a tight seal over the child’s mouth and pinch the child’s nose shut to prevent air from escaping. Watch the child’s chest during the breath to confirm a visible rise, indicating successful ventilation. Delivering air until the chest just begins to rise prevents over-inflation of the lungs and stomach.
How Child Rates Compare to Infant and Adult Rates
Resuscitation guidelines delineate three distinct age groups: infants, children, and adults, each with a specific treatment protocol. While the basic principles of rescue breathing are similar across all groups, the exact rate varies to match their physiological needs.
Infants require a relatively fast rate of one breath every two to three seconds when they have a pulse but are not breathing. This corresponds to the same 20 to 30 breaths per minute rate used for children. The shared rate reflects the similarly high oxygen demand and respiratory drive in both infants and children compared to adults.
In contrast, the rescue breathing rate for an adult is significantly slower, set at one breath every six seconds, which equals 10 breaths per minute. This slower pace aligns with the adult body’s lower resting respiratory rate and gas exchange requirements. Understanding these age-specific differences ensures the correct amount of oxygen is delivered without causing excessive ventilation.
Completing the Emergency Response
Once rescue breathing has been initiated, the rescuer must continue providing breaths and monitor the child’s condition. A pulse check should be performed about every two minutes to confirm the child still has a heartbeat and ensure the continued appropriateness of the intervention.
If the child’s pulse is absent, or their heart rate drops below 60 beats per minute with signs of poor perfusion, the response must transition immediately to full cardiopulmonary resuscitation (CPR). This involves alternating chest compressions with rescue breaths, as the child is now in cardiac arrest. The compression-to-ventilation ratio is 15 compressions to two breaths for two rescuers, or 30-to-two for a single rescuer.
Care should be maintained until EMS personnel arrive or until the child begins to breathe normally on their own. If the child regains spontaneous breathing but remains unconscious, they should be placed in a recovery position. This position, typically on their side, helps keep the airway open and prevents fluid from being inhaled.