CPR for Infants: A Life-Saving Skill for Parents and Caregivers

CPR for adults here

When an infant stops breathing or suffers a cardiac emergency, quick action can make the difference between life and death. Cardiopulmonary resuscitation (CPR) for infants is a critical skill that every parent, caregiver, and childcare provider should learn. In emergencies, knowing how to properly administer CPR can help restore oxygen to the infant’s brain and vital organs, increasing the chances of survival until medical professionals arrive.

Infants—defined as children under the age of 1—have specific anatomical and physiological differences from older children and adults, which is why infant CPR differs slightly from adult CPR. In this guide, we will go over the steps of CPR for infants, when to perform it, and important safety considerations. Whether you’re a new parent, a grandparent, or someone who regularly cares for young children, learning infant CPR is a life-saving skill that could make all the difference.

When to Perform Infant CPR

Before learning the steps, it’s important to recognize the situations when you should perform CPR on an infant:

1. Infant is Unresponsive: If the infant is unresponsive and not breathing or not breathing normally (such as gasping), CPR should be initiated immediately.
2. Infant is Not Breathing: If you find the baby unconscious and they are not breathing, or if they are struggling to breathe, CPR is necessary.
3. Infant Has No Pulse: If the baby’s heart stops beating or if you cannot feel a pulse, CPR should be started.
4. Choking: In the case of choking where the infant is unable to breathe, begin with back blows and chest thrusts (clearing the airway), and proceed to CPR if the infant becomes unresponsive.

If the baby is conscious but struggling to breathe or choking, attempt to clear the airway using back blows and chest thrusts, which we will explain further below.

If you’re ever uncertain whether CPR is needed, it’s always better to start CPR than to wait. Call 911 (or your emergency services number) immediately for help if you believe the infant needs CPR.

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Infant CPR: Step-by-Step Guide

Follow these steps carefully to perform CPR on an infant (under 1 year old). The process involves rescue breaths and chest compressions, but due to the fragility of an infant’s body, the technique is adapted for their smaller size.

1. Check the Infant’s Responsiveness

• Gently tap or shake the infant’s feet or shoulders and loudly call their name.
• If the infant does not respond or move, immediately call 911 (or your local emergency services number). If possible, ask someone nearby to make the call for help while you begin CPR. If you are alone, give two minutes of CPR before calling for help.
• Check for breathing: Look at the chest to see if it rises and falls. Listen for normal breathing sounds. If the infant is not breathing, or if they are gasping for breath, CPR should begin.

2. Position the Infant

• Place the Infant on a Firm Surface: Lay the baby on their back on a firm surface, such as the floor or a hard table. Never perform CPR on a soft surface, like a bed, as it can reduce the effectiveness of compressions.
• Position Your Hands Correctly:
  • Chest Compressions: Use two fingers placed in the center of the infant’s chest, just below the nipple line (where the ribs come together). Keep your fingers straight and use the pads of your fingers to apply pressure.
  • Rescue Breaths: Make sure the infant’s airway is open by tilting their head back slightly and lifting the chin. You may use your mouth to cover the infant’s nose and mouth (seal it completely).

3. Start Chest Compressions

• Compression Depth: Press down on the chest with two fingers, compressing about 1.5 inches (4 cm) deep. This is roughly one-third the depth of the chest.
• Compression Rate: Perform chest compressions at a rate of about 100-120 compressions per minute (the speed of a song like “Staying Alive” by the Bee Gees).
• Compression-to-Ventilation Ratio: For infant CPR, the recommended ratio is 30 chest compressions to 2 rescue breaths. After 30 compressions, give two rescue breaths.

4. Give Rescue Breaths

• Mouth-to-Mouth and Nose Breathing: After completing 30 chest compressions, perform two rescue breaths.
  • How to give rescue breaths: Cover the baby’s nose and mouth with your own mouth. Give a breath lasting about 1 second each, ensuring the chest rises with each breath. You should see the chest visibly rise with the breath. Do not give breaths too forcefully, as this can cause air to enter the stomach rather than the lungs.
  • Avoid excessive air pressure: You only need to deliver enough air to make the chest rise, so use moderate force.

5. Continue CPR Until Help Arrives

• Continue CPR: Repeat the cycle of 30 chest compressions and 2 rescue breaths until:
  • The infant starts breathing or moving.
  • Emergency medical personnel arrive to take over.
  • You are too exhausted to continue.
• If at any point, the infant starts to show signs of life—such as moving, breathing normally, or coughing—place them in the recovery position and monitor their breathing until help arrives.

Special Considerations for Infant CPR

• Use Gentle Pressure: Since infants are small and fragile, always use gentle, but firm pressure during compressions. Your goal is to deliver effective compressions without causing injury.
• Avoid Using Your Thumb: For infants, using the two-finger technique for compressions is preferred. Do not use your thumb as it may not allow for adequate compression depth and could potentially cause injury to the baby’s chest.
• Airway Management: When giving rescue breaths, it’s important to ensure that the infant’s airway is properly opened by tilting the head back slightly. Be mindful not to over-extend the neck, especially in newborns.

Choking in Infants

Choking is a common cause of respiratory distress in infants, and in such cases, CPR may need to be combined with airway clearing techniques. Here’s what you should do if an infant is choking:

1. Back Blows: For infants under 1 year old, place the baby face-down on your forearm, supporting their head and neck. Use the heel of your hand to deliver five firm back blows between the infant’s shoulder blades. Each blow should be hard enough to dislodge the object but not cause injury.

2. Chest Thrusts: If back blows don’t clear the airway, flip the baby onto their back and give five chest thrusts. Use two fingers in the center of the chest, just below the nipple line. Press down hard and fast to generate enough force to clear the obstruction.

3. Check the Mouth: After delivering back blows and chest thrusts, check the infant’s mouth to see if the object is visible and can be removed. Do not attempt to finger-sweep unless you can clearly see the object in the mouth.

If the infant becomes unresponsive, start CPR immediately (following the steps outlined above), as the airway may still be blocked.

How to Prepare for Emergencies

While CPR can be life-saving, the best approach is to prevent emergencies where possible and prepare for the worst. Here are some tips:

• Take a CPR Class: Enroll in a Pediatric or Infant CPR and First Aid course to learn hands-on techniques and get certified. Many organizations, including the American Heart Association (AHA) and the Red Cross, offer these courses.
• Learn Choking First Aid: In addition to CPR, learning what to do when a baby is choking can be equally vital. Make sure to practice back blows, chest thrusts, and checking the mouth for obstructions.
• Have Emergency Contacts Ready: Always have emergency phone numbers (like 911 or your local emergency services) easily accessible and share them with all caregivers.
• Keep Your Home Childproof: Reduce the risk of choking by keeping small objects, food, and toys out of the baby’s reach. Be cautious with foods that can pose a choking hazard.

Conclusion

Knowing how to perform CPR on an infant is a critical skill that could save a child’s life in an emergency. In the event that an infant stops breathing, is unresponsive, or is choking, being prepared to act quickly with infant-specific CPR techniques can make all the difference. Taking a certified CPR course and practicing these techniques regularly will increase your confidence and ensure you’re ready to respond in an emergency. Remember, quick, calm action is essential when responding to an infant in crisis.