One & Two Rescuer BLS for Infants (0 to 12 months old)

BLS for both children and infants is almost identical. Following are the main differences between BLS for children and BLS for infants:

• Check the pulse in the infant using the brachial artery on the inside of the upper arm between the infant’s elbow and shoulder. (Figure 11a)
• During CPR, compressions can be performed on an infant using two fingers (Figure 11b), if only one rescuer; or with two thumb-encircling hands (Figure 11c), if there are two rescuers and the rescuer’s hands are big enough to go around the infant’s chest.
• Compression depth should be one-third of the chest depth; for most infants, this is about 1.5 inches (4cm).
• If you are the only rescuer at the scene and find an unresponsive infant, perform CPR for two minutes before calling 911/EMS or using an AED.
• In infants, primary cardiac events are not common. Usually, cardiac arrest will be preceded by respiratory problems. Survival rates improve when you intervene with respiratory problems as early as possible. Remember that prevention is the first step in the Pediatric Chain of Survival.
• If you witness a cardiac arrest in an infant, call 911/EMS and get an AED as you would in the BLS sequence for adults or children.

ONE-RESCUER BLS FOR INFANTS

If you are alone with the infant at the scene, do the following:

1. Tap the heel of their foot and talk loudly at the infant to determine if they are responsive.
2. If the infant does not respond, have the second rescuer call 911/EMS and get an AED. (The ILCOR emphasizes that cell phones are available everywhere now and most have a built-in speakerphone, so you can call while at the scene.)
3. Assess if they are breathing (Figure 11d) while simultaneously checking for the infant’s brachial pulse for 5 but no more than 10 seconds (Figure 11e). If the infant does not respond and is not breathing (only gasping), yell for help.
4. If you cannot feel a pulse (or if you are unsure), begin CPR by doing 30 compressions followed by two breaths. If you can feel a pulse but the rate is less than 60 beats per minute, begin CPR. This rate is too slow for an infant. To perform CPR on an infant, do the following:
   • Be sure the infant is face-up on a hard surface.
   • Using two fingers, perform compressions in the center of the infant’s chest (Figure 11f); do not press on the end of the sternum as this can cause injury to the infant.
   • Compression depth should be about 1.5 inches (4 cm) and 100-120 compressions.
5. Perform CPR for about two minutes (using cycles of 30 compressions and two breaths). If help has not arrived, call 911/EMS and get an AED.
6. Use and follow AED prompts when available while continuing CPR until EMS arrives or until the infant’s condition normalizes.

TWO-RESCUER BLS FOR INFANTS

If you are not alone with the infant at the scene, do the following:

1. Tap the bottom of their foot and talk loudly at the infant to determine if they are responsive.
2. If the infant does not respond, have the second rescuer call 911/EMS, and get an AED. (The ILCOR emphasizes that cell phones are available everywhere now and most have a built-in speakerphone, so you can call while at the scene.)
3. Assess if they are breathing. Feel for the infant’s brachial pulse for 5 but no more than 10 seconds.
4. If you cannot feel a pulse (or if you are unsure), begin CPR by doing 15 compressions followed by two breaths. If you can feel a pulse but the rate is less than 60 beats per minute, begin CPR. This rate is too slow for an infant.
5. When the second rescuer returns, begin CPR by performing 15 compressions by one rescuer and two breaths by the second rescuer. If the second rescuer can fit their hands around the infant’s chest, perform CPR using the two thumb-encircling hands method (Figure 11g). Do not press on the bottom end of the sternum as this can cause injury to the infant.
6. Compressions should be approximately 1.5 inches (4 cm) deep and at a rate of at least 100-120 per minute.
7. Use and follow AED prompts when available while continuing CPR until EMS arrives or until the infant’s condition normalizes.