An Automated External Defibrillator (AED) is a portable electronic device that automatically diagnoses life-threatening cardiac arrhythmias and treats them through defibrillation. This application of electricity stops the arrhythmia, allowing the heart to re-establish an effective rhythm. When a child experiences sudden cardiac arrest, rapid AED deployment dramatically increases the chances of survival. Effective use requires having the correct equipment and knowing precisely where to place the electrode pads to ensure the electrical current passes through the heart.
Understanding Pediatric AED Equipment and Patient Criteria
Determining whether to use pediatric or adult equipment is the first step in treating a child with an AED. The standard guideline is to use pediatric pads, or a special attenuator key, on any child under eight years of age or weighing less than 55 pounds (25 kg). This equipment is designed to reduce the energy of the electrical shock delivered by the AED, typically attenuating the dose to about 50 joules, which is significantly lower than the adult dose that can range up to 360 joules.
Pediatric pads are smaller than adult pads and are engineered to prevent them from touching on a small child’s chest, which could lead to an ineffective shock. Using adult pads without energy reduction equipment could deliver a dangerously high dose of electricity. If pediatric pads or a child key are not immediately available, current guidelines emphasize that using adult pads is better than delaying defibrillation entirely. In this scenario, the adult pads must be placed in the alternative anterior-posterior position to prevent them from touching.
Standard Placement: Anterior-Lateral Method
The anterior-lateral placement is the preferred, standard method for children large enough that the pads will not overlap. This technique mirrors the placement used for adults and is generally recommended for children over the age of one up to eight years old, provided their body size allows the pads to be separated. This positioning creates a direct electrical pathway that effectively sandwiches the heart between the two electrodes.
The first pad is positioned high on the child’s right side of the chest, just beneath the collarbone and to the side of the breastbone. The second pad is then placed on the left side of the chest, near the lower rib cage and below the armpit, along the mid-axillary line. Before applying the pads, the skin must be exposed and should be as dry as possible to ensure proper adhesion and electrical conductivity. Any excessive body hair or jewelry in the placement area should be quickly removed to guarantee a solid connection, which is necessary for the AED to accurately analyze the heart’s rhythm.
Alternative Placement: Anterior-Posterior Method
The anterior-posterior (AP) method is the necessary alternative placement for infants and very small children where the standard anterior-lateral placement would result in the pads touching. This placement is also recommended when using adult pads on a small child because the larger size makes pad separation on the chest impossible. The primary goal is to ensure the heart remains directly in the path of the electrical current without the pads contacting each other, which would short-circuit the shock.
In the AP method, one pad is placed on the front side, specifically in the center of the child’s chest over the breastbone. The second pad is placed on the back side, ideally positioned between the shoulder blades. This front-and-back configuration ensures the heart is located directly between the electrodes, allowing the electrical energy to travel through the chest cavity and across the heart muscle.
Post-Placement Safety and Rescue Sequence
Once the pads are correctly and securely affixed to the child’s bare skin, power on the AED and follow the voice prompts. The device will instruct the rescuer to plug in the electrode cable, if necessary, and begin analyzing the heart rhythm. No one must touch the child during the analysis phase, as movement or contact can interfere with the AED’s ability to accurately detect a shockable rhythm.
If the AED detects a heart rhythm requiring a shock, it will charge and announce the need to deliver the electrical pulse. The rescuer must loudly announce “clear” and confirm all bystanders are clear of the child before pressing the shock button. Immediately following the shock, or if the AED advises against a shock, the rescuer must instantly resume Cardiopulmonary Resuscitation (CPR). The rescue sequence involves continuing chest compressions and rescue breaths for two minutes, until the AED prompts for re-analysis, or until emergency medical services arrive.