Finding a child unresponsive and not breathing is a frightening emergency that demands immediate, precise action. A correct and swift response can be the difference between survival and tragedy. The immediate priority is understanding the sequence of actions, as the steps for a child are distinctly different from those for an adult, particularly regarding timing.
Securing the Scene and Checking for Response
The first step in any emergency situation is to quickly ensure the environment is safe for both the child and the rescuer. Scan the area for obvious hazards such as electrical wires, standing water, or potential traffic before approaching the child. Only after confirming the scene is secure should you attempt to make contact with the child.
You must then check for responsiveness by gently tapping the child’s shoulder and calling out loudly, such as “Are you okay?” If there is no reaction, immediately shout for help from anyone nearby, pointing to an individual if possible to assign the task of calling 911. Next, quickly check for normal breathing by looking for chest rise and fall for no more than ten seconds. If the child is unresponsive and not breathing, or only gasping, immediate life support is necessary.
Child CPR Protocol: The “Act First” Rule
When alone with an unconscious, non-breathing child, the protocol for a lone rescuer is to “Act First” by providing two minutes of cardiopulmonary resuscitation (CPR) before calling emergency services. This approach is rooted in the physiological difference between pediatric and adult cardiac arrest. In children, the heart often stops because of a lack of oxygen caused by a respiratory issue, such as choking or a drowning event.
Starting CPR immediately provides the child with rescue breaths and chest compressions, which are intended to oxygenate the blood and circulate it to the brain and other organs. Delaying this immediate oxygen delivery to make a phone call significantly decreases the chance of survival. The two-minute period translates to approximately five cycles of compressions and breaths.
The “Act First” rule applies to infants (under one year old) and children (up to the onset of puberty). Only after completing this initial two minutes of focused care should the lone rescuer interrupt CPR to contact 911. This differs from the adult protocol, where the heart typically stops due to a primary cardiac problem and calling for help first is usually recommended.
Executing Initial Rescue Efforts
The initial two minutes of care begin with opening the child’s airway to prepare for rescue breaths. Place one hand on the forehead and two fingers of the other hand under the bony part of the chin, performing a gentle head-tilt, chin-lift maneuver. After the airway is open, deliver two initial rescue breaths, ensuring that the child’s chest visibly rises with each breath.
Immediately following the two breaths, start chest compressions at a rate of 100 to 120 compressions per minute. For a child, use the heel of one hand in the center of the chest, pushing straight down to a depth of about two inches, or approximately one-third the depth of the chest. For an infant, the two-finger technique is typically used on the breastbone, aiming for a depth of about 1.5 inches.
The lone rescuer must maintain a compression-to-breath ratio of 30 compressions followed by two breaths, making one complete cycle. Allow the chest to fully recoil after each compression to ensure the heart can refill with blood. Continue this sequence without interruption until five cycles are completed, which fulfills the initial two-minute requirement.
Communicating with Emergency Services
Once the initial five cycles of CPR are complete, the lone rescuer should call 911 or the local emergency number. If possible, activate the speakerphone function on your mobile device while continuing to perform CPR. This allows you to speak with the dispatcher without interrupting the life-saving compressions and breaths.
Relaying information clearly is important. Start by providing your exact location, including the street address and any specific landmarks. Tell the dispatcher that you are with an unresponsive, non-breathing child and that you are currently performing CPR. The dispatcher will provide guidance and instructions, which you must continue to follow until emergency medical services arrive.