Performing Cardiopulmonary Resuscitation (CPR) is crucial for an infant or child who is unresponsive and not breathing normally. Correct hand placement is vital because it ensures compressions are delivered effectively to the heart without causing injury. The required technique and force change drastically based on the patient’s size, meaning the location and method for chest compressions are highly dependent on age.
Distinguishing Between Infant and Child CPR Techniques
The approach to pediatric CPR is separated into two distinct categories based on age, which determines the size of the patient’s chest. An infant is defined as any child under one year of age, while a child is considered to be between one year old and the onset of puberty. This distinction recognizes the significant difference in body size and skeletal structure.
The smaller, more pliable chest of an infant requires a gentler, more focused compression method compared to a larger child. As a child grows, their chest cavity stiffens, necessitating a larger surface area for compression and greater force to achieve the proper depth. Determining the patient’s age is the first step, as it dictates the proper hand technique.
Hand Placement and Technique for Infants
For an infant under one year old, the focus is on applying pressure to the breastbone, or sternum, using two fingers. The rescuer should place the infant on a firm, flat surface and locate the correct site by imagining a horizontal line between the nipples. The two fingers are then placed on the sternum just below this imaginary line.
When a second rescuer is present, the preferred technique is the two-thumb encircling method, which delivers more consistent depth. The rescuer wraps both hands around the infant’s chest and uses both thumbs side-by-side on the breastbone. Compression depth should be approximately one-third the depth of the infant’s chest, which is about 1.5 inches (4 centimeters).
Compressions must be delivered at a rapid rate of 100 to 120 compressions per minute. Allowing the chest to fully recoil after each push is just as important as the compression itself, as this permits the heart to refill with blood. The rescuer must ensure they are pushing straight down and not over the ribs or the very bottom tip of the breastbone.
Hand Placement and Technique for Children (Ages One to Puberty)
For a child between the age of one year and puberty, the technique shifts from using two fingers to using the heel of the hand. The correct placement is over the lower half of the child’s breastbone. A simple way to locate this area is by finding the notch where the ribs meet at the bottom center of the chest and placing the heel of the hand just above that point.
The heel of one hand is typically sufficient to achieve the correct compression depth for a small to average-sized child. The force should be delivered from the shoulder, keeping the arm straight, to push down approximately one-third the depth of the chest, about 2 inches (5 centimeters). This maximizes pressure delivered to the heart while minimizing the risk of injury to the ribs.
If the child is larger or the rescuer finds they cannot achieve the necessary 2-inch depth with one hand, they should transition to using the heel of two hands, interlocking the fingers and stacking them one on top of the other. The rate of compression remains the same as for infants, between 100 and 120 times per minute. The choice between one and two hands is a practical decision based on the child’s body size and the ability to compress the chest to the required depth.