Infant and child CPR and choking: pediatric resuscitation guide¶

When an infant under one year old or a young child stops breathing or chokes on food, a coin, or a toy, every second matters. Unlike adults, whose cardiac arrest is usually triggered by sudden heart rhythm problems, pediatric cardiac arrest almost always stems from a respiratory emergency, such as choking, drowning, severe asthma, or suffocation.

Because oxygen deprivation is the primary threat to young children, pediatric CPR requires both chest compressions and rescue breaths. Following the standardized protocols established by the American Heart Association, the International Liaison Committee on Resuscitation, and the Red Cross restores oxygen delivery to the brain and heart.

Do this now: conscious choking infant (under 1 year old)¶

If a baby cannot cry, cough, or breathe, or makes high-pitched squeaking sounds:

1. Verify airway obstruction: If the infant is coughing loudly or crying vigorously, do not interfere. A strong cough is the most effective way to clear an airway. If the infant cannot make any sound, skin turns blue, or breathing halts, act immediately.
2. Support the head and neck: Place the infant face down along your forearm. Support the baby's jaw firmly between your thumb and fingers without pressing on the soft tissue of the throat. Rest your forearm on your thigh for stability, ensuring the baby's head is angled lower than their chest.
3. Deliver 5 back blows: Using the heel of your free hand, deliver 5 firm, distinct blows between the infant's shoulder blades.
4. Turn the infant face up: Sandwich the baby between your forearms, supporting the back of the skull, and turn them face up onto your opposite thigh. Keep the head lower than the torso.
5. Deliver 5 chest thrusts: Place 2 fingers on the center of the breastbone, just below the nipple line. Press down 4 cm (1.5 inches) with a quick, smooth downward thrust. Deliver 5 chest thrusts at a rate of 1 thrust per second.
6. Repeat the sequence: Continue alternating 5 back blows and 5 chest thrusts until the object pops out or the infant becomes unconscious.

Do this now: unconscious infant CPR (under 1 year old)¶

If an infant is unresponsive, limp, and not breathing or only gasping:

1. Call your local emergency number immediately:
   • Call emergency services (911 in the United States and Canada, 112 across the European Union, 999 in the United Kingdom, 000 in Australia). Put your mobile phone on speaker so your hands remain free.
   • If you are completely alone with no phone nearby, provide 2 minutes (about 5 cycles) of CPR first, then carry the infant with you to call emergency dispatch.
2. Place the infant on a firm, flat surface: Place the baby on their back on a table, floor, or firm ground.
3. Deliver 30 chest compressions:
   • Place 2 fingers in the center of the chest, just below the nipple line. Alternatively, encircle the infant's chest with both hands and place both thumbs side-by-side on the center of the breastbone.
   • Press straight down 4 cm (1.5 inches), which is about one-third the depth of the chest.
   • Push hard and fast at a tempo of 100 to 120 compressions per minute. Allow the chest to return to its normal position completely between each compression.
4. Look for the foreign object: Open the baby's mouth. If you see the dislodged object loose in the mouth, sweep it out gently with your pinky finger. Never perform a blind finger sweep, as this can shove the obstruction deeper into the windpipe.
5. Give 2 gentle rescue breaths:
   • Tilt the head back gently into a neutral sniffing position. Do not tilt an infant's head back too far, as hyperextending a baby's neck collapses their flexible trachea.
   • Cover both the baby's mouth and nose with your mouth to create an airtight seal.
   • Blow gently for 1 second, using only the air volume from your cheeks. Watch for the baby's chest to rise. If the chest does not rise, re-tilt the head slightly and try one more breath.
6. Repeat the 30 to 2 cycle: Deliver 30 chest compressions followed by 2 rescue breaths without interruption until the infant starts breathing, an AED is ready, or emergency medical technicians arrive.

Child choking and CPR (age 1 to puberty)¶

Children have larger airways than infants, requiring adjusted rescue maneuvers similar to adult CPR but scaled to their physical size:

Conscious choking child¶

• Stand or kneel behind the child to reach their waist height.
• Wrap your arms around the child's waist.
• Make a fist with one hand and place the thumb side against the middle of the child's abdomen, slightly above the navel and well below the lower tip of the breastbone.
• Grasp your fist with your other hand and deliver quick, upward abdominal thrusts (the Heimlich maneuver).
• Continue rapid upward thrusts until the foreign object is dislodged or the child becomes unresponsive.

Unconscious child CPR¶

• Compression technique: Use 1 hand or 2 hands on the lower half of the breastbone, depending on the child's size.
• Compression depth: Press down 5 cm (2 inches), roughly one-third of the chest depth.
• Compression rate: 100 to 120 compressions per minute.
• Rescue breathing: Pinch the child's nose closed, cover their mouth with your mouth, and deliver 2 normal breaths, watching for chest rise.
• Cycle: Maintain 30 compressions followed by 2 breaths.

Pediatric resuscitation comparison¶

Using an automated external defibrillator (AED) on children¶

Automated external defibrillators can be used safely on children and infants when cardiac arrest occurs:

1. Turn on the AED immediately: Open the lid or push the power button and follow voice prompts.
2. Use pediatric pads if available:
   • For infants and children under 8 years of age or weighing less than 25 kg (55 pounds), use pediatric attenuated pads or activate the pediatric key switch on the device.
   • Pediatric pads reduce the electrical energy dose to a safe level for a small child's heart.
3. Pad placement on infants and small children:
   • If the child is small and the pads risk touching each other on the chest, use anterior-posterior placement: place 1 pad in the center of the chest and the second pad on the center of the upper back between the shoulder blades.
4. If pediatric pads are unavailable, use adult pads: Do not delay defibrillation. Use adult pads with anterior-posterior placement so the pads do not touch or overlap.
5. Resume compressions immediately: Clear the patient when the AED analyzes or delivers a shock, then resume CPR starting with chest compressions immediately after the shock.

Preventing pediatric choking hazards¶

Most foreign body airway obstructions in infants and toddlers can be prevented through household precautions:

• High-risk foods: Cut hot dogs, grapes, cherry tomatoes, and large raw vegetables into small, lengthwise strips rather than round circular coin shapes. Avoid giving whole nuts, hard candies, popcorn, or spoonfuls of thick peanut butter to children under 4 years old.
• Small objects and toys: Keep coins, marbles, button batteries, latex balloons, and small toy parts out of reach. Latex balloons pose the single highest choking death hazard among non-food items because popped rubber molds tightly to the child's vocal cords.
• Button batteries and high-powered magnets: If a child swallows a button battery or magnetic spheres, seek emergency hospital care immediately. Button batteries generate an electrical current that burns through esophageal tissue in less than two hours.

... note "Take a course" Hands-on first aid training with the Red Cross, St John Ambulance, or regional emergency medical services teaches essential lifesaving skills with practical, guided experience on infant and child mannequins.

Related guides¶

• Hands-only CPR and cardiac arrest
• Adult choking relief
• Severe allergic reactions and anaphylaxis
• Emergency numbers by country