When an infant is unresponsive, checking for a pulse is a first step to determine if the heart is pumping blood effectively. Because a baby’s anatomy differs significantly from an adult’s, the location and technique for this assessment must be precise. Immediate action is necessary because a lack of circulation can lead to irreversible damage within minutes.
Locating and Assessing the Brachial Pulse
The definitive location for checking a pulse on an infant (a child under one year old) is the brachial artery. This artery runs along the inside of the baby’s upper arm, situated between the elbow and the shoulder. The brachial pulse is the preferred site due to its accessibility and reliability.
To perform the check, use two fingers, typically the index and middle fingers, and place them gently on the inner side of the arm. Apply only light pressure; pressing too firmly can compress the artery and block blood flow, resulting in a false negative. This assessment must be completed quickly, taking no less than five seconds and no more than 10 seconds. If the pulse cannot be found or the rescuer is unsure within that 10-second window, chest compressions must begin immediately.
The Critical Threshold for Starting Infant CPR
The pulse check assesses if the infant’s heart is beating and if the rate is sufficient to maintain life. If a pulse cannot be felt within the 10-second limit, chest compressions must begin immediately.
The specific heart rate threshold for initiating cardiopulmonary resuscitation (CPR) is a pulse rate less than 60 beats per minute (bpm). This slow rate indicates that the heart is not pumping enough oxygenated blood to the body’s vital organs.
This low heart rate is often accompanied by signs of poor perfusion, such as pale or bluish discoloration of the skin. If the infant has a pulse below 60 bpm and shows signs of poor perfusion, the rescuer must begin CPR immediately, starting with chest compressions.
Why Infant Pulse Checks Differ from Older Patients
Infant pulse check procedures differ significantly from those used on older children and adults due to anatomical differences. For older patients, the carotid artery in the neck is the standard location. However, using the carotid artery on an infant is avoided because it is less reliable.
The infant’s neck is short, and the carotid artery is small and difficult to locate quickly under stress. Attempting a carotid check also risks inadvertently compressing the trachea or other delicate neck structures. The brachial artery is closer to the surface of the skin, offering a more consistent and accessible pulse point for rapid assessment.