When a child is unresponsive, immediate and decisive action is required. For a lay rescuer, understanding the proper sequence of assessment and intervention is crucial. These initial steps focus on maximizing the child’s chance of survival by ensuring the environment is safe and providing critical life-saving interventions before emergency services arrive.
Securing the Scene and Assessing Responsiveness
The initial priority is ensuring the safety of both the child and the rescuer. Check the surrounding area for immediate hazards, such as electrical wires, traffic, or water. If the scene is unsafe, move the child quickly and carefully to a secure location before taking any other steps.
Once the area is safe, the next immediate step is to assess the child’s responsiveness. Gently tap the child’s shoulder (or the bottom of an infant’s foot) while shouting, “Are you okay?”. The goal is to elicit any kind of reaction, such as movement, sound, or eye opening, to quickly differentiate between a child who is merely sleeping deeply or stunned and one who is truly unresponsive. If there is no response to this stimulus, the child is considered unresponsive.
After confirming unresponsiveness, immediately shout for help to activate the emergency response system. If another person is nearby, direct them to call 911 and retrieve an automated external defibrillator (AED) if one is available. This ensures professional medical help is en route while the rescuer focuses on the child. If the rescuer is alone, the timing of the call depends on the next assessment steps.
Immediate Airway Management and Breathing Check
Position the child on a firm, flat surface to focus on the airway and breathing status. Since respiratory failure is the most common cause of cardiac arrest in children, prompt opening of the airway is necessary. For a child, use the head-tilt/chin-lift maneuver: place one hand on the forehead and two fingers under the chin to gently tilt the head back.
A difference exists when managing an infant’s airway, as their neck is more flexible. For an infant under one year old, place the neck in a neutral or “sniffing” position, avoiding excessive hyperextension. Once the airway is open, quickly check for effective breathing using the “Look, Listen, and Feel” technique for no more than 10 seconds.
Look for the rise and fall of the chest, listen for breath sounds, and feel for air movement. Normal breathing must be clearly present. A child who is only gasping or exhibiting agonal breaths is considered not breathing effectively and requires immediate intervention. Agonal respirations are not sufficient for oxygen exchange and are a sign of cardiac arrest.
Initiating Rescue Breaths for Non-Breathing Victims
If the child is not breathing or is only gasping, immediately provide oxygenation. Deliver five slow, effective rescue breaths before starting chest compressions. This initial oxygen boost is vital because pediatric cardiac arrests are often asphyxial, triggered by low oxygen levels.
To deliver a breath to a child, pinch the nose shut and create a tight seal over the mouth, blowing gently for about one second. For an infant, cover both the mouth and nose simultaneously. Each breath should be just enough to make the chest visibly rise, confirming air entry.
If a breath does not cause the chest to rise, it suggests an airway obstruction or improper positioning. The rescuer must quickly reposition the head with the appropriate tilt and attempt the breath again. If the second attempt is also unsuccessful, move immediately to chest compressions, as the compressions themselves can sometimes help to dislodge an obstruction. The delivery of these initial five breaths is a concentrated effort to restore oxygen to the brain and other organs.
Determining the Need for Chest Compressions
After the initial five rescue breaths, check for a pulse or other signs of life, such as movement or coughing. Lay rescuers are generally instructed to skip the challenging pulse check and proceed directly to chest compressions if there are no signs of life or normal breathing. This ensures no delay in starting the most critical life-saving measure.
Beginning chest compressions immediately escalates the intervention to full cardiopulmonary resuscitation (CPR). For a lone rescuer, the timing of the 911 call depends on whether the collapse was witnessed. If the collapse was unwitnessed, perform approximately five cycles of CPR (about two minutes) before calling 911, prioritizing immediate oxygen and circulation.
If the collapse was witnessed, immediately call 911 before starting CPR, as this suggests a possible primary cardiac event. In a two-rescuer scenario, one person begins CPR while the second activates the emergency response system. Prompt initiation of chest compressions and rescue breaths is the final step before emergency medical services arrive.