When a child suddenly collapses and is not breathing, the immediate reaction of any witness can determine the outcome. This time-sensitive situation demands swift and organized action. The child’s survival depends on a quick response that focuses on activating professional help and delivering high-quality, life-sustaining support until emergency medical services arrive. Understanding the correct sequence of steps for a lay rescuer is essential.
Assessing the Scene and Activating Emergency Services
Before touching the child, a rescuer must quickly confirm the scene is safe from hazards like traffic or live wires. The first step is to check for responsiveness by tapping the child’s shoulder and shouting loudly, while simultaneously checking if they are breathing normally. A child is defined in this context as between one year old and the onset of puberty.
If the child is unresponsive and not breathing, or is only gasping, the rescuer must immediately shout for nearby help. The next action depends on whether the collapse was witnessed, which informs the “Call First vs. Care First” decision. If the collapse was witnessed, implying a likely cardiac cause, the rescuer should call emergency services right away and retrieve an Automated External Defibrillator (AED) if one is nearby.
If the collapse was unwitnessed, suggesting a more probable respiratory cause, a single rescuer should provide about two minutes of cardiopulmonary resuscitation (CPR) before leaving the child to call for help and find an AED. This initial care provides oxygen and circulation to a child whose heart may have stopped due to a lack of oxygen. Contacting emergency services promptly is necessary to bring advanced medical support to the scene.
Initiating Child Cardiopulmonary Resuscitation (CPR)
Once emergency services have been activated, the focus shifts to initiating CPR. High-quality chest compressions must be delivered at a rate between 100 and 120 per minute, pushing hard and fast on the center of the chest. The compression depth should be about two inches, or approximately one-third the depth of the child’s chest.
The rescuer should use one or two hands, depending on the child’s size, to achieve the correct depth. Allow the chest to fully recoil after each compression, ensuring the heart can refill with blood between pushes. Minimizing interruptions in compressions is a core component of effective CPR, as blood flow stops completely whenever compressions pause.
After compressions, rescue breaths must be provided to deliver oxygen to the child’s lungs. For a single rescuer, the ratio is 30 compressions followed by two breaths; two rescuers should use a 15-to-two ratio. To deliver a breath, open the airway using the head tilt-chin lift maneuver, gently tilting the head back and lifting the chin. The breath should be delivered gently over one second, just enough to make the child’s chest visibly rise, and then watch the chest fall before delivering the second breath.
The initial breaths are important in children because their hearts often stop due to a lack of oxygen, which rescue breathing helps to correct. These cycles of compressions and breaths must continue until the AED arrives or emergency medical personnel take over. Maintaining a consistent rhythm and proper depth ensures the child receives the best chance of survival.
Utilizing Automated External Defibrillators (AEDs)
The Automated External Defibrillator (AED) should be applied as soon as it is available, as early defibrillation greatly increases the chance of survival. Turn on the device and follow its verbal or visual prompts immediately. For children between one and eight years old, or those weighing less than 55 pounds, pediatric pads or a dose attenuation system should be used if available.
Pediatric pads are smaller and contain a built-in mechanism that reduces the energy level of the electrical shock. If pediatric pads are not available, adult pads should be used, but placement must be adjusted to ensure they do not touch each other. One pad should be placed on the front of the chest, and the other on the child’s back, in an anterior-posterior configuration.
The AED will analyze the child’s heart rhythm and advise whether a shock is needed. Ensure no one is touching the child before delivering the shock. After the shock is delivered, or if the AED advises no shock, immediately resume chest compressions and follow the device’s prompts. CPR must continue while the AED is analyzing the heart rhythm or charging to minimize interruptions in blood flow.
Transitioning Care and Follow-Up
CPR should continue uninterrupted until one of three conditions is met: the child shows definitive signs of life (such as purposeful movement or normal breathing), emergency medical services arrive and take over care, or the rescuer is too exhausted to continue. If the child regains consciousness or begins breathing normally, immediately stop compressions and place the child in the recovery position. This position helps keep the airway open and prevents aspiration if the child vomits.
The child should be rolled onto their side, with one knee bent to support their body and the head tilted back slightly to maintain an open airway. Even if the child appears to be breathing effectively, monitor them closely until professional help arrives. The period following such a traumatic event can be emotionally taxing for both the family and the rescuer.
Witnessing or participating in a resuscitation can lead to significant psychological stress. Seeking support and debriefing after the event is recommended for the rescuer to process the emotional impact of the life-saving effort. While providing immediate, high-quality care is the primary goal, the long-term well-being of all involved should also be considered.