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Adult, Child, and Infant CPR: Understanding the Distinctions

Mackenzie Thompson

by Mackenzie, Life Saver, NHCPS

Co-authored by Karl Disque, D.O. RPH

posted on May 22, 2023 at 2:40 pm

If you possess the knowledge to perform adult CPR, you have a good foundation to provide infant CPR or child CPR, as well. However, it’s important to note that there are distinct variations in the techniques and procedures used for each age group. These differences can significantly affect the success of CPR on infants and children.

It’s essential to understand that this is not a comprehensive manual on CPR for all ages but a detailed examination of the differences in the procedure. Thus, it’s highly recommended to obtain CPR certification to ensure you are proficient in providing accurate and efficient CPR for individuals of all ages.

How are Infants, Children, and Adults Differentiated When Performing CPR?

As individuals grow and progress at unique rates, comprehending the definitions of each age group in CPR is crucial to administering appropriate care to each person.

Infant CPR

Within the realm of CPR, an infant refers to a child who is under the age of one year. If you are aware that the child is 12 months or younger, performing infant CPR is the recommended approach.

However, determining the age of a child is not always straightforward, especially in emergency situations. In such cases, using your best judgment is crucial. To help you make an informed decision, there are some guidelines you can consider. Typically, most one-year-olds are in the early stages of walking. Hence, if the child is not exhibiting any signs of unsteady walking and appears to be an infant, it’s reasonable to assume they are under one year old if there is no other way to determine their age. This is particularly important, as performing adult CPR on an infant or a child can be ineffective and can even cause harm.

Child CPR

In CPR, a child refers to an individual who has surpassed infancy but has not yet reached puberty. The average age range for puberty onset in the United States is between 8-13 years for girls and 9-14 years for boys. If you are unsure about the age of the child or infant you are dealing with, it’s essential to note that providing either one CPR without hesitation can be life-saving.

Adult CPR

Adult CPR is appropriate for individuals who have passed the stage of puberty. However, teenagers and some pre-teens may also require this type of CPR, especially if their bodies have undergone significant changes in size and weight. Administering adult CPR requires different techniques from those used in infant CPR and child CPR, and it’s essential to provide it accurately to maximize its effectiveness.

Frequent Causes of Cardiac Incidents in Infants and Children

Understanding the causes of cardiac arrest in different age groups–children, infants, and adults–is essential to providing the best possible care and improving the chances of survival. The appropriate techniques used in administering CPR can make a significant difference in the effectiveness of the treatment.

Main Causes of Infant Cardiac Events

Infants under 6 months of age are most commonly affected by the Sudden Infant Death Syndrome (SIDS). Unfortunately, the exact cause of SIDS is unknown. However, experts believe that infants who suffer from SIDS may lack the ability to wake up when they are unable to breathe. As a result, they may become entangled in bedding or accidentally roll over, which can lead to cardiac arrest. Although SIDS can be fatal, infants who have experienced SIDS-causing cardiac arrest may still be resuscitated if prompt action is taken.

For infants aged 6 to 12 months, respiratory failure or airway obstruction is the most likely cause of cardiac arrest. Suffocation accounts for two-thirds of infant injuries. However, other medical conditions such as hypertrophic cardiomyopathy, coronary artery abnormalities, or arrhythmias can also occur. Trauma is another possible cause of cardiac arrest in infants, so it’s important to be aware of this when administering CPR.

Given the various causes of cardiac arrest in infants, it’s essential to know how to properly perform infant CPR to increase the chances of survival. In addition, being aware of the potential causes of cardiac arrest can help identify and prevent dangerous situations. Whether it’s providing rescue breaths or performing chest compressions, taking the appropriate measures can make a significant difference in saving a child’s life.

Main Causes of Cardiac Events in Children

Children are at a higher risk of experiencing a cardiac event due to several causes, including choking, suffocation, drowning, and trauma.

  • Food-choking incidents alone send around 12,000 children to emergency rooms in the US each year.
  • Suffocation, which includes choking, is the fourth leading cause of death in children in the US, according to The New England Journal of Medicine.
  • Drowning is responsible for around 1000 deaths of children each year, and it is the most common cause of death in infants and children between the ages of 0-4.
  • Trauma caused by vehicle and bike crashes is also a leading cause of cardiac events in children. About 600 children die in car accidents each year, and it is estimated that 33% of them were not properly restrained. Studies have shown that wearing a helmet can protect a child from 85% of head injuries and 89% from brain damage in the case of bike accidents.

Main Causes of Cardiac Events in Adults

Although the rates of cardiac events in children may be concerning, the incidence of such events in adults is even higher. Heart disease is the primary cause of death among adults in the United States, with almost 700,000 fatalities attributed to it annually. In the US, someone experiences a heart attack every 40 seconds, highlighting the frequency of such incidents. Heart disease is typically caused by:

  • Scarring resulting from a prior heart attack,
  • Thickened heart muscle due to poorly managed high blood pressure,
  • Inappropriate medication dosing,
  • A drug used not for its primary purpose,
  • Or other heart disease-related disorders.

In such instances, the provision of CPR can be life-saving.

What is the survival rate of CPR by age?

The chances of surviving to discharge after receiving out-of-hospital CPR for children and adults differ significantly. For children, the survival rate ranges from 17-40%, which may appear low but it is a significant improvement from the previous rate of 2.6%. This improvement can be attributed to the increased awareness and knowledge of CPR and advancements in pediatric intensive care. It’s important to note that if a child or infant is found quickly, within a few minutes, their chances of survival increase significantly.

In contrast, the survival rate for adults who don’t receive bystander CPR is typically much lower, at around 7%. However, this rate increases significantly to 11% when CPR is initiated by a bystander.

Differences in Chest Compressions by Age

When performing CPR on an adult or child, the compression is usually done with the palm of the hand. However, when it comes to infant CPR, this approach can exert excessive pressure on the chest, causing harm. In such cases, it is advisable to use two fingers of one hand instead. Position your fingers just below the nipple line, and apply a downward force straight in the middle. Lower the breastbone by around 1.5 inches (4 cm), and let the chest come up before repeating the compression, which should be immediate. The ideal rate for compressions is 100 to 120 beats per minute.

For children, compressions should be around 2 inches (5cm) or about 1/3 of the chest’s depth, also at 100 to 120 beats per minute.

For adults, the recommended depth for compressions is between 2 to 2.4 inches (5 to 6cm), again at a rate of 100 to 120 beats per minute. Of course, this is a difficult task to evaluate but certain rhythms of well-known songs may be of help here for you. The classic rhythm for the CPR chest compressions is considered the “Stayin’ Alive” by the Bee Gees, but also you can use the “Baby shark” rhythm instead which might be more often heard nowadays.

Are Chest Compressions Enough for CPR?

If you require CPR, it is more probable that a stranger will provide it to you rather than someone you know, at a rate of 45% compared to 15% from a family member, friend, or coworker. Although giving breaths during CPR is generally regarded as a low-risk activity, some individuals may be hesitant to do so, particularly for a stranger, if they lack a mask. As a result, some may opt for compression-only CPR, also known as hands-only CPR.

Research indicates that those who receive full CPR are 2.6 times more likely to survive compared to those who receive no CPR. Similarly, those who receive hands-only CPR are twice as likely to survive compared to those who receive no CPR. While not the ideal scenario, doing something is better than nothing.

On the other hand, with infants and children, specialists recommend that full CPR be given, which includes checking airways, giving breaths, and compressions, among other steps. For a good reason, it is not recommended to perform hands-on CPR on children. Oxygen deprivation for more than four minutes can cause brain damage, impairing learning ability and significantly altering the long-term potential for a good quality of life. Therefore, if CPR is prolonged without restoring breathing, there is a higher risk of neurological function loss.

Providing Breaths

As previously noted, breathing difficulties rather than heart problems are more common among infants and children during an emergency situation. This information can guide your response, as you can make certain assumptions and adopt a different approach accordingly. For example, they may be experiencing an airway obstruction.

Assessment of the Air Passage and Removal of Obstructions

When it comes to infants, choking incidents can be classified as either “mild” or “severe” obstructions. In mild cases, the child may still be able to breathe somewhat, but they may cough or wheeze. If you can see the object causing the obstruction, try removing it carefully with your fingers, taking care not to push it further in. In such cases, you can attempt a chest thrust and back slap while supporting the infant’s head and neck.

With a partial obstruction, it may be challenging to dislodge the object with chest thrusts and back slaps because air can still get around it. Therefore, try to calm the infant and remove the obstruction. If you cannot remove it quickly, call 911.

In severe cases, very little air can get through, so use back slaps and chest thrusts. If the infant becomes unresponsive, place them on a firm, flat surface, call for assistance, and begin infant CPR.

If you suspect that a child or adult has an airway obstruction, it’s possible that they may be responsive to your instructions. You can encourage them to cough in an attempt to clear the obstruction from their airway. If this is not successful, perform the initial step in clearing a person’s airway obstruction. First, stand beside the person and provide support to their front. Next, bend the person over at a 90-degree angle. Then, use the heel of your hand to give five firm slaps to the person’s back. If the object blocking their airway is not dislodged, proceed to perform the abdominal thrust maneuver:

  1. Stand behind the person who is choking and wrap your arms around their waist.
  2. Make a fist with one hand and place the thumb side of your fist just above the person’s navel, in the middle of their abdomen.
  3. Grasp your fist with your other hand and press hard into the person’s abdomen with a quick upward thrust.
  4. Repeat thrusts until the object blocking the airway is dislodged.
  5. If the person becomes unconscious, lower them to the ground and begin CPR.

It’s important to note that the abdominal thrust maneuver should only be performed on a person who is conscious and choking. If the person is coughing forcefully or can speak, encourage them to keep coughing to try to dislodge the object on their own. If the person is unconscious, call for emergency medical help and begin CPR.

One way to potentially save lives in the event of choking is to teach both children and adults how to perform a modified version of the abdominal thrust maneuver on themselves by leaning over the back of a chair or a table. This can be particularly useful if they are alone and no one is around to assist. For step-by-step instructions on how to perform CPR on an infant, you can refer to the information provided in this article.

Infant CPR and Using Mouth-Nose Seal

When administering breaths during CPR, the technique differs between adults and infants. In adult CPR, you would hold the nose and breathe through the mouth. However, when providing breaths to an infant, you will need to cover both their nose and mouth with your mouth, as it is much smaller than an adult’s. This allows for two possible entry points for air if one is blocked. In the case of airway obstruction, this technique can help to ensure that the infant is still receiving oxygen. Additionally, if you have a mask available, it can be used to cover both the nose and mouth during CPR for adults, children, and infants.

Can an AED be Used on Individuals of Any Age?

healthcare-professional-holding-an-aed-machineAn AED is a simple and effective device that can enhance survival rates when used in conjunction with CPR. As it is an automated device, it can detect the optimal time to administer the shock and will instruct you to step away from the person when it’s time to do so (Clear!). It can be utilized on adults, children, and infants, but the positioning of the pads differs depending on the age group.

When performing CPR on a child, place one pad on the upper right chest, just above the breast, and the second pad on the lower left chest, beneath the armpit. For infant CPR, attach one pad to the center of the chest and the other to the back.

Ensuring Brain Function

After just 4 minutes without oxygen, an adult, child, or infant could start experiencing irreversible brain damage. This means that time is a crucial factor when dealing with a medical emergency involving breathing difficulties.

Calling For Help

When you’re the only rescuer attending an adult, it’s usually recommended to call 911 first if no one else is coming to help. You can then proceed with the CPR steps while waiting for the emergency services to arrive. But in the case of a child or an infant, you should first yell for someone to call 911 or Emergency Medical Services (EMS) and then start performing CPR right away.

CPR Certification – Consider It If You Work With Other People

Enrolling in a CPR course can be advantageous for individuals aged from teenage to adulthood. Studies have indicated a positive association between the percentage of individuals certified in CPR in a particular locality and the probability of survival for an individual experiencing an emergency in that community.

CPR certification should be considered by these professionals:

  • Healthcare professionals, including doctors, nurses, and medical assistants
  • Emergency medical services (EMS) personnel, including paramedics and EMTs
  • Law enforcement officers and first responders
  • Firefighters and rescue workers
  • Teachers and school staff
  • Coaches and athletic trainers
  • Daycare providers and childcare workers
  • Lifeguards and swimming instructors
  • Workplace safety personnel and employees
  • Anyone interested in being prepared to respond to a cardiac emergency, including family members and caregivers.

In case of an emergency, acting quickly and knowing what to do is crucial to save a life. Obtaining a CPR certification can provide you with the necessary skills and confidence to take action promptly and prevent a severe outcome or keep a person’s brain supplied with oxygen until professional help arrives. Save a Life by NHCPS has earned the trust of numerous healthcare professionals who have been certified or recertified in CPR and more advanced life-saving techniques. By enrolling in an online CPR and First Aid Course, you can acquire the knowledge and confidence required to handle emergency situations effectively.

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About Mackenzie

Mackenzie is a seasoned life saver and a multifaceted professional in the medical field. With an impressive 8-year track record in medical education, Mackenzie boasts a comprehensive set of certifications, including ACLS, PALS, BLS, and CPR, which reflect her unwavering commitment and expertise. Her significant contributions to teaching and the development of medical content underscore her profound knowledge and dedication to advancing healthcare.

Beyond her medical prowess, Mackenzie seamlessly integrates her passion for education with her proficiency in media and marketing. Her academic journey at Indiana University culminated in a degree in Media and Marketing, further solidifying her expertise in these domains.

In addition to her impressive professional achievements, Mackenzie possesses a refined taste for global exploration, photography, design aesthetics, sartorial elegance, and the culinary arts, with a particular affinity for Chinese cuisine. Currently based in the vibrant city of Manhattan, she continues to be a driving force in the medical community. She is an invaluable asset to SaveaLife.com, where she champions excellence and innovation with unwavering dedication.

Contact Mackenzie at [email protected]

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