Baby and Child CPR: What It Actually Involves
Why paediatric resuscitation starts with five rescue breaths rather than compressions, what the technique is for a baby and for a child, and the one thing worth memorising about choking in under-ones.
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Quick answer
CPR on a baby or child is not adult CPR done gently. It starts with five rescue breaths before any compressions, because in children the heart usually stops as a result of a breathing problem rather than a cardiac one. Compressions go at 100 to 120 a minute, pressing down by at least a third of the depth of the chest. For a baby under one, that is the two-thumb encircling technique. The ratio is 15:2 if you have been trained in paediatric resuscitation, otherwise 30:2.
This page explains what paediatric CPR involves. It is not a substitute for being taught it. Chest compressions and rescue breaths are physical skills, and reading about them is not the same as having done them on a manikin with someone correcting you.
Why it starts with breaths
This is the difference that matters most, and it is the one people trained only in adult CPR do not expect.
When an adult’s heart stops, the usual cause is a cardiac one, and the blood still in circulation carries oxygen for a while. That is why adult resuscitation goes straight to compressions and why hands-only CPR is a reasonable thing for an untrained bystander to do.
In babies and children it is usually the other way round. The heart stops because breathing has failed first, whether from choking, drowning, an asthma attack, an infection or a seizure. By the time the heart stops, the oxygen is already gone. Compressing a chest that has no oxygen in it to circulate achieves very little.
So paediatric resuscitation starts with five initial rescue breaths, and those breaths are the part most likely to make a difference.
What the sequence looks like
- Check for danger, then check whether they respond.
- Open the airway and check breathing. Do not spend long on this.
- Give five rescue breaths.
- Start compressions at 100 to 120 a minute, pressing down by at least one third of the depth of the chest and letting it come all the way back up between compressions.
- Continue at 15:2 if you have been trained in paediatric basic life support, or 30:2 if you have not.
- Keep going until help arrives and takes over, or the child starts to show signs of life.
Get someone to phone 999 as early as you can. If you are on your own with a phone, put it on speaker so you can keep your hands on the child.
Babies, children and the differences that matter
| Baby (under 1) | Child (1 to puberty) | |
|---|---|---|
| Compression technique | Two thumbs, hands encircling the chest | Heel of one hand, or two hands for a larger child |
| Depth | At least one third of the depth of the chest | At least one third of the depth of the chest |
| Rate | 100 to 120 a minute | 100 to 120 a minute |
| Rescue breaths | Cover mouth and nose, small puffs | Pinch the nose, seal over the mouth |
| Choking | Back blows and chest thrusts. Never abdominal | Back blows and abdominal thrusts |
The choking row is the one worth memorising even if you remember nothing else. A baby under one is never given abdominal thrusts. Their liver sits low and relatively unprotected, and abdominal thrusts can cause serious internal injury. Chest thrusts instead.
“At least a third of the chest” is deeper than people expect
The most common failure in real paediatric resuscitation is not doing it wrong. It is doing it too gently.
Pressing down by a third of the depth of a baby’s chest feels alarming when you have never done it. People who have only read about CPR almost always compress too shallowly, because the instinct with a small child is to be careful. Effective compressions are the point; a broken rib heals and a cardiac arrest does not.
Rate is the other one. A hundred to a hundred and twenty a minute is considerably faster than most people imagine, which is why courses get you doing it against a metronome or a manikin that tells you.
This is precisely why a screen cannot teach this and why the Early Years framework insists on a trainer being physically present for the emergency elements.
Drowning and cold water
Drowning is an asphyxial arrest, which is the situation paediatric resuscitation is built for. Resuscitation Council UK guidance is to start standard paediatric basic life support with five rescue breaths as soon as it is safe to do so, on land or in a boat. Do not attempt rescue breaths in the water.
Cold changes the picture in one important way. In hypothermic cardiac arrest the guidance is to start standard CPR in every case and as soon as possible. Cold water arrests can have better outcomes than they look like they will, so a child pulled from cold water is a case for starting and continuing, not for making a judgement about whether it is worth it.
Who should be trained in this
Anyone responsible for children, and particularly:
- Early years settings. Nurseries, pre-schools and childminders need the full 12-hour paediatric first aid qualification, taught face to face with the trainer physically present, because that is what the Early Years Foundation Stage framework requires. The requirements are in paediatric first aid requirements, and the difference between the full and emergency courses in full or emergency paediatric first aid.
- Schools and clubs. Staff and coaches who are the responsible adult when something happens.
- Parents, grandparents and nannies. There is no requirement, and there is a very good reason to do it anyway.
- Workplaces with children on site. Leisure centres, soft play, retail, hospitality. A workplace first aid certificate does not cover paediatric technique, and your first aid needs assessment should say so if members of the public including children are foreseeable casualties.
A workplace first aid certificate and a paediatric one are not interchangeable in either direction. The techniques genuinely differ, and so do the conditions covered.
Frequently asked questions
How do you do CPR on a baby?
Five rescue breaths first, covering the mouth and nose with small puffs. Then compressions using the two-thumb encircling technique, at 100 to 120 a minute, pressing down by at least a third of the depth of the chest. Continue at 15:2 if you are trained in paediatric resuscitation, or 30:2 if not.
Why do you give rescue breaths before compressions for a child?
Because in children the heart usually stops as a consequence of breathing failing first, so the oxygen is already gone by the time the heart stops. Compressions alone would circulate blood that has no oxygen in it. In adults the cause is usually cardiac, which is why adult CPR starts with compressions.
How hard do you press on a baby's chest?
At least one third of the depth of the chest. It feels like more force than seems right, and the commonest mistake by a wide margin is pressing too gently.
Is it 15:2 or 30:2 for a child?
Fifteen compressions to two breaths if you have been specifically trained in paediatric basic life support. Thirty to two if you have not. Either is far better than nothing.
What is the difference between baby and child CPR?
Mainly the compression technique and the choking treatment. A baby under one gets two-thumb encircling compressions and, if choking, chest thrusts rather than abdominal thrusts. A child gets the heel of one hand, or two hands if they are large, and abdominal thrusts for choking.
Can you learn baby CPR online?
You can learn what it involves. You cannot learn to do it, because compression depth and rate are physical skills that have to be practised and corrected. For early years settings it is also not an option: the EYFS framework requires the emergency elements to be taught with the trainer physically present.
Does a workplace first aid certificate cover children?
No. Paediatric technique differs and the conditions covered differ. If children are foreseeable casualties where you work, your first aid needs assessment should account for that separately.
What if I break a rib?
Keep going. Ribs heal. Compressions that are too shallow to circulate blood are the thing that actually costs a life, and that is the far more common problem.
What do I do if a baby is choking?
Back blows first, then chest thrusts, never abdominal thrusts for a baby under one. If they become unresponsive, start CPR. Anyone who has received thrusts of any kind should be seen by a doctor afterwards.
How long do you keep going?
Until emergency help arrives and takes over, or the child shows signs of life. With cold water drowning in particular, keep going, because outcomes in hypothermic arrest can be better than they appear.
If you look after children, this is worth learning properly rather than reading about. Our paediatric first aid courses run in Bolton, Wigan and Manchester, or at your own setting. Call 0845 838 4643 or use the enquiry form on this page.
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