An Automated External Defibrillator (AED) delivers an electrical shock to a person experiencing sudden cardiac arrest, which occurs when the heart’s electrical system malfunctions. Defibrillation is the only definitive treatment for certain life-threatening heart rhythms. In a pediatric emergency, specialized pediatric pads are the safest choice, as they ensure the child receives an appropriately dosed electrical current. When these preferred pads are unavailable, the choice to use adult pads requires immediate, informed action.
Understanding Pediatric AED Requirements
The fundamental difference between using an AED on a child and an adult is the necessary electrical energy dose. Pediatric pads are specifically designed to reduce, or attenuate, the adult energy level delivered by the device. This attenuation protects a smaller body and heart from excessive electrical exposure.
The standard threshold for requiring pediatric pads is typically a child under eight years of age or weighing less than 55 pounds (25 kilograms). Adult AEDs deliver a high-energy shock, often between 150 and 360 Joules. Pediatric pads reduce this output to a much lower, safer level, generally in the range of 50 to 75 Joules.
Delivering an unnecessarily high electrical dose carries the risk of causing myocardial injury to developing heart tissue. Attenuated pads or a child key are the standard of care for young patients. However, the risk of tissue damage must be weighed against the near-certainty of death if a shockable rhythm is left untreated.
The Critical Decision: Using Adult Pads on a Child
When a child collapses from sudden cardiac arrest, the primary threat to survival is the lack of immediate defibrillation. Consensus guidelines establish a clear hierarchy of action: if pediatric pads are not immediately accessible, the use of adult pads is strongly recommended over delaying treatment.
The time elapsed until defibrillation is the most significant factor determining survival outcomes. Every minute without a shock dramatically reduces the chance of survival. The risk of cardiac injury from an unattenuated shock is substantially less than the risk of death from an untreated lethal heart rhythm.
The immediate action principle dictates that the benefit of attempting to reset the heart’s rhythm outweighs the potential side effects of a higher-energy shock. The AED will only advise a shock if it detects a treatable rhythm, such as ventricular fibrillation. Confirm the child is unresponsive and not breathing normally before proceeding.
If only adult pads are available, power on the AED and follow its voice prompts without hesitation. Delaying treatment to search for pediatric equipment costs precious minutes. An adult device is better than no device in this emergency.
Safe Application Techniques for Adult Pads
Once the decision is made to use adult pads, the application technique must be modified to ensure effectiveness and minimize electrical bridging. Adult pads are significantly larger than pediatric pads, making standard placement on a small chest impossible without overlap. If the pads touch, the current short-circuits across the surface, failing to deliver necessary energy through the heart.
Anterior-Posterior Placement
To prevent overlap, use the anterior-posterior placement. Place one adult pad on the center of the child’s chest (anterior position). Place the second adult pad on the child’s back, between the shoulder blades (posterior position). This ensures the heart is positioned between the two pads, allowing the current to pass effectively through the chest cavity.
If the AED unit has a manual child key or switch, activate this feature immediately, even when using adult pads. Some modern AEDs can detect a child key or special cable to automatically reduce energy output, regardless of the pad type. This step may deliver a partially or fully attenuated shock, reducing the risk of myocardial damage.
The anterior-posterior positioning is the best method for creating a safe, non-touching pathway, even if the large pad covers a significant portion of the child’s chest. Ensure the skin is dry and the pads are firmly adhered to the bare skin for good electrical contact before the AED analyzes the rhythm.
Post-Action Steps and Medical Follow-up
After the AED delivers a shock, immediately resume high-quality cardiopulmonary resuscitation (CPR). The shock is meant to restart the heart’s natural rhythm, but it does not guarantee immediate circulation. Continue CPR for two minutes before the AED re-analyzes the heart rhythm.
The AED provides voice prompts guiding the sequence, alternating between CPR and rhythm analysis. Only stop using the AED when professional emergency medical services arrive, or if the child wakes up and begins moving and breathing normally. The device must remain attached and ready to deliver further shocks if necessary.
Mandatory Medical Evaluation
Because the child received an unattenuated, high-voltage shock, a mandatory medical evaluation is required, even if the child appears recovered. The higher energy level carries an increased risk of complications, including damage to the heart muscle or surrounding tissue. Medical professionals must assess for any internal injury resulting from the high-dose defibrillation.