When a child or infant collapses, immediate cardiopulmonary resuscitation (CPR) improves the chances of survival. Knowing exactly where to position the hands on the chest is paramount; incorrect placement risks injury and fails to generate necessary blood flow to the brain and vital organs. The goal of chest compressions is to manually circulate oxygenated blood until professional medical help arrives. Because a child’s anatomy differs significantly from an adult’s, the technique must be precisely adapted to the patient’s size and age.
Age Categories for Pediatric CPR
The techniques used for pediatric chest compressions are determined by two distinct age categories based on physical development and anatomical structure. Infants are defined as patients under one year of age, and their small, flexible chest walls require a specialized, gentler approach. The primary cause of cardiac arrest in this group is often a respiratory issue, making effective compressions and breaths equally important.
Children are categorized as those from one year of age up to the onset of puberty, which is typically marked by the presence of underarm or chest hair in males or breast development in females. This broader group includes a significant range of body sizes, necessitating a flexible compression technique. The size and rigidity of the chest wall allow for the use of a hand-based technique, similar to that used for adults, but adjusted for depth and force.
Compression Technique for Infants
For an infant under one year old, the correct hand position for a single rescuer involves the use of two fingers. The location for compression is the center of the chest, directly on the breastbone or sternum. To locate this spot, picture an imaginary line connecting the infant’s nipples and place the tips of the index and middle fingers just below this line. This placement ensures the force is applied over the heart and avoids the delicate structures of the ribs or the pointed end of the breastbone, known as the xiphoid process.
The compressions must be delivered quickly, at a rate between 100 and 120 compressions per minute. The depth of each compression should be approximately 1.5 inches, or about one-third the total depth of the infant’s chest. Achieving this depth is necessary to effectively squeeze the heart between the sternum and the spine.
If two rescuers are present, the preferred method is the two-thumb encircling technique. The hands wrap around the infant’s chest, and the thumbs press on the same spot just below the nipple line. This technique is often more effective at consistently achieving the required compression depth and ensuring full chest recoil between pushes.
Compression Technique for Older Children
When performing compressions on a child aged one year to puberty, the technique transitions to using the heel of the hand, adapting to the larger body size. The placement remains centered on the breastbone, specifically on the lower half of the sternum. The rescuer should place the heel of one hand directly in the center of the chest, avoiding the ribs on either side.
Depending on the child’s size and the rescuer’s strength, either a one-hand or a two-hand technique can be used. For smaller children, the heel of one hand may be sufficient to deliver the necessary force. A larger child may require a two-hand technique, where the second hand is placed on top of the first.
The decision to use one or two hands is based entirely on the effort needed to achieve the target compression depth of about two inches, or one-third the depth of the child’s chest. Maintaining a rate of 100 to 120 compressions per minute is required for this age group.
Ensuring Effective Compressions
Correct hand placement is only the first step toward effective chest compressions; the mechanical action must also be precise to circulate blood successfully. A fundamental component of high-quality CPR is allowing the chest to fully return to its normal position after each compression, a process known as full chest recoil.
This full release is mechanically necessary because it allows the heart chambers to completely refill with blood before the next compression pushes it out. Incomplete chest recoil is a common error that prevents the heart from drawing in enough blood, which severely reduces the overall effectiveness of the resuscitation effort.
Maintaining the precise central placement on the sternum ensures that the force is applied to the heart and not accidentally directed toward the lower ribs or the abdomen. This minimizes the risk of causing injuries such as fractured ribs or damage to internal organs like the liver, while maximizing the life-saving flow of blood.