CPR stands for cardiopulmonary resuscitation. It is a lifesaving procedure that is done when someone's breathing or heartbeat has stopped. This may happen after drowning, suffocation, choking, or injuries. CPR involves:
Rescue breathing, which provides oxygen to a child's lungs
Chest compressions, which keep the child's blood circulating
This article discusses CPR in children ages 1 - 8.
Permanent brain damage or death can occur within minutes if a child's blood flow stops. Therefore, you must continue CPR until the child's heartbeat and breathing return, or trained medical help arrives.
CPR can be lifesaving, but it is best done by someone trained in an accredited CPR course. The newest techniques emphasize compression over rescue breathing and airway, reversing long-standing practice.
The procedures described in this article are not a substitute for CPR training.
All parents and those who take care of children should learn infant and child CPR if they haven't already. See www.heart.org for classes near you.
Time is very important when dealing with an unconscious child who is not breathing. Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 - 6 minutes later.
Machines called automated external defibrillators (AEDs) can be found in many public places, and are available for home use. These machines have pads or paddles to place on the chest during a life-threatening emergency. They use computers to automatically check the heart rhythm and give a sudden shock if, and only if, that shock is needed to get the heart back into the right rhythm.
When using an AED, follow the instructions exactly.
There are many things that cause a child's heartbeat and breathing to stop. Some reasons you may need to do CPR on a child include:
Head trauma or serious injury
CPR should be done if the child has the following symptoms:
The following steps are based on instructions from the American Heart Association.
Check for alertness. Shake or tap the child gently. See if the child moves or makes a noise. Shout, "Are you OK?"
If there is no response, shout for help. Tell someone to call 911 and get an AED (if available). Do not leave the child alone until you have done CPR for about 2 minutes.
Carefully place the child on his or her back. If there is a chance the child has a spinal injury, two people should move the child to prevent the head and neck from twisting.
Perform chest compressions:
Place the heel of one hand on the breastbone -- just below the nipples. Make sure your heel is not at the very end of the breastbone.
Keep your other hand on the child's forehead, keeping the head tilted back.
Press down on the child's chest so that it compresses about 1/3 to 1/2 the depth of the chest.
Give 30 chest compressions. Each time, let the chest rise completely. These compressions should be fast and hard with no pausing. Count the 30 compressions quickly: "1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30, off."
Open the airway. Lift up the chin with one hand. At the same time, tilt the head by pushing down on the forehead with the other hand.
Look, listen, and feel for breathing. Place your ear close to the child's mouth and nose. Watch for chest movement. Feel for breath on your cheek.
If the child is not breathing:
Cover the child's mouth tightly with your mouth.
Pinch the nose closed.
Keep the chin lifted and head tilted.
Give 2 rescue breaths. Each breath should take about a second and make the chest rise.
Continue CPR (30 chest compressions, followed by 2 breaths, then repeat) for about 2 minutes.
After about 2 minutes of CPR, if the child still does not have normal breathing, coughing, or any movement, leave the child if you are alone and call 911. If an AED for children is available, use it now.
Repeat rescue breathing and chest compressions until the child recovers or help arrives.
If the child starts breathing again, place him or her in the recovery position. Periodically recheck for breathing until help arrives.
If you think the child has a spinal injury, pull the jaw forward without moving the head or neck. Do NOT let the mouth close.
If the child has signs of normal breathing, coughing, or movement, do NOT begin chest compressions. Doing so may cause the heart to stop beating.
Unless you are a health professional, do NOT check for a pulse. Only a health care professional is properly trained to check for a pulse.
When to Contact a Medical Professional
If you have help, tell one person to call 911 while another person begins CPR.
If you are alone, shout loudly for help and begin CPR. After doing CPR for about 2 minutes, if no help has arrived, call 911. You may carry the child with you to the nearest phone (unless you suspect spinal injury).
Most children need CPR because of a preventable accident. The following tips may help prevent some accidents in children:
Teach your children the basic principles of family safety.
Teach your child to swim.
Teach your child to watch for cars and ride bikes safely.
Teach your child firearm safety. If you have guns in your home, keep them locked in an isolated cabinet.
Teach your child the meaning of "don't touch."
Never underestimate what a child can do. Assume the child can move and pick up things more than you think. Think about what the child may get into next, and be ready. Climbing and squirming are to be expected. Always use safety straps on high chairs and strollers.
Choose age-appropriate toys. Do not give small children toys that are heavy or fragile. Inspect toys for small or loose parts, sharp edges, points, loose batteries, and other hazards. Keep toxic chemicals and cleaning solutions safely stored in childproof cabinets.
Create a safe environment and supervise children carefully, particularly around water and near furniture. Electrical outlets, stove tops, and medicine cabinets can be dangerous for small children.
Emergency Cardiovascular Care Committee, Subcommittees, and Task Forces of the American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112:IV1-IV203.
Hazinski MF, Samson R, Schexnayder S. 2010 Handbook of Emergency Cardiovascular Care for Healthcare Providers. American Heart Association; 2010.
Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.