Infant CPR and Choking

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Infants more often have a breathing problem than an actual heart problem. Prevention of choking in infants is crucial. It is important to begin CPR immediately and perform five sets of CPR before going to get additional help.

If someone else is available, send them to call 911 and to find an AED. One set of CPR consists of 30 compressions and two breaths. When the second rescuer returns, have them follow the AED prompts, apply AED pads, and help with CPR.

If the infant is unresponsive and not breathing or only gasping for air, provide CPR.

When giving CPR to an infant victim, do the following:

  1. Make sure the scene and area around the infant is safe.
  2. Tap and shout to determine if the infant is unresponsive.
  3. Yell for help. If a second person is available have them call 911 and get an AED.
  4. Check breathing.
  5. If not responding and not breathing or only gasping, then give five sets of 30 compressions and two breaths.
  6. Call 911 if a second person has not already done so.
  7. Resume CPR and give compressions and breaths.

Infant CPR (0 to 12 Months)

CPR for children and infants is almost identical. An infant that does nothing when you tap or talk loudly is considered unresponsive and CPR needs to be given.

Take Note

As a rescuer, if you are untrained in CPR, then give the “hands-only” CPR. The “hands-only” CPR is when you give continuous compressions but no breaths.

Infant CPR Chest Compressions
Infant CPR Chest Compressions
Infant CPR Chest Compressions

Figure 25

Compressions

Push hard and fast as you would in a child or adult receiving CPR. Position the infant on a firm, hard surface to make giving CPR easier.

To give an infant CPR, do the following:

  1. Position the infant on their back on a firm, hard surface (Figure 25a).
  2. Move any clothing away from the chest (Figure 25b).
  3. Place two fingers of one hand on the breastbone right below the nipple line (Figure 25c).
  4. Push straight down approximately 1.5 inches (4 cm) at a rate of 100 to 120 beats per minute.
  5. Let the chest recoil to its normal position after every compression.

Performing compressions correctly is essential to effective CPR and can be physically tiring. If someone else can help, switch off every two minutes while minimizing interruptions during compressions.

Giving Breaths

Giving breaths during CPR can help infants. Like children, many cases of cardiac arrest in infants are primarily due to respiratory problems. Giving breaths and administering chest compressions are important for infants receiving CPR. A good breath will cause the chest to rise.

To open the person’s airway, do the following:

  1. Put one hand on their forehead.
  2. Place your fingers on the bony part of their chin.
  3. Gently tilt the head back while lifting the chin.
Infant CPR - Giving Breaths A
Infant CPR - Giving Breaths B
Infant CPR - Giving Breaths C

Figure 26

Be careful not to tilt the head too far back as this can block the airway. Be sure to press on the bony part of the chin and not the soft part under the chin as pressing the soft part may also block the airway.

Once you’ve opened the infant’s airway, you are ready to give breaths.
Next, do the following:

  1. Hold the airway open as described above by gently pressing forehead back and lifting chin with your fingers. (Figure 26a).
  2. Take a deep breath and seal your mouth around the infant’s mouth and nose (Figure 26b).
  3. Blow for one second and watch the chest rise (Figure 26c). Very little volume or force is required to inflate an infant’s lungs. Blowing too much or too hard will damage the infant’s lungs. Only a gentle exhale for a tiny puff of air is required for an infant.
  4. Repeat for a second breath.

If you are unable to cover both mouth and nose entirely with your mouth, use the following method for rescue breathing:

  1. Open the airway using the head-tilt/ chin-lift maneuver.
  2. Pinch the infant’s nose closed. Create a seal using your lips to surround the infant’s mouth.

If the chest does not rise after the first breath, let the head go back to normal position and then re-open the airway by tilting head and lifting the chin. Try to get a breath in while watching for chest rise. Do not interrupt compressions for any more than 10 seconds when giving breaths.

CPR Mask Infants A
CPR Mask Infants B
CPR Mask Infants C

Figure 27

Mask Use

Giving breaths in CPR is generally safe for the rescuer. However, if a mask is available, it should be used. The mask fits over the infant’s mouth and nose. Many masks have a pointed or tapered end which should go over the bridge of the infant’s nose. Make sure the mask fits properly; if it is too large, a proper seal cannot be obtained and efforts to deliver breaths will be ineffective.

When using a mask to give breaths,
do the following:

  1. Place the mask over the infant’s mouth and nose (Figure 27a).
  2. Open their airway by performing the head-tilt/chin-lift maneuver.
  3. Ensure a good seal between the mask and the face. (Figure 27b)
  4. Give a breath for over one second and watch the chest rise. (Figure 26c)

Activating EMS (Calling 911)

  1. Always make sure the scene is safe when approaching an infant. If you become injured or disabled, it will only make the situation worse.
  2. Tap the infant and talk loudly to determine if they are unresponsive. If they fail to make any response or reaction, they are considered unresponsive. An unresponsive infant will not move when you touch them. They will not cry or make any sounds, and their body will be limp.
  3. Yell for help and call 911 using a cell phone. If no cell phone is available, send someone else to call 911 if possible.
  4. If you are alone, begin five cycles of CPR (about two minutes) before calling 911.

Choking in Infants

Choking occurs when food or a foreign object is stuck in the throat and blocks the airway. Infants often put small objects in their mouth and are at an increased risk of choking. Severe choking requires quick action. Immediately perform back slaps and chest thrusts.

Table 3 will help determine whether the choking is mild or severe.

Degree of Obstruction Responsiveness Rescuers Actions
Mild Obstruction
  • Breathing but may also be wheezing
  • Coughing and making noise
  • Stay with the infant, try to keep them calm
  • Call 911 if the obstruction is not cleared quickly
Severe Obstruction
  • Weak or no cough
  • Unable to make noise or talk; may make high-pitched noise
  • Little or no breathing
  • Appears cyanotic (blue around lips and fingertips)
  • Act fast
  • Follow the steps for relief of choking for infant

Table 3

Relief of Choking in Infants - A
Relief of Choking in Infants - B
Relief of Choking in Infants - C
Relief of Choking in Infants - D

Figure 28

Relief of Choking

Back slaps and chest thrusts are used on infant who are choking.

When an infant is choking, do the following:

  1. Hold the infant in your lap.
  2. Put the infant face down and the head lower than the chest; the infant should be resting on your forearm. Put your forearm on your thigh (Figure 28a).
  3. Support the infant’s head and neck with your hand and be sure to avoid putting pressure on the throat.
  4. Give five back slaps between the infant’s shoulder blades with the heel of your hand. (Figure 28b).
  5. Using both hands and arms, turn the infant face up, so they are now resting on your other arm; this arm should now be resting on your thigh.
  6. Using two fingers in the same spot as for CPR, provide five quick chest thrusts (Figure 28c).
  7. If the obstruction is not relieved, turn the infant face down on your other forearm and repeat the process. (Figure 28d).
  8. Continue until the infant begins to breathe or becomes unresponsive.

Try to keep the infant’s head lower than the rest of the body when performing back slaps and chest thrusts. If you can see a foreign object in the infant’s mouth and can easily remove it, do so. Avoid blindly sweeping the mouth with a finger as it may push a foreign object deeper into the airway. Watch and feel for breathing to begin.

If the infant stops responding, position them on a firm, flat surface and yell for help. Check for breathing and begin CPR. After 30 compressions, open the airway and look for a foreign object. If visible, remove it and attempt to ventilate with two breaths.

If the infant does not respond or begin breathing, continue to provide CPR until additional help arrives. You will know an infant has become unresponsive as they will stop moving and squirming in your arms and the body will become limp. In this case, begin CPR immediately with chest compressions followed by giving breaths.

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