A child collapsing is an alarming event that demands immediate action. Positive outcomes are directly linked to the speed and effectiveness of the actions taken in the first few minutes. This guidance provides a framework for bystanders responding to an unresponsive child, focusing on safety, activating professional help, and initiating life support until emergency services arrive. Since the primary cause of cardiac arrest in children is often respiratory failure, prompt intervention is particularly significant.
Securing the Scene and Activating Emergency Services
Before touching the child, quickly scan the immediate environment for hazards such as traffic, water, electrical wires, or unstable structures. Rescuer safety is paramount; the child should only be moved if the current location is unsafe for the rescuer or prevents effective care. Once the scene is safe, activate the emergency response system.
For a lone rescuer, the decision to “Call First” or “Care First” depends on the child’s age and whether the collapse was witnessed. If the collapse was sudden and witnessed (more likely a primary heart issue), call the local emergency number immediately. If the collapse was unwitnessed, or if the patient is an infant or child (arrest generally due to a breathing problem), provide two minutes of care (CPR) before pausing to call for help.
When contacting emergency services, use a speakerphone if possible to allow communication with the dispatcher while providing care. The dispatcher will require a precise location and details about the child’s condition and often provides instructions or coaching. Good Samaritan laws exist in many places to protect bystanders who provide reasonable assistance in good faith, encouraging people to act without fear of civil liability.
Rapid Assessment of Consciousness and Breathing
The next step is a rapid assessment to determine the child’s need for intervention. Check for responsiveness by gently tapping the child’s shoulder and shouting, “Are you okay?” Observe for movement, sound, or eye-opening. If the child remains unresponsive, open the airway using the head-tilt/chin-lift maneuver to ensure the tongue is not blocking the throat.
While maintaining the open airway, check for normal breathing for no more than 10 seconds. This check involves looking for chest rise, listening for breath sounds, and feeling for air movement against the cheek. Normal breathing is distinct from agonal breathing, which may sound like gasping or snorting and is not considered effective. If the child is unresponsive, not breathing, or only exhibiting agonal gasps, immediate life support action is required.
Initiating Life Support Actions
If the child is unresponsive and not breathing normally, Cardiopulmonary Resuscitation (CPR) must begin immediately, starting with chest compressions. Place the child on a firm, flat surface to ensure compressions are effective. For a child (aged one year to puberty), use the heel of one or two hands on the center of the chest, pushing down approximately one-third the depth of the chest (about two inches or 5 cm).
Compressions should be delivered at a rate of 100 to 120 beats per minute, allowing the chest to fully recoil between each push. The standard ratio for a lone rescuer is a cycle of 30 compressions followed by two rescue breaths (30:2). To give rescue breaths, pinch the child’s nose shut and seal your mouth completely over their mouth, delivering a gentle breath over about one second, just enough to make the chest visibly rise.
For an infant (under one year), compressions are delivered using two fingers placed just below the nipple line. The compression depth is about 1.5 inches (4 cm), or one-third the chest depth. When delivering rescue breaths to an infant, the rescuer may cover both the mouth and nose to form a seal, delivering small puffs of air. If an Automated External Defibrillator (AED) becomes available, use it immediately, applying pediatric pads or activating the child mode for children under eight years of age to deliver a lower-energy shock.
Monitoring and Preparing for EMS Arrival
Once CPR has begun, maintain it continuously until the child shows clear signs of recovery or emergency medical services (EMS) personnel take over. High-quality CPR requires minimal interruptions, so cycles of compressions and breaths must be executed efficiently. If the child begins to breathe normally but remains unconscious, place them into the recovery position. This position helps keep the airway open and allows any fluids to drain safely from the mouth.
To position the child for recovery, roll them onto their side with the head gently tilted back to maintain the airway. This ensures stability and prevents the tongue from obstructing the throat. Constantly monitor the child’s breathing and level of consciousness while waiting for help.
When EMS arrives, the final and significant action is the information handover. Provide a clear, concise summary of the event, including:
- What happened before the collapse.
- How long the child was unresponsive.
- The duration and quality of CPR performed.
- If an AED was used.
This crucial information allows the medical team to make rapid, informed decisions about subsequent treatment.