CPR and first aid for children and infants

Cardiac arrest in a child is fortunately rarer than in an adult — but when it happens the cause is often different and this means that the best first aid is slightly different from what you give an adult. Knowing the difference can make you more confident if you one day stand with a child who does not respond.

§Why children are not just small adults

In adults, in more than half of cardiac arrests, a heart rhythm disorder (ventricular fibrillation) is the cause — the heart itself fails first. In children, the picture is often reversed: cardiac arrest occurs as a result of oxygen deprivation, e.g. because the airways are blocked, the child is drowning, or breathing fails for other reasons, and the heart stops as a consequence. This difference in cause is the background for why the procedure is slightly different in children.

§Five breaths before you start compressions

Because oxygen deprivation is so often the triggering factor in children, it is recommended that you start with five insufflations before proceeding to chest compressions — unlike in adults, where you go straight into compressions. The idea is to get oxygen into the body as quickly as possible, because it is often the lack of oxygen itself that is the core of the problem.

§Ratio between compressions and breaths

The reason ordinary lay people can use the same procedure as for adults is pedagogical: the simpler and more uniform the method is, the greater the chance that you remember it correctly and dare to act when it matters. The most important thing is not the precise number, but that you get started with compressions and breaths at all without hesitation.

§Infants require extra caution

The younger and smaller the child, the more the technique must be adapted. An infant's chest and airways are much smaller and more delicate than an adult's, and both the force of compressions, hand position and blow-in technique must be adjusted accordingly. This is precisely where practical exercise with a training manikin in the right size makes a big difference – theory can tell you why but only training gives you the hands and feel for how.

§Foreign body and other acute conditions in children

The same precautionary principle applies to other acute conditions in children, eg foreign body in the airway: the basic principle of back blows and abdominal thrusts is the same as in adults, but the force and technique are adapted to the child's size, and in infants a special, more gentle procedure is used. Regardless of age, the same basic advice applies: if the child can still cough hard on their own, let coughing do the work and only intervene when coughing weakens or stops.

“You can read about the principles. The steady hand and proper grip only come from practicing it on a course with proper equipment in the right size.”

— First aid point