An Automated External Defibrillator (AED) is a portable device that delivers an electrical shock to the heart to potentially save the life of someone experiencing sudden cardiac arrest. The device analyzes the heart’s rhythm and advises the user whether a shock is needed, guiding the rescuer through the process with voice prompts. Using an AED on a child requires specific attention because a young body cannot tolerate the high-energy dose designed for an adult. This difference necessitates the use of special equipment and procedures to ensure the treatment is safe and effective for a pediatric patient.
The Critical Difference in Energy Delivery
Pediatric AED pads are necessary because a child’s heart and smaller body mass are susceptible to damage from the full electrical charge intended for an adult. Adult AEDs typically deliver a high level of energy, often around 150 to 360 joules, which is appropriate for a mature patient. For a child, this high dose can cause injury to the heart muscle or surrounding tissue.
Pediatric pads contain special internal circuitry called an attenuator, which reduces the energy dose delivered to the patient. This mechanism effectively lowers the shock to a level appropriate for a child, generally reducing it to between 50 and 75 joules. This low-energy shock is sufficient to stop the disorganized electrical activity of the heart without risking serious harm. In some advanced AED models, a physical key or a switch performs this dose reduction, allowing the use of the same pads for both adults and children.
Identifying the Pediatric Patient for AED Use
Determining when to use pediatric pads relates directly to the patient’s size, which dictates the required energy dose. General guidelines suggest that pediatric pads should be used on any child under eight years of age. Another standard measure is the patient’s weight, with pediatric pads recommended for those weighing less than 55 pounds (25 kilograms).
These age and weight thresholds correlate with the body size for which the attenuated, lower-energy shock is appropriate. If the child is eight years or older, or weighs more than 55 pounds, they are considered a size that can receive the standard adult shock, and adult pads should be used. Rescuers should check the specific instructions provided on their AED device or the pediatric pad packaging for manufacturer variations.
Pad Placement and Contingency Planning
Proper placement of the pads is important to ensure the electrical current passes effectively through the heart. For children, the pads must never touch each other, as this can cause the electrical current to short-circuit, bypassing the heart and rendering the shock ineffective. This is relevant for smaller children where the chest surface area is limited.
The recommended placement for pediatric patients is the anterior/posterior method. This means placing one pad on the front of the child’s chest over the breastbone and the other pad on the child’s back between the shoulder blades. This front-and-back positioning ensures the heart is centered in the electrical pathway and keeps the pads safely separated.
In the urgent situation where only adult AED pads are available for a child who meets the pediatric criteria, the recommended action is to proceed with the adult pads. Delaying defibrillation to wait for pediatric-specific equipment significantly lowers the chance of survival. In this contingency scenario, the adult pads must still be placed in the anterior/posterior position to prevent them from touching and maximize the chance of a successful shock. It is better to deliver a higher-energy shock than no shock at all to a patient in sudden cardiac arrest.