The sudden collapse of a child requires immediate action, though it often causes panic and uncertainty in bystanders. Understanding the correct, immediate steps is crucial, as rapid intervention significantly improves the chances of a positive outcome. The body’s response to a lack of oxygen or circulation is swift, meaning the minutes before professional medical help arrives are the most valuable for preserving brain function. This guide provides a clear, step-by-step framework for managing this high-stress emergency.
First Steps Securing the Scene and Summoning Aid
The first action upon witnessing a collapse is to ensure the safety of the area before approaching the child. This involves quickly scanning for environmental hazards like traffic, live electrical wires, or unstable structures that could put the rescuer at risk. Scene safety always takes precedence over immediate patient care, as an injured rescuer cannot help the child.
Once the scene is safe, establishing a plan for summoning emergency services is the next step. If you are not alone, immediately point to a specific bystander and instruct them to call 911 or the local emergency number and to find an automated external defibrillator (AED). This clear delegation ensures the call is made without delay.
If you are alone, the decision to call first or provide care first depends on the circumstances. For a sudden, witnessed collapse in a child, especially if a heart problem is suspected, call 911 immediately before beginning care, as early defibrillation is a priority. If the collapse was unwitnessed, or likely caused by a breathing problem (such as near-drowning or choking), perform two minutes of cardiopulmonary resuscitation (CPR) before pausing to call for help. The dispatcher will need a precise location, a description of the emergency, and the child’s current state.
Assessing the Child’s State
After securing the scene and initiating the call for help, determine the child’s level of consciousness. Gently tap the child’s shoulder and shout, “Are you okay?” to check for responsiveness. For an infant (defined as under one year of age), gently tapping the sole of the foot is the appropriate method to check for a reaction.
If the child does not respond, the rescuer must assess for breathing. Observe the chest and abdomen for normal movement for no more than 10 seconds. Shallow, ineffective breaths or occasional gasping is not considered normal breathing and should be treated the same as no breathing.
While trained medical professionals may attempt to palpate a pulse, lay rescuers should focus on the lack of responsiveness and the absence of normal breathing. If the child is unresponsive and not breathing normally, immediately initiate chest compressions. This simplified assessment allows for the prompt start of life-saving intervention, which is important since cardiac arrest in children is often secondary to respiratory failure.
Emergency Care Performing CPR and Rescue Breathing
If the child is unresponsive and not breathing normally, immediately begin high-quality CPR, starting with chest compressions. The technique differs slightly between an infant and a child (defined as one year old to the onset of puberty). For a single rescuer, the ratio of compressions to breaths is 30:2 for both infants and children.
For an infant, two fingers are placed on the breastbone just below the nipple line. The chest is compressed to a depth of approximately 1.5 inches, or about one-third the depth of the chest. The rate of compressions for all pediatric patients must be between 100 and 120 per minute. After 30 compressions, open the airway using the head-tilt/chin-lift maneuver, avoiding excessive neck extension, and deliver two rescue breaths.
For a child, compressions are performed with the heel of one or two hands, depending on the child’s size, placed on the lower half of the breastbone. The compression depth should be at least two inches, about one-third the depth of the chest. Each rescue breath should be a gentle breath lasting about one second, ensuring the chest visibly rises.
Compressions must be hard and fast, allowing the chest to fully recoil after each push to permit the heart to refill with blood. Minimizing interruptions in the 30 compressions and two breaths cycle is necessary to maintain adequate blood flow to the brain and vital organs. This process continues until an AED is ready, emergency medical services (EMS) arrive, or the child shows signs of life.
Ongoing Care While Awaiting Medical Assistance
Once CPR has started, the rescuer must continue the 30:2 cycles until professional help takes over or the child begins to move or breathe normally. If the child begins breathing effectively but remains unresponsive, they should be placed in the recovery position. This involves gently turning the child onto their side to maintain an open airway and prevent aspiration of fluids.
Continuous monitoring of the child’s breathing and responsiveness is required, even if they appear stabilized. If the child is breathing but displaying signs of shock (such as pale, cool, or clammy skin), they should be kept warm with a blanket. The rescuer should be prepared to provide a concise and factual handover to the arriving EMS personnel.
This information should include a description of the initial event, the child’s medical history, any known medications, and an account of the care provided, including the duration of CPR. Providing this summary allows the medical team to transition into advanced care without delay. The rescuer’s role concludes with the transfer of care to the medical professionals.