What Should You Do If You Witness a Child Collapse?

If you see a child suddenly collapse, your first actions in the next sixty to ninety seconds will shape everything that follows: check whether the child responds, shout for someone nearby to call emergency services, and begin chest compressions if the child is not breathing normally. Cardiac arrest in children is rarer than in adults, but survival depends heavily on what bystanders do before paramedics arrive. The gap between collapse and the start of CPR is, in many cases, the difference between a child who recovers well and one who does not.

The First Thirty Seconds

When a child drops to the ground, your instinct to rush over is the right one. Tap the child firmly on the shoulders (or the soles of the feet in a very young infant) and call their name loudly. You are looking for any response: movement, a moan, eye opening. If there is none, the situation is urgent.

Shout for help immediately. If another person is nearby, direct them specifically: “You, call 911” (or your local emergency number) “and bring an AED if there is one.” Being explicit matters because vague calls for help often go unanswered. If you are alone, use your phone’s speaker or speakerphone and call emergency services yourself before doing anything else. Then start CPR. Do not leave a child who is not breathing to go look for a phone.

While checking for responsiveness, glance at the child’s chest. You need to determine whether they are breathing normally. Occasional gasping breaths, sometimes called agonal breathing, are not normal breathing. They look like infrequent, labored gulps of air and can fool bystanders into thinking the child is still breathing on their own. Recognizing agonal breathing as a sign of cardiac arrest is one of the most critical skills a bystander can have, and training programs across Europe have identified it as a core teaching point for this reason.¹ If the child is unresponsive and not breathing normally, treat it as cardiac arrest and begin CPR.

How to Perform Chest Compressions on a Child

CPR on a child is not identical to CPR on an adult, but the principle is the same: push hard and fast on the center of the chest to keep blood circulating to the brain and heart until professional help arrives.

For children roughly age one through puberty, place the heel of one hand (or both hands for a larger child) on the lower half of the breastbone and compress the chest about two inches deep, at a rate of 100 to 120 compressions per minute. That pace is roughly the tempo of a fast pop song. Let the chest come all the way back up between each compression.

For infants under one year, the technique changed with the 2025 American Heart Association guidelines. The old two-finger method has been dropped because it often fails to reach adequate depth. Instead, the AHA now recommends either a one-hand technique or the two-thumb encircling-hands technique, where you wrap both hands around the infant’s torso and press with your thumbs on the breastbone.² How deep should you go? CT-based research found that compressing an infant’s chest to about one-third of its front-to-back diameter reaches roughly half the chest’s internal width, which is in the range most likely to generate effective blood flow.³ In practical terms, that means pushing about one and a half inches for most infants.

If you are trained and willing, give rescue breaths: tilt the head back gently, lift the chin, seal your mouth over the child’s mouth (or mouth and nose for an infant), and give two breaths after every 30 compressions. Each breath should last about one second and be just enough to make the chest visibly rise. If you are not trained in rescue breathing or are uncomfortable doing it, chest compressions alone are still far better than doing nothing.

When the Child Is Choking, Not in Cardiac Arrest

Not every collapse involves the heart. A child who was eating, playing with small objects, or coughing violently may have a foreign-body airway obstruction. The approach here is different from CPR.

For infants with severe choking, the 2025 AHA guidelines recommend alternating cycles of five back blows (delivered between the shoulder blades with the infant face-down along your forearm) and five chest thrusts (similar to compressions, with the infant face-up). Abdominal thrusts are not used on infants. For older children, the guidelines call for five back blows alternating with five abdominal thrusts, similar to the Heimlich maneuver.² If the child becomes unresponsive during choking, transition immediately to CPR.

Using an AED on a Child

An automated external defibrillator can be the single most important tool in a cardiac arrest. These devices are increasingly available in schools, airports, sports venues, and other public spaces. If someone brings one to you, use it right away without stopping CPR until the pads are ready to apply.

Turn the AED on and follow the voice prompts. If pediatric pads or a pediatric attenuator is available, use those for children under about eight years old. These pads deliver a lower energy shock sized for a smaller body. A post-market study of attenuated pediatric pads found that among eight children in ventricular fibrillation who received shocks, all had their abnormal rhythm terminated and five survived to hospital discharge.⁴ If pediatric pads are not available, use adult pads. Place one on the front of the chest and one on the back to avoid overlap. The AHA’s 2025 guidelines emphasize the immediate application and use of an AED with a pediatric attenuator if one is available.² The device will analyze the heart rhythm and advise you whether a shock is needed. You cannot accidentally shock a child whose rhythm does not require it.

Let the 911 Dispatcher Coach You

Even if you have no CPR training, the dispatcher can walk you through every step in real time. This is not a backup plan; it is an effective frontline strategy. A nationwide study in Japan found that dispatcher-assisted bystander CPR dramatically increased the rate at which bystanders actually performed CPR, and it was linked to better neurological outcomes at one month compared to cases where no bystander CPR occurred.⁵

A separate study of over 1,500 pediatric out-of-hospital cardiac arrests confirmed that bystander CPR, whether with or without dispatcher guidance, roughly doubled the odds of the child surviving to hospital discharge compared to cases where no bystander CPR was performed.⁶ The location of the arrest matters too. In public settings, the benefit of bystander CPR was even more pronounced, possibly because witnesses were more likely to act quickly and AEDs were more accessible.⁷

Keep the phone on speaker. The dispatcher will tell you where to place your hands, how fast to push, and when to give breaths. They will stay on the line until paramedics arrive. You do not need to remember everything from this article or a class you took years ago. The dispatcher’s job is to be your real-time guide.

Why Children Collapse in the First Place

Cardiac arrest in children is different from what happens in most adults. While adult cardiac arrest is often caused by a heart attack from clogged arteries, in children and young athletes the underlying causes tend to be structural heart defects, inherited electrical problems in the heart, or abnormal coronary arteries.⁸ Many of these conditions produce no obvious symptoms beforehand, which is what makes sudden collapse so shocking for families.

That said, a study of children and young adults who experienced sudden cardiac arrest found that nearly three-quarters had at least one cardiovascular symptom before the event, most commonly fatigue or lightheadedness. About a quarter had experienced syncope (fainting) or unexplained seizure-like episodes that had never been identified as cardiac in origin.⁹ This is worth knowing because a child who has fainted before, especially during exercise or with no clear trigger, deserves a conversation with a pediatrician about cardiac screening. Not every fainting spell is cardiac, but some are early warning signs that go unrecognized.

Children may also collapse from non-cardiac emergencies including choking, drowning, severe asthma attacks, anaphylaxis, or hypoglycemia.¹⁰ The initial approach is the same regardless of the cause: check for responsiveness, call for help, and start CPR if the child is unresponsive and not breathing normally. Even in drowning or asthma, when the original problem is breathing rather than the heart, cardiac arrest follows quickly once the body runs out of oxygen.

Overcoming Hesitation

Knowing what to do and actually doing it are two different things. Research consistently identifies several barriers that stop bystanders from starting CPR, including fear of causing harm, fear of legal consequences, and uncertainty about whether the situation is truly an emergency.¹¹ In some communities, concerns about litigation are a major deterrent.¹²

Here is the reality: in the United States and most other countries, Good Samaritan laws protect bystanders who provide emergency care in good faith. You will not be successfully sued for attempting CPR on a child who is not breathing. The far greater risk is doing nothing. A child in cardiac arrest who receives no CPR has a survival-to-discharge rate under 4%, compared to roughly 9 to 12 percent when a bystander steps in.⁶ Imperfect CPR is vastly better than no CPR. You may crack a rib. That heals. A brain starved of oxygen for ten minutes does not.

The Disparity Problem

Not all children receive bystander CPR at equal rates, and the data on this is stark. A large U.S. study from the Cardiac Arrest Registry to Enhance Survival (CARES) found that Black children were about 40% less likely to receive bystander CPR than white children, and children in low-income, low-education neighborhoods were also significantly less likely to receive it.¹³ The gap widened further in the most disadvantaged neighborhoods: Black children in the highest-disadvantage areas were about half as likely to get bystander CPR as white children in the lowest-disadvantage areas.

More recent data confirms these patterns are not resolving on their own. Children in the lowest-opportunity neighborhoods and Black children are less likely to have their arrest witnessed, less likely to receive bystander intervention, and independently have lower odds of a favorable outcome. Lower bystander response partially explains the worse outcomes associated with both neighborhood disadvantage and race.¹⁴ Broader reviews of resuscitation disparities across the U.S. show that gaps persist at every stage, from bystander CPR to defibrillator use to hospital-level post-resuscitation care.¹⁵

The implication is practical: CPR training programs targeted at underserved communities can save lives that are currently being lost. If you live in or work with one of these communities, pushing for accessible CPR education in schools and community centers is one of the most concrete things you can do to close the gap.

Mobile Apps and Community Response Networks

A growing number of communities use smartphone apps that alert CPR-trained volunteers when a cardiac arrest is detected nearby. A systematic review and meta-analysis found that these mobile applications improved survival rates by about a third compared to traditional emergency services alone, and also increased the rate at which bystanders performed CPR and used defibrillators.¹⁶ One urban U.S. county that integrated the PulsePoint app with its 911 system reported bystander CPR rates above the national average after deployment.¹⁷

Apps like PulsePoint, GoodSAM, and others vary by region, but the concept is the same: when someone calls 911 for a possible cardiac arrest, the app pings nearby registered responders and shows them the location of the nearest AED. If you are trained in CPR, registering for one of these apps in your area is a low-effort way to potentially help a child or anyone else who collapses in your vicinity. Research on school-based AED and CPR programs supports a similar idea at the institutional level: when schools invest in training and equipment, survival from cardiac arrest on school grounds can be relatively high.¹⁸

What Happens After the Paramedics Take Over

Once emergency medical services arrive and take over resuscitation, the child enters a critical window. If spontaneous circulation returns, the child faces what clinicians call post-cardiac arrest syndrome, a cascade of complications that can include brain injury, heart dysfunction, and a body-wide inflammatory response. Pediatric post-arrest care focuses on anticipating and treating these problems to protect the brain and other organs.¹⁹

One approach that received significant attention is therapeutic hypothermia, where the child’s body temperature is intentionally lowered to protect the brain. The results in children have been less clear-cut than in adults. A trial of hypothermia after out-of-hospital pediatric cardiac arrest found no significant difference in favorable neurological outcomes between children cooled to lower temperatures and those kept at normal body temperature, though one-year survival trended slightly higher in the hypothermia group without reaching statistical significance.²⁰ A second large trial looking at in-hospital cardiac arrest found essentially the same thing: no meaningful difference in neurological outcomes or survival between hypothermia and normal temperature management.²¹ The science on optimal temperature management in pediatric arrest remains an active area of research.

Long-Term Recovery and the Impact on Families

Surviving cardiac arrest is the beginning of a longer story, not the end. Among children who leave the hospital with favorable neurological function, the large majority maintain that status over time. A follow-up study found that 33 of 35 children who had good neurological outcomes at discharge continued to do well in the long term. For those discharged with significant neurological impairment, the picture was more mixed: some improved over months to years, but many remained impaired, and a substantial number died during the follow-up period.²² Survivors commonly require rehabilitation services and educational support regardless of how well they appear to recover initially.²³

The toll extends to families. Parents of children who survive cardiac arrest report significant anxiety, limited personal time, and disruption to family activities lasting months to a year or more after the event.²⁴ This is relevant for bystanders too. If you are the one who performed CPR on a child, whether the outcome was good or not, the emotional weight of that experience is real. Many emergency responders and lay rescuers develop stress reactions after witnessing or responding to a child’s cardiac arrest. Seeking support from a mental health professional or a peer support program after such an event is not weakness; it is a reasonable response to an extraordinary situation.

1
Best Practice & Research Clinical Anaesthesiology. Schoolchildren as lifesavers in Europe – Training in cardiopulmonary resuscitation for children
2
PubMed. Part 6: Pediatric Basic Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
3
PubMed Central. Estimation of optimal pediatric chest compression depth by using computed tomography
4
Resuscitation. Attenuated pediatric electrode pads for automated external defibrillator use in children
5
PubMed Central. Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study
6
PubMed. Effects of Dispatcher-assisted Cardiopulmonary Resuscitation on Survival Outcomes in Infants, Children, and Adolescents with Out-of-hospital Cardiac Arrests
7
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8
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9
The Journal of the American Board of Family Medicine. Warning Symptoms and Family History in Children and Young Adults with Sudden Cardiac Arrest
10
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11
PubMed Central. Barriers and facilitators to delivering bystander cardiopulmonary resuscitation in deprived communities: a systematic review
12
Hong Kong Journal of Emergency Medicine. Good Samaritan Law and bystander cardiopulmonary resuscitation: Cross-sectional study of 1223 first-aid learners in Hong Kong
13
PubMed Central. Race/Ethnicity and Neighborhood Characteristics Are Associated With Bystander Cardiopulmonary Resuscitation in Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Study From CARES
14
Resuscitation. Pediatric out-of-hospital cardiac arrest outcomes by Child Opportunity Index, race and ethnicity
15
PubMed Central. Racial, ethnic, and socioeconomic disparities in out-of-hospital cardiac arrest within the United States: Now is the time for change
16
PubMed Central. Mobile applications enhance out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis
17
PubMed Central. Impact of a 9-1-1-Integrated Mobile App on Bystander CPR: Implementation of PulsePoint in an Urban County
18
Current Opinion in Pediatrics. CPR and AEDs save lives: insuring CPR–AED education and CPR–AED access in schools
19
PubMed. Pediatric Post-Cardiac Arrest Care: A Scientific Statement From the American Heart Association
20
PubMed. Therapeutic hypothermia after out-of-hospital cardiac arrest in children
21
PubMed. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children
22
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24
Frontiers in Pediatrics. Cognitive and Psychological Outcomes Following Pediatric Cardiac Arrest