When a child is found unresponsive, immediate action is required to determine the emergency and begin life-saving intervention. Quickly assessing the child’s condition is the first step in the pediatric chain of survival. The primary goal is to assess circulation and breathing to decide whether the child needs rescue breaths or cardiopulmonary resuscitation (CPR). Understanding the correct sequence of events and where to check for a pulse is fundamental for any lay rescuer.
Prioritizing Scene Safety and Activating Help
Before touching the child, the rescuer must confirm the environment is safe for everyone involved. This involves checking for hazards like traffic or electrical wiring, and moving the child only if the location presents immediate danger. Once the scene is secured, determine the child’s responsiveness by gently tapping and shouting, such as calling their name.
If the child remains unresponsive, the rescuer should immediately shout for help. If help arrives, direct one person to call the local emergency number and retrieve an automated external defibrillator (AED). If the rescuer is alone, they must decide whether to call first or provide immediate care, depending on whether the collapse was witnessed or unwitnessed.
Simultaneously, the rescuer assesses the child’s breathing by looking for chest rise and fall. An unresponsive child who is not breathing normally, or is only gasping, indicates a respiratory or cardiac emergency. This assessment should be done quickly, taking no more than 10 seconds, and is performed at the same time as the pulse check.
Locating and Assessing the Pulse
The location for checking a pulse on an unresponsive child changes based on the child’s size and age. A pulse check is performed for a minimum of 5 seconds but must not exceed 10 seconds. Using the index and middle fingers, the rescuer should apply gentle pressure, as pressing too hard can sometimes block the pulse entirely.
For infants (under one year of age), the most reliable location is the brachial artery. This artery is located on the inside of the upper arm, positioned roughly halfway between the elbow and the shoulder. The rescuer should cup the infant’s arm and place two or three fingers gently on this area to feel the pulsation.
In children one year of age up to the onset of puberty, the preferred site is the carotid artery, which offers a more accessible and stronger pulse. To locate this, the rescuer places two or three fingers on the side of the neck, sliding into the groove between the windpipe (trachea) and the large neck muscle. An alternative site is the femoral artery, located in the inner thigh crease.
The choice between these locations is guided by the rescuer’s comfort and the child’s body habitus. The 10-second limit is absolute regardless of the site chosen. Finding a definite pulse shifts the focus from an immediate cardiac emergency to a respiratory one, while a lack of pulse demands immediate circulatory support.
Next Steps Following Pulse Assessment
The outcome of the 10-second pulse check determines the child’s immediate life-saving needs. If the pulse is absent, or if the heart rate is less than 60 beats per minute with signs of poor perfusion, the child is considered to be in cardiac arrest. In this situation, the rescuer must immediately begin high-quality chest compressions and rescue breaths (CPR).
If the child has a pulse but is still not breathing normally or is only gasping, the focus shifts to providing rescue breathing. The rescuer should administer one breath every three to five seconds, aiming for a rate of 12 to 20 breaths per minute. This intervention addresses the common cause of cardiac arrest in children, which is respiratory failure.
The rescuer must continue to monitor the child closely until emergency medical services (EMS) arrive. If the child remains unresponsive but begins breathing normally and has a strong pulse, they should be monitored continuously. The pulse should be re-checked every two minutes during rescue breathing to ensure the heart rate does not drop below 60 beats per minute.