If a child is not responding to you, you will need to call 999 or 112 for emergency help and follow the instructions of the ambulance service call handler which will include starting CPR.
CPR stands for cardiopulmonary resuscitation.
Rescue breaths must be performed on a child, as cardiac arrest in children is likely to be caused by a respiratory problem.
If a child is unresponsive you need to call 999 or 112 for an ambulance and if they are not breathing normally, you need to start CPR straight away.
After you have performed a primary survey, (check for response, call 999 or 112 for an ambulance, open the airway and check for normal breathing and signs of life for no more than 10 seconds), if the child is unresponsive and not breathing normally, you must start CPR. Ask a helper to find and bring a defibrillator (AED), if available.
If you are trained in paediatric basic life support (BLS), give five rescue breaths while waiting to connect to the emergency services.
If you are on your own without a phone, you need to give five rescue breaths first, and one minute of CPR before calling 999 or 112 for an ambulance. After a minute of CPR, and if possible, take a smaller child with you to find a phone for the call.
Start CPR. Place the child on a firm surface and open their airway. To do this, place one hand on their forehead to tilt their head back and use two fingers from the other hand to gently lift the chin.
Give five initial rescue breaths.
Take the hand from the forehead and pinch the soft part of the nose closed, allowing the mouth to fall open.
With the head still tilted, take a breath and put your mouth around the child’s, to make a seal and blow gently and steadily for up to one second, until the chest rises.
Remove your mouth and watch the chest fall.
That’s one rescue breath.
If the chest doesn't rise, reposition the airway and/or try and improve the seal, and/or check their mouth for an obstruction and give the next rescue breath.
Do this five times.
If their chest does not rise, move on to chest compressions.
It is important that you perform rescue breaths as cardiac arrest in a child is likely caused by a respiratory problem. Always start with five initial rescue breaths and then 30 compressions followed by two breaths.
You will then need to give 30 chest compressions.
Kneel by the child and put one hand in the centre of the child’s chest.
Push down a third of the depth of the chest (about five centimetres).
Release the pressure allowing the chest to come back up fully.
Repeat this 30 times at a rate of 100 to 120 compressions per minute.
The beat of the song ‘Stayin' Alive’ can help you keep the right rate as will the 999 or 112 call handler.
After 30 compressions, open the airway and give two breaths.
Keep alternating 30 compressions with two breaths (30:2) until:
emergency help arrives and takes over
the child starts showing signs of life and starts to breathe normally
a defibrillator is ready to use.
If you are trained in paediatric BLS or the ambulance call handler tells you to, use the 15:2 ratio.
If the helper returns with a defibrillator, ask them to switch it on and take the pads out while you continue with CPR. They should remove or cut through clothing to get to the child's bare chest. They may also need to wipe away any moisture or sweat.
The defibrillator will give voice prompts on what to do and this may include asking them to turn on 'child mode' if this is available.
If asked, turn on child mode if the child is less than eight years old. If there is no child mode available it is better to deliver a larger, adult shock than to wait for an ambulance.
Attach the pads to the child’s chest by removing the backing paper and applying the pads as shown.
For a larger child, more than 25kg in weight (about eight years of age):
The first pad should be on the upper right side below the collarbone.
The second pad should be on the child’s left side below and in line with their armpit.
For a smaller child, less than 25kg in weight (under about eight years of age):
The first pad should be in the middle of the front of the chest.
The second pad should be on the child’s back, between their shoulder blades.
The defibrillator will analyse the heart's rhythm. Stop CPR and make sure no one is touching the child. It will then give a series of visual and verbal prompts that should be followed.
If the defibrillator tells you that a shock is needed, tell people to stand back. The defibrillator will tell you when to press the shock button. After the shock has been given, the defibrillator will tell you to continue CPR for two minutes until it re-analyses.
If the defibrillator tells you that no shock is needed, continue CPR for two minutes until the defibrillator re-analyses.
If the child shows signs of becoming responsive like coughing, opening eyes, speaking, and starts to breathe normally, put them in the recovery position. Monitor their level of response and prepare to give CPR again if necessary.
If you have used a defibrillator, leave it attached.
