Infant and child CPR and choking: pediatric resuscitation guide¶

When an infant under 1 year old or a child stops breathing or chokes on food, a coin, or a small toy, every second matters. Unlike adults, whose sudden cardiac arrest is usually triggered by a primary coronary artery blockage or electrical heart rhythm disturbance, pediatric cardiac arrest almost always starts as a respiratory emergency (such as foreign-body airway choking, drowning, severe asthma, croup, pneumonia, or suffocation) that starves the heart muscle of oxygen until the heart stops beating.

Because children in cardiac arrest have already depleted the oxygen in their blood before their heart stops, pediatric CPR requires both chest compressions and rescue breaths (unlike Hands-Only CPR in adults). This guide follows current International Liaison Committee on Resuscitation (ILCOR), American Heart Association (AHA), UK Resuscitation Council, and Red Cross guidelines to help you clear a blocked airway and resuscitate an infant or child.

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

If a baby is awake but suddenly cannot cry, cannot cough, cannot breathe, turns blue around the lips, or makes only silent mouth movements or high-pitched squeaks:

1. Confirm severe airway obstruction. If the baby is crying loudly or coughing forcefully, do not slap their back, as a strong cough clears the airway best; stay with them and watch closely. Act immediately only if the cough becomes silent, breathing stops, or they cannot make sound.
2. Position the infant face-down along your forearm. Sit or kneel and rest your forearm on your thigh for stability. Hold the baby face-down along your forearm with their head angled lower than their chest, supporting their bony jaw and cheekbones between your thumb and fingers without pressing on the soft throat under the chin.
3. Deliver 5 firm back blows. Using the heel of your free hand, deliver 5 quick, firm back blows squarely between the infant's shoulder blades.
4. Sandwich and turn the infant face-up. Place your free hand and forearm along the baby's back, cradle the back of their head in your palm, and flip the baby safely face-up onto your opposite thigh, keeping their head lower than their torso.
5. Deliver 5 downward chest thrusts. Place 2 fingers (or 2 thumbs) on the center of the breastbone, just below the imaginary line between the nipples. Press straight down 4 centimeters (1.5 inches), about one-third the depth of the chest, 5 distinct times at a rate of 1 thrust per second.
6. Repeat 5 back blows and 5 chest thrusts continuously. Keep alternating 5 back blows and 5 chest thrusts until the object pops out and the baby cries, or until the baby becomes limp and unresponsive (at which point you immediately begin Unconscious Infant CPR below).

Do this now: unresponsive infant or child CPR¶

If an infant (under 1 year) or child (age 1 to puberty) is unresponsive, limp, and not breathing normally (or only making occasional gasps):

1. Shout for help and call your local emergency number on speakerphone. Have a bystander dial 911 in the United States and Canada, 112 across the European Union, 999 in the United Kingdom, or 000 in Australia (see all dinomoro tsa tshohanyetso) and fetch an Automated External Defibrillator (AED). If you have a mobile phone on you, dial immediately and put it on speakerphone so you start CPR with zero delay. (If you are completely alone with no phone nearby and the collapse was not sudden/witnessed, perform 2 minutes / 5 cycles of CPR first before carrying the baby or running to a phone).
2. Lay the infant or child flat on their back on a firm, hard surface. Use the floor, the ground, or a sturdy table; never perform CPR on a soft mattress or sofa where the whole body sinks down with every push.
3. Give 30 chest compressions hard and fast (100 to 120 per minute).
   • For an infant (under 1 year): Use the 2-thumb encircling hands technique (wrap both hands around the baby's ribcage and press the lower half of the breastbone with both thumbs side-by-side) or the 2-finger technique (press with two fingertips straight down on the center of the chest just below the nipple line). Push down 4 centimeters (1.5 inches), or one-third the front-to-back depth of the chest.
   • For a child (age 1 to puberty): Place the heel of 1 hand (or 2 hands interlaced if the child is larger or your hands tire) on the lower half of the breastbone. Push straight down 5 centimeters (2 inches), or one-third the depth of the chest.
   • Let the chest recoil (spring all the way back up) completely after every single push.
4. Open the airway and check the mouth if they were choking. If the arrest started from choking, open the mouth wide and look inside; if you clearly see a loose object, sweep it out gently with your pinky finger. Then open the airway using a neutral "sniffing" position for an infant (do not tilt a baby's head far back) or a gentle head-tilt, chin-lift for a child.
5. Give 2 gentle rescue breaths (1 second each).
   • For an infant: Cover both the baby's mouth and nose tightly with your mouth and blow a gentle puff of air from your cheeks for 1 second just until you see the baby's chest visibly rise. Let the chest fall, then give a second 1-second puff.
   • For a child: Pinch the child's soft nostrils closed with your thumb and index finger, seal your lips over the child's mouth, and give 2 gentle 1-second breaths just until the chest rises.
6. Continue cycles of 30 compressions and 2 breaths without stopping. Keep going at a 30:2 ratio until the infant or child begins breathing and moving, an AED arrives and is ready to analyze, or paramedics take over your position.

Pediatric choking and CPR decision algorithm¶

flowchart TD
    Start["Infant (<1 yr) or Child (1 yr to Puberty) in Crisis"] --> ConsciousCheck{"Is the infant or child conscious and responsive?"}

    ConsciousCheck -->|Yes, Conscious Choking| SoundCheck{"Can they cough forcefully, cry, or speak?"}
    SoundCheck -->|Yes, strong cough| Encourage["Do NOT Slap Back or Interfere<br/>Stay close and encourage coughing<br/>Call emergency dispatch if obstruction persists"]
    SoundCheck -->|No, silent/unable to breathe| AgeChoke{"What is the child's age?"}

    AgeChoke -->|Infant Under 1 Year| InfantChoke["Alternate 5 Back Blows and 5 Chest Thrusts<br/>Support jaw; keep head lower than chest<br/>NEVER perform abdominal thrusts on an infant"]
    AgeChoke -->|Child Age 1 to Puberty| ChildChoke["Give Abdominal Thrusts (Heimlich) or<br/>5 Back Blows + 5 Abdominal Thrusts<br/>Repeat until object clears or child goes limp"]

    InfantChoke --> GoesLimp{"Did they become limp/unresponsive?"}
    ChildChoke --> GoesLimp
    GoesLimp -->|Yes| StartCPR

    ConsciousCheck -->|No, Unresponsive| BreathCheck{"Breathing normally? (Ignore occasional gasps)"}
    BreathCheck -->|Yes, breathing normally| RecoveryPos["Place in Side Recovery Position<br/>Call 911 / 112 / 999 and monitor breathing"]
    BreathCheck -->|No, not breathing or only gasping| StartCPR["Call 911/112/999 on Speakerphone<br/>Give 30 Compressions : 2 Rescue Breaths<br/>Rate: 100 to 120/min; look in mouth before breaths if choking<br/>Attach AED with pediatric pads as soon as available"]

Comparing infant, child, and adult resuscitation rules¶

Anatomical differences between a baby, a growing child, and an adult require critical adjustments to hand placement, compression depth, and airway angle.

Critical anatomical differences in infant and child airways¶

Understanding why infant and child anatomy differs from an adult's prevents two common rescuer mistakes that accidentally block breathing or injure internal organs:

1. Why you must NEVER perform abdominal thrusts (Heimlich) on an infant under 1 year¶

In an infant under 12 months old, the abdominal cavity is small, the abdominal wall muscles are thin, and the liver and spleen are proportionally huge, extending well below the protective cage of the lower ribs. Performing upward abdominal thrusts on a baby under 1 year old frequently ruptures the baby's liver or spleen, causing fatal internal bleeding. That is why infants under 1 year receive 5 back blows and 5 chest thrusts on the hard breastbone, never abdominal thrusts.

2. Why hyperextending an infant's neck kinks their windpipe shut¶

An infant has a very large back of the skull (occiput) relative to their body, a short neck, a proportionally large tongue, and a windpipe (trachea) made of soft, pliable cartilage rings resembling a flexible drinking straw rather than a rigid pipe.

• When an infant lies flat on their back on a floor, their large back skull naturally tips their chin forward onto their chest.
• However, if you tilt an infant's head all the way back like an adult, the soft cartilage rings of the baby's trachea buckle and fold shut, completely blocking your rescue breaths from entering the lungs and forcing air into the baby's stomach instead.
• Always position an infant's head in the neutral "sniffing" position (looking straight up at the ceiling as if sniffing a flower, with the ear canal aligned horizontally with the front of the shoulder). Placing a thin folded hand towel under the baby's shoulders helps hold this exact neutral alignment naturally.

3. Why the 2-thumb encircling hands technique is superior for infant CPR¶

Current resuscitation guidelines from the AHA, ILCOR, and UK Resuscitation Council highlight the 2-thumb encircling hands technique over the older 2-finger method whenever possible:

• Wrap your fingers around the sides and back of the infant's ribcage to support their back while placing both of your thumbs side-by-side on the center of the breastbone just below the nipple line.
• Pressing with both thumbs generates higher coronary perfusion pressure, achieves a more consistent 4-centimeter (1.5-inch) depth, and prevents your fingers from cramping or slipping off the narrow sternum during 2-minute CPR cycles.

Conscious choking in a child (age 1 year to puberty)¶

If a toddler or school-aged child is choking and cannot speak, cough loudly, or breathe:

1. Ask "Are you choking?" and check for the universal choking sign (hands clutched to the throat, panicked expression, silent cough, or high-pitched inspiratory stridor).
2. Ho otla ka morao le ho phunya ka mpeng:
   • Protocol ea Machaba / Sefapano se Sefubelu / UK / EU / ANZCOR: Tšetleha ngoana ka pele thekeng, u tšehetse sefuba sa bona ka letsoho le le leng, 'me u fane ka **likotlo tse 5 tse bohale tse ka morao ** pakeng tsa mahare a mahetla ka serethe sa letsoho le leng. Haeba ntho e sa hlahe, latela hang-hang ka ho phunyeletsa ho fihlela ho 5 ka mpeng.
   • Mokhoa oa ho otla ngoana ka mpeng (Heimlich maneuver): Khumama kapa u eme ka morao ho ngoana hore 'mele oa hao o be bophahamong ba oona. Koahela matsoho a hao ka tlas'a matsoho a bona thekeng tsa bona. Etsa feisi ka letsoho le le leng 'me u behe lehlakore la monoana oa letsoho la setebele sa hao khahlanong le mola o bohareng oa mpa, ka holim'a konopo ea mpa (mokhubu) le ka tlas'a ntlha e supang ea lesapo la sefuba (mokhoa oa xiphoid). Tšoara feisi ea hao ka letsoho le leng 'me u hulele ka hare le holimo ka ho sututsa ka potlako le ka mokhoa o hlakileng ho fihlela ntho eo e thunya.

Libetri tsa likonopo tse koetsoeng le limakenete tse matla haholo¶

Ha se ntho e 'ngoe le e 'ngoe e koetsoeng e thibang pompo; lichelete tsa tšepe le libeteri tse nyenyane hangata li lula bohareng ba metso (peipi ea lijo) ha ngoana a ntse a khona ho hema le ho bua. Lintho tse peli tsa ntlo li emela maemo a tšohanyetso a ka hare haeba a metsoa:

Lithium coin / konopo ea betri (Molao oa ho chesa lik'hemik'hale oa lihora tse 2)¶

Haeba ngoana a koenya (kapa a sutumelletsa ka linkong kapa tsebeng) beteri ea lithium coin cell e sephara, e chitja (joalo ka beteri ea CR2032 ea limilimithara tse 20 e fumanoang mecheng ea linotlolo tsa koloi, li-remote control, sekala sa dijithale, mabone a tee a se nang mollo le likarete tsa litumeliso tsa ’mino), ke *tsietsi e behang bophelo kotsing esita leha ngoana a e-na le matšoao a tloaelehileng a ho hema.

Ha konopo ea betri e lula ka har'a esophagus e mongobo, mathe a tlatsa potoloho ea motlakase pakeng tsa lipalo tse ntle le tse mpe tsa betri. Sena se hlahisa motlakase o kantle o arolang limolek'hule tsa metsi ka hydrolysis ho hlahisa caustic sodium hydroxide (lye) hantle khahlano le lebota la 'metso. Ka mor'a lihora tse 2 ** feela, betri e ka chesa lesoba ka ho toba ka har'a esophagus ho kena ka har'a windpipe (tracheoesophageal fistula) kapa ** aorta **, e bakang matsatsi a bolaeang a mali a ka hare kapa libeke ka mor'a hore betri e tlosoe.

** Protocol ea hang-hang ea betri (litataiso tsa AHA / Poison Control / NASPGHAN)**:

1. Khanna hang-hang u ee phaposing ea tšohanyetso ea sepetlele sa bana bakeng sa X-ray ea tšohanyetso le ho tlosoa ha endoscopic. U se ke ua emela hore matšoao a hlahe.
2. Give pasteurized HONEY en route ONLY if the child is 12 months (1 year) of age or older and the battery was swallowed within the last 12 hours:
   • Fana ka 10 milliliters (li-teaspoon tse 2) tsa mahe a linotši a lapeng ka molomo metsotso e meng le e meng e 10 (ho fihla ho litekanyetso tse 6) ha u ntse u khanna ho ea sepetlele, kapa 10 milliliters ea sucralfate suspension ha e le teng. Mahe a linotsi a Viscous a koahela bokaholimo ba betri ka har'a esophagus, a etsa mokoallo o thibelang alkaline hydroxide buildup mme o fokotsa botebo ba ho chesoa ke lisele pele ngaka e ntša betri.
   • NEVER give honey to an infant under 12 months (1 year) old due to the risk of infant botulism.
   • ** LE KA mohla u se ke ua lieha ho khanna ho ea sepetlele** ho ea reka mahe a linotši, ’me u se ke ua fana ka mahe a linotši haeba ngoana a sa khone ho e koenya, a khangoa, kapa haeba ho se ho fetile lihora tse fetang 12 ka mor’a hore a jeoe (ha ’metso e ka ’na eaba e se e ntse e phuntsoe).
3. O SE KE wa etsa hore motho a hlatse hape o seke wa fana ka dijo kapa dino tse ding.

Limanete tsa neodymium tse matla haholo¶

Haeba ngoana a koenya limakenete tse peli kapa ho feta tse nyenyane tsa lefatše tse sa tloaelehang (kapa makenete a le mong le ntho ea tšepe), limakete li hohelana ka mabifi likotopo tse arohaneng tsa mala a manyenyane le a maholo, li penya lerako la mala pakeng tsa tsona ’me li baka ischemic necrosis, ho phunya mala, le lefu le bolaeang la peritonitis. Batla hang-hang lefapha la tšohanyetso X-rays bakeng sa leha e le efe e belaelloang hore makenete e kene.

Tšebeliso ea AED ea bana le ho beoa liphahlo bakeng sa masea le bana¶

Le hoja hoo e ka bang karolo ea 80 ho isa ho 90 lekholong ea bana ba tšoaroang ke lefu la pelo e bakoa ke ho hlōleha ho phefumoloha kapa ho khangoa (ho hlahisa bradycardia kapa asystole), karolo ea 10 ho isa ho 20 lekholong ea bana ba tšoeroeng ke lefu la pelo ba ba le morethetho o tšosang oa pelo (** ventricular fibrillation ** kapa ** pulseless ventricular * tachycardia) joalo ka hypertrophic cardiomyopathy, long QT syndrome, kapa commotio cordis ka mor'a hore baseball kapa hockey puck e otle sefuba). Ho hokela Automated External Defibrillator (AED) hang ha e fihla ho bohlokoa.

Croup vs. epiglottitis khahlano le mmele wa kantle ho naha: ho bolela ho hema ka lerata ka thoko¶

Hangata batsoali ba tšoha ha ngoana e monyenyane a tsoha har'a bosiu a ntse a phefumoloha ka molumo o matla, o phahameng oa ho hema (stridor) kapa ho khohlela. Ho khetholla lipakeng tsa ho koaleha ha mochini ka tšohanyetso, kokoana-hloko ea kokoana-hloko le epiglottitis ea baktheria ho u thusa ho nka khato e nepahetseng ntle le ho mpefatsa tsela ea moea e tukang ka phoso:

1. Ho thijoa ha tsela ea moea ea motho osele (Ho khangoa): Ho etsahala hang-hang ntle le temoso ha ngoana a ntse a ja, a bapala ka lintho tsa ho bapala tse nyenyane, kapa a hahaba fatše; ha ho na* ha ho feberu ea pele kapa serame **. Qala ho otla ka morao le ho otla sefuba / ka mpeng hang hang ha khohlela e khutsitse kapa e sa sebetse.
2. Viral Croup (Laryngotracheobronchitis): Hangata e ama bana ba likhoeli li 6 ho isa ho lilemo tse 3 ka mor'a letsatsi le 1 ho isa ho a 2 la nko e tsoellang hanyenyane le feberu e tlaase, e phahamang haholo bosiu. Ho ruruha ho pota-pota lebokose la lentsoe ho etsa hore ho be le sekhohlela se tloaelehileng ** seal-joaloka ho khohlela ** le molumo o phahameng oa ho lla ha u hema (stridor). Boloka ngoana a khobile matšoafo a bile a otlolohile liropeng tsa hao (ho lla ho mpefatsa moferefere oa moea), mo behe ka nakoana moeeng o pholileng oa bosiu kapa moeeng o mouoane oa kamore ea ho hlapa, ’me u batle thuso ea meriana e potlakileng (bakeng sa tekanyo e le ’ngoe ea oral dexamethasone steroid kapa nebulized epinephrine) haeba stridor e utloahala le ha ngoana a phomotse kapa ha letlalo le koloba le molala.
3. Acute Epiglottitis kapa Bacterial Tracheitis: Ke boemo ba tšohanyetso ba bongaka bo sa tloaelehang, bo behang bophelo kotsing bo khetholloang ke **feberu e matla ka tšohanyetso **, chefo le ponahalo e tšosang, ho se khone ho koenya mathe (ho rotha ka selelung), lentsoe le sa hlakang, le ho lula o otlolohile o otlolohile ka matsoho le "lefu le tsoelipaneng"). flopping koala. Le ka mohla u se ke ua robatsa ngoana ea nang le seo ho belaelloang hore ke epiglottitis mokokotlong oa hae, le ka mohla u se ke ua mo otla mokokotlong kapa ka mpeng, hape le ka mohla u se ke ua kenya khaba kapa monoana ka hanong ho sheba 'metso oa bona, kaha ho mo koala molomo ho ka etsa hore a koalehe hang-hang. Letsetsa 911 / 112 / 999 hang-hang 'me u ba ts'oare ka khutso ba otlolohile sebakeng sa bona sa boiketlo ho fihlela ba fanang ka thuso ea bongaka maemong a tšohanyetso ba fihla.

Lijo tse kotsing e kholo ea ho khangoa le thibelo ea malapa bakeng sa bana ba ka tlase ho lilemo tse 4¶

Bana ba ka tlase ho lilemo tse 4 ba na le liphaephe tse tšesaane (hoo e batlang e le bophara ba manala a bona a pinki) 'me ha ba e-s'o be le meno a ka morao kapa ho hlafuna le ho koenya reflex e hlokahalang bakeng sa ho sila lijo tse tiileng, tse chitja kapa tse thellang.

• Lokisetsa lijo tse chitja tse kotsi ka mokhoa o sireletsehileng: Ka linako tsohle sela merara kaofela, tamati ea cheri, monokotšoai o moholo, le cheri e koetsoeng ka bolelele ho quarters (le ka mohla u se ke ua tšela ka har'a li-discs tse chitja tse bōpehileng joaloka chelete ea tšepe, tse ntseng li koala tsela ea moea). Sela hot dogs and sausage ho theosa ka bolelele ho theosa bohareng pele u seha likotoana tse nyane tsa crescent.
• Qoba lijo tse thata, tse khomarelang, kapa tse hatelloang tlas'a lilemo tse 4: Boloka matokomane, makotomane, lipompong, lipompong, lipompong tse thata, marotholi a khohlela, marshmallows, chewing gum, lichelete tse tala tsa rantipole, le likhaba tse teteaneng tsa peanut butter moo bana ba sa fihleng ho tsona (kapa peanut butter e tšesaane).
• **Felisa libalune tsa latex, lichelete tsa tšepe, le likaroloana tse nyane tsa ho bapala **: Likhechana tsa libalune tsa latex tse sa koaeloang kapa tse pentiloeng ** ke sesosa se le seng se ka sehloohong se seng sa lijo se bakang lefu le bolaeang la ho khangoa ke bana ho pholletsa le United States le Europe hobane rabara e tenyetsehang e lumellana ka thata holim'a monyako oa phefo ea moea 'me e ke ke ea ntšoa habonolo ke khatello ea moea. Karolo efe kapa efe ea ho bapala e ka kenang ka har'a "tube" e tloaelehileng ea "cardboard toilet paper roll" (4.4 centimeters / 1.75 inches inches) ke kotsi ea ho bipetsa bana ba ka tlase ho lilemo tse 3.

Lipotso tse botsoang khafetsa¶

Mehloli e hlahlobiloe¶

• American Heart Association (AHA): * 2020 le 2024 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Karolo ea 4: Pediatric Basic and Advanced Life Support *.
• Komiti ea Bohokahanyi ea Machaba ea Tsosoloso (ILCOR): * Tumellano ka Saense le Litlhahiso tsa Phekolo (CoSTR) bakeng sa Tšehetso ea Bophelo ba Bana *.
• Resuscitation Council UK: 2021 Pediatric Basic Life Support Guidelines le Pediatric Foreign Body Airway Obstruction Algorithm.
• American Red Cross le International Federation of Red Cross le Red Crescent Societies (IFRC): * Thuso ea Pele, CPR, le AED International Resuscitation Guidelines *.
• National Capital Poison Center (United States) le North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN): * National Button Battery Ingestion Triage and Honey Treatment Guideline *.

Litataiso tse amanang¶

• Batho ba baholo le ba lilemong tsa bocha Matsoho feela CPR
• Pholoso ea batho ba baholo ba choking (Heimlich maneuver)
• Pholoso ya metsi le ho tsosa moya
• Matšoao a matla a ho kula le epinephrine ea bana
• Lenane la linomoro tsa tshohanyetso