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Don't Leave It to Luck
Learn Infant/Child CPR
By Donna Smith and Jessica Williams

Sheri Goeser Stritof from Ocean Park, Wash., found out that at any time, a child could need cardio-pulmonary resuscitation (CPR). One crisp, sunny day, she had a premonition that something bad would happen to one of her children. She was right.

"Eighteen years ago, while taking a college examination, I felt that one of our kids was in danger," says Stritof. "Quickly finishing the test, I rushed home. As I pulled into our circular driveway, I could see my husband, Bob, and our young son, Larry. However, our 18-month-old daughter, Judy, was nowhere in sight."

Stritof called out to her husband, asking him where the baby was. The panicked look on his face alerted Stritof that something was not right. "He ran to the back yard,” she says. “I heard him screaming, 'Help me, God!' and my heart sunk. I knew he had found her in the swimming pool, and I rushed into the house with Larry and called for help."

Bob laid Judy's limp body on the kitchen counter and started doing infant CPR on her. Luckily, Judy began coughing up water and breathing on her own as the paramedics arrived. The scary thing is, Bob hadn't learned CPR by taking a certified class. Luck was on Judy and Bob's side that day.

"Later when we were at the hospital, I asked him how he had learned infant CPR," says Stritof. "He said he had watched a show on TV that described it, and when he was pleading for help, that information just popped into his mind."

Today, Judy is an active, bright, beautiful and talented aspiring actress. Judy says they were lucky that Bob was able to recall what he saw on television earlier.

Don't play the odds when it comes to saving the life of your child or someone else's. "Don't gamble with your children's life," says Stritof. "Learn CPR."

The ABCs of Infant and Child CPR
Would you know what to do if your child stopped breathing? As a parent, it is imperative to know how to perform CPR on your child in the event of an emergency. The ABCs (Airway, Breathing, Circulation) of CPR still apply when attempting to resuscitate an infant or child, but the following procedures are different from adult CPR.

Infants have a smaller lung capacity and a faster breathing rate than adults. Their rib cage is more fragile, and their neck is shorter. All of these important factors are why procedures for infant CPR differ from adult and child CPR. Here are the steps for infant CPR:

  1. Assess responsiveness by gently shaking the infant's shoulder. Shout for help. When help comes, instruct them to call 911.

  2. Place the infant on a hard surface such as a kitchen floor. Be extremely careful not to twist or move the neck, as there may be a spinal injury.

  3. Use the Look, Listen and Feel approach to assess the situation. Look for chest rises, Listen for breathing, Feel for the infant's breath on your cheek. This should take 3 to 5 seconds. If the infant is struggling to breathe, do not perform mouth-to-mouth (now called "rescue breathing") – just maintain an open airway.

  4. Open the infant's airway by placing one hand on the forehead and the other hand under the chin. Tilt the head back gently. Be sure you do not over-extend the neck, which can cause a blocked airway. Look, Listen and Feel for breathing again. If opening the airway did not produce breathing, begin rescue breathing immediately.

  5. To perform rescue breathing, cover both the infant's nose and mouth with your mouth, getting a good seal. The breath you will deliver should be a gentle "puff" lasting 1 1/2 to 2 seconds. After each breath, remove your mouth from the infant to allow a normal exhale. After giving two breaths, and seeing the chest rise, check the infant's pulse.

  6. Check pulse on the inside of the arm halfway between the elbow and shoulder using your index finger and middle finger. Check for 5 to 10 seconds.

If Pulse Is Felt:

  • DO NOT perform chest compressions.
  • Give one breath every 3 seconds.
  • Check pulse every 20 breaths.
  • Continue rescue breathing until help arrives or until infant begins breathing again.

If Pulse Is Absent:

  • Begin chest compressions by placing your middle and ring finger on the sternum one finger's width below the nipple line. Depress chest half an inch to 1 inch.
  • Give two quick compressions every second to imitate the infant's fast heart rate. Count compressions aloud to keep rhythm.
  • Give one breath after every five compressions.
  • Check pulse after 1 minute of compressions and rescue breathing. Continue to check pulse every few minutes.
  • Continue compressions and rescue breathing until the infant revives or help arrives.

If you are able to revive the infant, seek immediate medical treatment as soon as possible. The CPR rescue breathing and compression rates are different for children 1 to 8 years old than that of an infant or adult. While you should still check for responsiveness, shout for help and assess breathing with the Look, Listen and Feel method, the next procedures are different and you need to study them carefully. Here are the steps for child CPR:

  1. Perform the assessment checks for responsiveness and breathing. Shout for help. (See instructions above for infant CPR.)

  2. Open the child's airway by gently tilting the head back, being careful not to over extend. Look, Listen and Feel for breathing again. If the child is struggling to breathe, do not begin rescue breathing; just maintain an open airway.

  3. If the child is not breathing, perform rescue breathing right away. Pinch the child's nostrils shut and place your mouth over the child's mouth. Be sure there is a good seal. Steadily blow air into the child's mouth until you see the chest rise. Each breath should take 1 1/2 to 2 seconds. Remove your mouth after each breath to allow a normal exhale. After two good chest rises, check the child's pulse.

  4. Place your index finger and middle finger tips on the child's Adam's apple, then slide your fingers down the part of the neck that is facing you (you should be on the side of the child) until you locate the child's pulse. Check pulse for 5 to 10 seconds.

If Pulse Is Felt:

  • DO NOT perform chest compressions.
  • Give one breath once every 4 seconds.
  • Check pulse every 15 breaths.
  • Continue rescue breathing until help arrives or child begins breathing again.

If Pulse Is Absent:

  • Begin chest compressions by placing the heel of one hand over the lower half of the sternum (breastbone) two finger widths above the notch where the sternum and ribs meet. Use only one hand and be sure to use only the heel; do not use your fingers as you might injure the ribs. Straighten your arm and lock your elbow. Center your shoulders above your hand so compressions are straight down on the sternum. Depress the sternum 1 to 1 1/2 inches. Count compressions aloud to keep rhythm.
  • Give one breath every five compressions. Take your hand off the chest and open the airway to do this. Watch for a chest rise and fall.
  • Check pulse after one minute of chest compressions and rescue breathing. Continue to check pulse every few minutes.
  • Continue compressions and rescue breathing until child revives or help arrives.

These are the basic procedures for infant and child CPR, but written instructions cannot take the place of proper training and practice on dummies. Contact the American Red Cross or your local hospital for information on where to take classes. Be prepared! CPR is an invaluable tool that can save your child's life.

Dr. Paul Pepe, professor of surgery and chairman of emergency medicine (EM) at the University of Texas Southwestern Medical Center, answers some common questions about CPR.

What is the most common mistake a parent makes when their child starts choking?

Not knowing what to do – not being trained and not being prepared ahead of time. But, when a young infant chokes, if they're conscious, we actually want the parent to call for help.

Another mistake is trying to stick your fingers down and take out whatever needs to be removed. Sometimes this pushes it down further. If there is a choking and the child is moving some air – it's partially obstructed – unless you can see it right there at the end of the mouth and can pull it out, reaching down to try and get something out with your fingers can actually sometimes make it worse by impacting the item more into the throat. The general advice is that unless it's clearly obvious – it's something you can remove at the edge of the mouth – the best thing to do is call 911 or whoever you have in your local area to get help on the way.

If the child becomes unconscious, or is lifeless and not responding or breathing, that is the time to do CPR. It turns out that the classic CPR we do today, which is grabbing your hands around and with your thumbs in the middle of the chest squeezing on the whole chest, actually will do more to pop it out than most of the other procedures done in the past. In other words, don't do those back slaps or Heimlich on the kids. Doing a journal CPR procedure is the key thing to do.

If I'm alone and don't know CPR and my child begins to choke, what should I do?

If a parent is alone and they don't know CPR, call 911. Most places today have EMD or emergency medical dispatch operations. The dispatchers have instructions that they can read over the telephone. But the bottom-line for everyone is to take courses and learn CPR.

Can a baby be injured if CPR is performed incorrectly on them?

Although theoretically you would think a baby could be injured, surprisingly, studies have shown little evidence that injury occurs through CPR on these ages of children (0 to 36 months). More important, even if there were any injuries that occur, in that situation where CPR is needed and it's life and death, there's no question that the trade off between an injury and a life being saved is well worthwhile.

Where and when should I take CPR?

Most hospitals will offer the course before the birth of your baby, or you can call the American Red Cross. The best time to learn CPR is yesterday. We generally recommend a refresher course because we've recently changed the guidelines, although minimally, but it's so easy to learn its always easy to go back. Data has shown that in cases of drowning, 80 percent of children can be resuscitated if CPR is started right away, and the children are neurologically intact. I'd rather give my child an 80 percent chance of making it rather than a 60 percent chance. But most importantly, take that first course, it'll show you what to do.

Want to see more?

About the Authors: Donna Smith is a senior editor for iParenting Media, and a mother of three. Jessica Williams is a contributing writer for iParenting Media, and the mother of three.

About the Expert: Dr. Paul Pepe is professor of surgery and chairman of emergency medicine (EM) at the University of Texas Southwestern Medical Center, where he overseas the university's large EM residency training program as well as the emergency medical services provided at Parkland Memorial Hospital in Dallas. He has become internationally recognized as one of the key researchers and educators in the evolving fields of resuscitation, EMS and injury prevention.

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