If a baby 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 baby, as cardiac arrest in children is likely to be caused by a respiratory problem.
If a baby is unresponsive, you need to call 999 or 112 for an ambulance and if they are not breathing normally, you need to start 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 baby is unresponsive and not breathing normally, you must start CPR. Ask a helper to find and bring a defibrillator, if available.
If you're trained in paediatric basic life support (BLS), give five rescue breaths while waiting to connect to the emergency services.
If you're 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, take the baby with you to make the call.
Start CPR. Place the baby on a firm surface and open their airway. To do this, place one hand on their forehead and very gently tilt their head back until their face is flat to the sky. With your other hand, use your fingertip and gently lift the chin.
Give five initial breaths.
Take a breath and put your mouth around the baby’s mouth and nose 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 try and improve the seal and 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 baby 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.
Use both hands to encircle the baby’s chest and put your thumbs on the centre of the baby's chest.
Push down a third of the depth of the chest (about four 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 chest 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 baby 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 CPR. They should remove or cut through clothing to get to the baby'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 there is no child mode available it is better to deliver a larger, adult shock than to wait for an ambulance.
They should attach the pads to the child’s chest by removing the backing paper and applying the pads as shown.
The first pad should be in the middle of the front of the chest.
The second pad should be on the baby's back, between their shoulder blades.
The defibrillator will analyse the heart's rhythm. Stop CPR and make sure no one is touching the baby. 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 baby shows signs of becoming responsive like coughing, opening eyes, making a noise, 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.
