When a child becomes unresponsive and stops breathing normally, the swift initiation of cardiopulmonary resuscitation (CPR) can dramatically influence the outcome. Pediatric emergencies (infants under one year old and older children up to puberty) often stem from respiratory failure rather than sudden cardiac events, making oxygen delivery a high priority. Current life support protocols emphasize immediate, effective action to maximize survival by minimizing time spent on non-therapeutic activities. A rapid assessment determines the appropriate intervention, recognizing that seconds lost can lead to permanent damage.
Prioritizing Compressions Over Pulse Checks
For a lay rescuer encountering an unresponsive child who is not breathing or is only gasping, current guidelines recommend immediately beginning chest compressions without attempting to find a pulse. This emphasis is based on evidence that untrained rescuers frequently struggle to reliably locate a pulse, wasting precious time. The greatest benefit comes from the immediate circulation of any remaining oxygenated blood to the brain and vital organs.
The assessment for signs of life, including checking for breathing and a pulse, should take no more than 10 seconds. If a rescuer is uncertain whether a pulse is present within that brief window, or if no breathing is observed, the protocol is to initiate CPR immediately. This acknowledges the difficulty in detecting a faint pulse, especially in a small child with poor circulation. Time spent searching for a pulse is time taken away from providing chest compressions.
This approach separates the role of the untrained bystander from the healthcare provider. While a trained professional might attempt a pulse check, the lay rescuer’s primary task is to recognize the lack of responsiveness and abnormal breathing, then begin the cycle of compressions and rescue breaths. High-quality chest compressions (100 to 120 per minute) are the priority, as they sustain life until emergency medical services arrive.
Specific Pulse Check Locations for Trained Rescuers
Trained rescuers, such as healthcare providers, may perform a pulse check to confirm the need for CPR or determine the appropriate intervention, which must be completed within 10 seconds. The location for this assessment differs based on the child’s age due to anatomical differences and ease of access. For an infant (under approximately one year of age), the preferred location is the brachial artery.
The brachial artery runs along the inside of the upper arm, between the shoulder and the elbow. To check the pulse, the rescuer should use two or three fingers and press gently in the groove on the inner side of the arm, ensuring not to press too firmly, which could stop the blood flow. This site is favored in infants because their short necks make the carotid artery hard to access, while the brachial artery is easier to isolate and feel.
For a child (from one year of age up to the onset of puberty), the carotid artery is the recommended pulse check site. It is located in the neck, in the groove between the trachea (windpipe) and the large muscle on the side of the neck. Placing two fingers gently on this location allows the rescuer to feel for the major artery supplying blood to the brain.
An alternative site for an older child is the femoral artery, located in the groin area where the upper thigh meets the abdomen. The carotid and femoral arteries are major central pulses that are more likely to be detectable than peripheral pulses if circulation is severely compromised. Regardless of the site chosen, the strict 10-second limit must be observed to prevent delays in initiating chest compressions if a pulse is absent or too slow.
The Immediate Action Following Assessment
The brief assessment of the child’s breathing and pulse leads directly to the next steps in resuscitation. If a pulse is definitively felt and the child is breathing normally, the rescuer should continue to monitor the child until emergency responders arrive. If the child is unresponsive and not breathing normally but has a pulse, the rescuer should begin rescue breathing.
Rescue breaths are provided at a rate of one breath every three to five seconds (12 to 20 breaths per minute), while continuously checking the pulse every two minutes. If the child has a pulse that is slow (less than 60 beats per minute) and shows signs of poor perfusion (such as pale or bluish skin), chest compressions must be added to the rescue breaths. This slow heart rate indicates a problem requiring mechanical assistance to circulate blood.
If the assessment confirms the absence of a pulse or if the pulse is uncertain after the 10-second check, the rescuer must immediately begin full CPR, starting with chest compressions. A single rescuer performs cycles of 30 compressions followed by two breaths, while two rescuers use a ratio of 15 compressions to two breaths. Activating the emergency response system must happen quickly, either by the rescuer or a bystander, to ensure professional help and a defibrillator are on the way.