Infant CPR is a vital skill more of us should have.
Knowing infant CPR is a skill every parent, caregiver, and anyone who spends time with babies should have in their toolkit. You never know when an emergency might strike — infants can choke, have breathing issues, or even go into cardiac arrest, and it’s incredibly important to be prepared. But understanding the intricacies of adult CPR is completely different than knowing how to perform the technique on an infant. And having this essential skill means you’re ready to protect the most vulnerable and precious members of your family.
To learn more, we went straight to an expert, my pal Jen Arnold — an author, expert, neonatologist, and of course, a mother. Here’s the vital info each of us needs to absorb.
Can you describe the specific steps you’d take to perform CPR on an infant?
First off, it’s important to establish when it’s appropriate to perform CPR on an infant. The Cliff’s Notes calculation is, according to the American Heart Association: If the child is unresponsive, plus no breathing or only gasping, you should provide CPR.
But in much more detail, here are the steps you should take:
Step 1. Check for responsiveness: Gently tap the infant’s shoulder or foot and yell. You should begin CPR for any infant who’s unresponsive, not breathing normally, and doesn’t have signs of life.
Step 2. Call for help or send someone to call 911 and get your Automated External Defibrillator (AED) if you have one, and put it on the child as soon as you can.
Step 3. Put the infant on a hard, flat surface where he or she won’t fall.
Step 4. Perform chest compressions: Push on the middle of the chest 30 times at a depth of 1½ inches, approximately 1/3 the diameter of the chest, with 2 fingers placed on the lower third of the sternum, just below the intermammary, or nipple, line. The rate is 100-120 compressions per minute, which is the beat to “Staying Alive.” Maintain a consistent, steady rhythm, ensuring the chest fully recoils between compressions, which is vital for effectively performing CPR on an infant.
Step 5. Open the airway: Using the head tilt/chin lift maneuver, tilt the infant’s head upwards and lift their chin so their tongue doesn’t obstruct their airway. Be careful not to overextend, especially if there’s potential for injury to the baby’s neck or spinal cord.
Step 6. Give 2 breaths: Take a breath, seal the infant’s mouth and nose with your mouth, and gently blow for one second. Watch for their chest to rise.
Step 7. Continue performing 30 compressions, each cycle followed by two breaths, until help arrives.
Some other important notes:
-If you need to leave the infant to call 911, make sure to provide 5 cycles of 30 compressions and 2 breaths before leaving to call 911 and get the AED.
-For infants and children, if bystanders are unwilling or unable to deliver rescue breaths, rescuers should provide chest compressions only.
The main difference in infant versus adult CPR is that we still recommend giving breaths to infants, but no longer recommend it for adults when the technique is performed by laypersons — though we do give breaths in the hospital setting. That’s because of the hesitancy to provide mouth to mouth, and the causes of cardiac arrests in adults. There are other differences as well, such as the fact that when it comes to chest compressions, you use two fingers for infants versus the palm of the hand for adults.
What are the most common causes of cardiac arrest in infants, and how do they influence your approach to performing infant CPR?
For adults, the most common cause of cardiac arrest is a cardiac event, most often coronary artery disease leading to a heart attack. But the most common causes of cardiac arrest in infants are respiratory, often related to respiratory failure or an airway blockage.
The second most common cause for infants is shock, AKA a life-threatening medical emergency that occurs when the body doesn’t have enough blood circulating, which reduces the flow of oxygen and nutrients to vital organs. This can happen due to a number of causes, including trauma and severe infections. In infants, when cardiac arrest is related to a heart issue, it’s usually due to a congenital heart disorder.
During infant CPR, what are the key signs to look for to assess if you’re performing it correctly?
It’s important to focus on technique. So for your breaths, you should see the infant’s chest rise and fall with each breath. If you don’t see that, try improving the head position — with the chin tilt as described above — opening the mouth, and improving your seal and coverage of the mouth and nose during each breath. For chest compressions, you should make sure your compressions are reaching a depth of about 1/3 the depth of the chest, and make sure you’re allowing the chest to recoil after each compression. It also helps if someone else is available to partner with chest compressions and breaths, so one person can focus on each task.
What precautions should you take to be sure you’re keeping the infant safe — and how do you adjust your technique for differently sized babies?
Ensure that you and the baby are in a safe place, and that the baby is resting on a hard flat surface such as the floor, where there’s no chance of them falling. And there are adjustments based on the size of the infant or child. For chest compressions in infants, you have two options: using two fingers — middle and ring fingers — on the lower half of the breastbone, or using two thumbs while encircling the chest with your hands. The two-thumb method has been shown to be more effective — better blood flow and less fatigue for the compressor — but only if your hands can effectively encircle the baby’s chest. For kids older than 1 year, use one or two hands placed on the center of the chest, just below the nipple line.
How do you handle a situation where you’re alone and need to perform CPR on an infant? What steps should you take to ensure that you’re doing CPR correctly — and staying in touch with emergency services?
In general, it’s ideal to be able to notify emergency services as soon as possible, but you also don’t want to delay providing life-saving CPR. If you didn’t witness the infant’s arrest and you’re alone, perform CPR for 2 minutes prior to calling EMS and finding an AED. If you do witness the arrest — say the infant suddenly becomes unresponsive — and you’re alone, call EMS before returning to the child to start CPR.
Emergency services can also walk you through the steps of infant CPR. First, they’ll ask you specific questions, such as the exact location and nature of the emergency, but after they’ve dispatched help, the person on the phone should be able to provide guidance on things such as the rate of compressions if you forget. And it’s always a good idea to stay on the phone until EMS arrives.
