CPR for children requires different techniques

The steps for CPR on an adult is 30 chest compressions to two breaths (if you feel comfortable with the breaths, or have protection from the patients’ mouth). An automated external defibrillator (AED) should be used to evaluate and possibly shock every two minutes, which is five cycles of CPR. Do not check for a pulse unless you are a professional healthcare provider and have been trained in this. All information that is provided here and in the previous information regarding CPR is focused toward general population and not the healthcare industry which receives more specialized instruction in CPR. And, as I mentioned last column, contact the Red Cross, American Heart Association, or American Safety & Health Institute to locate some local CPR instructors for a full course if you want to be proficient at the skills of CPR.

But now for today’s additional information:

CPR for children

Sudden cardiac arrest (heart stopped and no pulse) is less common in children than it is in adults. It usually happens when there is a lack of oxygen caused by a breathing problem such as choking, near-drowning or respiratory infections. Because oxygen often corrects the problem in a child, when an unresponsive, non-breathing child is found, CPR is performed for one minute before activating 911. This may reverse the lack of oxygen and revive the child. Any time you do CPR, even if you revive the patient, they should still be taken to the hospital regardless; the patient needs to be assessed to find out what the problem was. This is especially true in children and infants.

In order to use an AED on a child from 1 year of age through 8 years of age a special pediatric cable is used to reduce the amount of energy provided by the electrical shock. For many manufacturers, the pads for children will be pink somewhere on the attachment. The labeling on the package should say CHILD or PEDIACTRIC, and there will be a bulky block in the middle of the cables which dials down the power of the shocks

Doing CPR on children aged 1 to 8 years old is similar to doing CPR on adults. However, there are some minor differences. Most are due to the child’s smaller size. If you are doing CPR on a child that you do not personally know and you do not know the age, just remember that the CPR is very similar to an adult. The key is whether you need just one hand or two hands to get a full chest compression onto the patient.

• When compressing the chest, the heel of only one hand is used instead of two hands, and the chest is pressed down about 1/2 of its depth. That does not mean 1/2 inch, it means 1/2 of the distance between the chest in its normal position and the hard surface that the child is on. Do not worry about breaking ribs or hurting anything; a child’s body is much more pliable and flexible than an adults’ and if the patient isn’t breathing, that takes precedence over everything else.

• Perform five cycles of 30 chest compressions followed by two breaths, then use an AED to evaluate the heart rhythm if available. If an AED is not available, and the child is still not breathing normally, coughing or moving, continue cycles of 30 compressions

to two breaths until help arrives.

CPR for infants

An infant is defined as a child younger than 1 year of age. Because an infant is smaller than a child, the CPR technique for infants contains further changes.

• Even smaller breaths are given — enough to just get the chest to rise. Only two fingers are used to compress the chest down about 1 inch.

• Otherwise, the CPR sequence is the same as for the child, which is the same as for an adult.

• There are no recommendations for the use of AEDs in children less than 1. There are also no recommendations against it, but there is not enough research in either direction to understand what may happen as a result.

Christian M Hartley is the training officer, public information officer, and a lieutenant with the Houston Fire Department. Questions and comments are welcome at hartley@myopinionmatters.org.