Cardiopulmonary resuscitation (CPR) is a time-sensitive intervention that can significantly improve outcomes for infants experiencing cardiac or respiratory arrest. Because of the baby’s small size, accurate chest compression placement is essential for effective blood circulation and preventing injury. Understanding the specific anatomical landmark for compressions is the most important step in administering life-saving care. This article details the precise location, technique, and parameters necessary for infant CPR.
Recognizing the Need for Infant CPR
Infant CPR guidelines apply to babies up to 12 months of age. Before initiating physical contact, a rescuer must ensure the scene is safe. The rescuer should then check for a response by gently tapping the baby’s foot and calling out. If the baby remains unresponsive, the rescuer must immediately activate emergency medical services or send someone to call for help.
The decision to begin chest compressions rests on whether the infant is unresponsive and not breathing normally, or is only gasping. A heart rate below 60 beats per minute, coupled with signs of poor perfusion such as pale or bluish skin discoloration, also indicates the need for CPR. Rescuers should check for a pulse for no more than 10 seconds, typically at the brachial artery on the inside of the upper arm. If a pulse cannot be confirmed or is dangerously slow, compressions should begin immediately.
Precise Chest Compression Location
The goal of compression placement is to apply pressure directly over the lower half of the sternum, or breastbone, which lies in the center of the chest. Correct positioning ensures the force is delivered to the heart, which sits just beneath this bone. To locate this spot, the rescuer should visualize an imaginary line running horizontally between the baby’s nipples.
The compression area is situated on the sternum, just below this imaginary nipple line. Rescuers must avoid pressing on the ribs or the very bottom tip of the sternum, known as the xiphoid process. Applying pressure to the xiphoid process risks causing damage to the baby’s liver or other internal organs.
The proper anatomical landmark is a small, focused area that maximizes compression effectiveness while minimizing injury risk. By placing fingers or thumbs on the lower sternum, the rescuer targets the area most likely to generate adequate blood flow to the brain and other organs.
Technique, Depth, and Rate
Once the correct location is identified, the rescuer must choose the appropriate technique for delivering compressions. A single rescuer commonly uses the two-finger technique, placing the tips of the index and middle fingers, or middle and ring fingers, just below the nipple line. For two rescuers, the two-thumb encircling hands technique is preferred because it achieves greater compression depth and is less fatiguing. In this technique, the thumbs are placed side-by-side on the sternum while the fingers encircle and support the baby’s back.
The compression force must be deep enough to be effective, but not cause harm. Guidelines recommend a compression depth of approximately 1.5 inches, corresponding to roughly one-third of the baby’s chest depth. After each compression, the rescuer must allow the chest to fully recoil back to its normal position, which permits the heart to refill with blood.
The compression rate is standardized at 100 to 120 compressions per minute to ensure consistent blood flow. The compression-to-ventilation ratio for a single rescuer is 30 compressions followed by two rescue breaths. When two trained rescuers are present, the ratio shifts to 15 compressions for every two breaths to reduce interruptions.
When to Stop and What Happens Next
The rescuer should continue providing CPR without interruption until specific conditions are met. This includes the infant showing signs of life, such as responsive movement or normal breathing. If an automated external defibrillator (AED) becomes available, compressions should continue until the device is ready to use and its prompts are followed.
CPR should also continue until trained emergency medical services (EMS) personnel arrive and take over care. The rescuer should stop if they become physically exhausted and cannot continue delivering high-quality compressions. Minimizing interruptions is a priority to ensure the brain receives continuous oxygenated blood flow.