An unresponsive child fails to react to sound or touch, signaling a serious medical emergency. This lack of reaction, where the child may be limp, silent, or appear to be sleeping abnormally, means the brain is not receiving necessary oxygen. Immediate, sequential action is required, as every moment counts toward a positive outcome. This guide provides the necessary steps to take until professional medical help arrives.
Ensuring Safety and Activating Emergency Services
The first action is to quickly scan the immediate environment for potential dangers. Look for hazards like moving traffic, water, electrical sources, or toxic fumes that could threaten both the child and yourself. If the child is in an unsafe location, move them to a safe, flat surface only if it is feasible without causing further injury, especially if a spinal injury is suspected.
Once the scene is safe, activate the emergency response system. If you are not alone, shout for help and instruct a specific bystander to call emergency services (911 or the local equivalent) and retrieve an Automated External Defibrillator (AED). If you are the only person present, use your cell phone on speaker to call for help while remaining next to the child to begin the assessment.
Performing the Primary Assessment
Determine the child’s level of consciousness by attempting to elicit a response. For an older child, gently tap their shoulder and shout their name. For an infant, gently tap the soles of their feet to check for any reaction, avoiding forceful shaking. If there is no movement, sound, or response, the child is confirmed as unresponsive.
Next, simultaneously assess the child’s breathing and circulation, taking no more than 10 seconds. Open the child’s airway using the head-tilt/chin-lift maneuver: place one hand on the forehead and two fingers under the chin to gently lift the jaw and slightly extend the neck. If a neck or spinal injury is suspected, use the jaw-thrust maneuver instead, which lifts the jaw forward without tilting the head.
While maintaining the open airway, check for normal breathing by looking for chest rise, listening for air movement, and feeling for breath. Simultaneously, check for a pulse: use the brachial artery (upper arm) for an infant, or the carotid artery (side of the neck) for a child. If you cannot feel a pulse within 10 seconds, or if the heart rate is less than 60 beats per minute with signs of poor circulation, immediately begin chest compressions.
Initiating Life Support Procedures
The primary assessment dictates the immediate life support procedure. If the child has a pulse but is not breathing normally, begin rescue breathing immediately. Deliver one gentle rescue breath every three to five seconds (12 to 20 breaths per minute). Each breath should be just enough to make the child’s chest visibly rise, and you must check the pulse every two minutes.
If the child has no pulse or a pulse below 60 beats per minute with poor perfusion, immediately begin Cardiopulmonary Resuscitation (CPR), starting with chest compressions. The modern sequence prioritizes compressions first, known as the C-A-B (Compressions, Airway, Breathing) sequence. The compression rate for all children and infants should be between 100 and 120 compressions per minute.
Compression Technique
For an infant (under one year old), use two fingers placed just below the nipple line in the center of the chest. Push down approximately 1.5 inches, or about one-third of the chest depth.
For a child (one year to puberty), use the heel of one or two hands, depending on the child’s size. Compress the chest by about two inches, which is roughly one-third of the chest depth. Full recoil of the chest wall between compressions is important to allow the heart to refill with blood.
Compression-to-Breath Ratio
The compression-to-breath ratio is standardized for lay rescuers. If you are alone, deliver 30 compressions followed by two rescue breaths. If two rescuers are present, the ratio changes to 15 compressions followed by two breaths to provide more frequent ventilation. Minimize interruptions to compressions to maintain consistent blood flow to the brain and vital organs.
Continuous Monitoring Until Help Arrives
Continuous, high-quality care must be maintained until emergency medical services take over. If performing CPR, continue the 30:2 or 15:2 cycles without interruption, switching rescuers every two minutes if possible to prevent fatigue. Avoid stopping to check for a pulse unless the child shows an obvious sign of life, such as purposeful movement or normal breathing.
If the child becomes responsive or begins breathing normally, place them in the recovery position, provided there is no suspicion of a spinal injury. For a child over one year, gently roll them onto their side with the top leg bent for stabilization. Ensure the head is tilted back slightly to keep the airway open and allow fluids to drain.
For an infant, they can be held securely on their side or placed on a firm surface on their side. Continually monitor the child’s condition, watching for any change in color, breathing effort, or level of consciousness. Do not cease life support efforts unless the child revives, an AED is ready to analyze their heart rhythm, or you are physically unable to continue.