The cessation of breathing in a newborn demands immediate, decisive action from a caregiver. This information provides emergency protocols but is not a replacement for certified, hands-on training, such as Infant Cardiopulmonary Resuscitation (CPR) or Pediatric Advanced Life Support (PALS). These guidelines are for a sudden, unexpected emergency and are designed to empower a lay rescuer to act until professional medical help arrives, as preparedness significantly impacts the outcome.
Activating Emergency Services and Initial Assessment
The first step in any emergency is to confirm the baby’s condition and secure professional help. Gently attempt to rouse the newborn by flicking the sole of the foot or rubbing the back, which provides gentle stimulation without shaking the baby. If the baby remains unresponsive, does not move, and is not breathing or is only gasping, immediate intervention is necessary.
If you are alone, begin five cycles of intervention (about two minutes of care) before stopping to call local emergency services. If another person is present, they must call for help and retrieve an Automated External Defibrillator (AED), if available, while you begin resuscitation immediately. Do not spend more than ten seconds checking for a pulse; if the baby is unresponsive and not breathing normally, assume a medical emergency. Lay the infant on a firm, flat surface for effective chest compressions.
Step-by-Step Newborn CPR and Rescue Breathing
To begin resuscitation, position the newborn on their back and open the airway using the head-tilt, chin-lift maneuver. The head should be placed in a neutral or “sniffing” position, which slightly extends the neck without tilting the head too far back, as this can inadvertently close the soft airway. This alignment is crucial for allowing air to enter the lungs efficiently.
The intervention involves delivering two gentle rescue breaths, often called “puffs.” Form a seal by covering the infant’s mouth and nose with your mouth and deliver a breath just enough to make the chest visibly rise over one second. If the chest does not rise, reposition the head and attempt the second breath, ensuring the airway is clear.
Immediately begin chest compressions using two fingers placed on the breastbone just below the imaginary line connecting the nipples. Depress the chest approximately 1.5 inches, or about one-third the depth of the chest, allowing the chest to fully recoil after each compression. The compressions should be delivered at a rapid rate of 100 to 120 times per minute, roughly following the rhythm of the song “Stayin’ Alive.”
For a single lay rescuer, the cycle continues with 30 compressions followed by two rescue breaths, repeated without interruption. This 30:2 ratio ensures a balance between maintaining blood circulation and providing oxygenation. Continue these cycles until the baby shows obvious signs of recovery, emergency personnel take over, or you are too exhausted to continue.
Addressing Specific Airway Obstruction (Choking)
If the newborn is conscious but silently choking, unable to cry, cough, or breathe, the cause is likely a mechanical airway blockage. The intervention for a conscious choking infant is distinct from standard CPR and involves alternating back blows and chest thrusts. Hold the infant face down along your forearm, supporting the head and neck, with the head lower than the chest.
Deliver five firm back blows using the heel of your hand between the infant’s shoulder blades. Then, turn the baby face up, supporting the head and neck, keeping the head still lower than the chest. Deliver five quick chest thrusts using two fingers, placed in the same location as chest compressions but delivered abruptly to create a cough-like expulsion of air.
Repeat the sequence until the object is expelled or the baby becomes unresponsive. Only attempt to remove the object if you can clearly see it; a blind finger sweep can push the obstruction further down the airway. If the baby becomes unresponsive, immediately transition to the standard CPR protocol, starting with chest compressions.
Post-Emergency Actions and Prevention Strategies
Once the baby begins to breathe again or emergency medical services arrive, continuous care is necessary. If the baby recovers before help arrives, place them in a recovery position and monitor their breathing closely until professionals perform a full medical assessment. All newborns who have undergone resuscitation or choking maneuvers should be thoroughly examined by a medical professional due to the potential for internal injury.
Preventative measures, particularly related to sleep, significantly reduce the risk of respiratory events like Sudden Infant Death Syndrome (SIDS). These simple, consistent practices are the most effective strategies for long-term respiratory health and safety:
- Always place the newborn on their back for every sleep until the baby reaches one year of age.
- Ensure the sleep surface is firm and flat, covered only by a fitted sheet, with no soft bedding, pillows, bumper pads, or toys present in the crib.
- Practice room-sharing, where the baby sleeps in the same room but on a separate surface from the parents, for at least the first six months.
- Maintain a smoke-free environment.
- Avoid overheating by dressing the baby in only one layer more than an adult would wear.