An unresponsive child is defined by a lack of movement or reaction to external stimuli. This state signals a medical emergency where immediate, decisive action is paramount. Prioritizing rapid assessment, activating professional emergency services, and initiating life support without delay offers the best chance for a positive outcome.
Scene Safety and Emergency Call
Before approaching an unresponsive child, quickly scan the surrounding area for any dangers. Hazards like moving traffic, exposed electrical wires, or standing water must be neutralized or avoided to ensure a safe environment for rescue efforts. Once the scene is safe, activate the emergency response system by calling 911 or your local emergency number.
If you are the only rescuer and did not witness the child collapse, activate EMS immediately before starting care. If you witnessed the collapse or the situation is likely respiratory (such as a drowning), provide approximately two minutes of immediate care before calling. When speaking with the dispatcher, clearly state your exact location, the nature of the emergency, and the child’s estimated age and current status. If another person is present, instruct them to call for help and retrieve an Automated External Defibrillator (AED) while you begin assessment and intervention.
Assessing Life Signs
After ensuring safety and calling for help, determine the child’s level of consciousness by gently tapping their shoulder and shouting loudly. If there is no reaction, place the child on a firm, flat surface for effective chest compressions. Next, open the airway using the head-tilt/chin-lift maneuver to move the tongue away from the back of the throat. For infants, use only a very slight head tilt to avoid closing off their flexible airway.
Simultaneously assess for breathing and a pulse, checking for no more than ten seconds. Look for the rise and fall of the chest, listen for air movement, or feel for breath on your cheek. Check for an infant’s pulse using the brachial pulse on the inside of the upper arm. For a child, check the carotid pulse in the groove on the side of the neck or the femoral pulse in the inner thigh. If no pulse is felt, or if the pulse rate is less than 60 beats per minute with signs of poor circulation, begin cardiopulmonary resuscitation (CPR) immediately.
Delivering Immediate Life Support
Begin chest compressions at a rate between 100 and 120 compressions per minute for both infants and children. The compression depth must be at least one-third the anterior-posterior diameter of the chest, which translates to approximately 1.5 inches (4 cm) for an infant and 2 inches (5 cm) for a child. Allow the chest to fully recoil between each compression.
For an infant, a single rescuer should use the two-finger technique on the lower half of the sternum. If two rescuers are present, they should use the two thumb-encircling hands technique for effective compression depth. A child requires either one or two hands for compressions, depending on their size, to achieve the required two-inch depth.
The compression-to-breath ratio is standardized across both age groups for lay rescuers. If you are the only person providing care, deliver two rescue breaths after every 30 chest compressions, maintaining a 30:2 ratio. When a second trained rescuer is available, the ratio shifts to 15 compressions followed by two breaths, or 15:2, to increase the frequency of ventilation.
To deliver a rescue breath, maintain the open airway and form a complete seal over the child’s mouth, or over the infant’s mouth and nose simultaneously. Deliver a breath over one second, watching for a visible, slight rise of the chest to confirm air entry. Avoid excessive ventilation, which can cause air to enter the stomach. CPR is important in children because their cardiac arrests are often caused by respiratory failure, making oxygen delivery a priority.
What to Do Until Help Arrives
Life support must be maintained without interruption until professional help arrives. If a second rescuer is present, switch off every two minutes (or after five cycles of compressions and breaths) to prevent fatigue. Continuously monitor the child for any signs of movement, normal breathing, or a return of consciousness.
If the child begins to breathe normally and has a pulse, but remains unconscious, carefully place them into the recovery position. Roll the child onto their side, ensuring their mouth is facing downward to allow any fluids to drain freely and prevent aspiration. For a small infant, a rolled-up blanket placed behind their back can help maintain a stable side position.
If you observe an object obstructing the airway, only attempt to remove it if you can clearly see it; blind finger sweeps can push the obstruction deeper. Continue chest compressions and rescue breaths, as these actions can help dislodge a foreign body. CPR should not be stopped until emergency medical services personnel explicitly instruct you to cease or take over care.