About CPR for an Infant

Infant CPR, or cardiopulmonary resuscitation, is a lifesaving technique that is performed when an infant has stopped breathing or whose heart has stopped beating, usually due to accidents, injuries, suffocation or drowning. CPR involves a combination of rescue breathing and chest compressions. Infant CPR modifies the steps to suit the anatomical difference of infants from adults. Infants are defined as children under 12-months old.

History

• Doctors and midwives have long known about how to revive newborns by breathing into the infant's body. In 1954, James Elam was the first to conduct studies on mouth-to-mouth and mouth-to-nose ventilation as a mean of oxygenating the body. With the help of Peter Safar, they directed numerous studies on the effectiveness. The study of chest compressions started with William Bennett Kouwenhoven, James Jude and Guy Knickbocker when they discovered that applying a type of chest pressure can artificially circulate the blood in dogs and revive cardiac arrest patients. The process of CPR was not formalized until 1960 when the discoveries were shared and combined.

Start CPR Immediately

• If an infant is not responding, has stopped breathing or has no pulse, start CPR immediately and have someone else call 911. If alone, perform CPR for 2 minutes or for five cycles of breaths and compressions before calling 911. An infant's body is delicate, and with oxygen deprivation, the child risks suffering brain damage and eventually death. By doing breath work and compressions in CPR, oxygen will circulate through the body.

When to Do CPR

• With an unconscious infant, try to get a response first by tapping the bottom of the feet and calling out loudly. Assess the surrounding and situation to determine the possible cause. Do not shake the baby or move the baby excessively in case of sustained injury. If the infant does not respond, check for breathing. Look for the chest to rise and fall and place your cheek close to the mouth and nose for 5 seconds to feel for the breath. If the infant is breathing, wait for help to arrive or proceed to the emergency room.
  If there's no breath, check for the pulse on the brachial artery. Locate this artery on the upper arm, between the elbow and shoulder, on the inside aspect of the arm instead of the carotid artery, used on adults. If there is a pulse, you do not use CPR. Use the rescue breathing method instead to keep oxygen flowing into the body. If there is not a pulse, use both breathing and compressions.

Airway

• Unlike adults, you do not need to tilt the infant's head back very far to open up the airway; instead, place a hand on the forehead and lift the chin with a couple fingers. Check for anything in the baby's mouth that may be hindering airflow. Check to see if the baby is choking on something by giving two cursory breaths to see if the chest will rise and fall. If you don't see chest movement with the breaths, the airway is blocked. Start first aid for infant choking.

Mouth-to-Mouth

• Give two puffs in between compressions. Use your mouth to cover the infant's mouth and nose during the breaths, which helps deliver more oxygen faster. Other methods as needed are mouth-to-nose, mouth-to-mouth, and mouth-to-barrier device if you have it. Use a reasonable amount of air for the chest to rise but avoid being forceful. Too much air in the stomach can cause the infant to vomit.

Compression

• Use only two fingers during chest compressions rather than the hand-over-hand technique used on adults. Place the fingers on the sternum just below the level of the nipples and avoid pressing down on the tail of the breastbone. When doing compressions, push straight down 30 times about one-third the depth of the chest. Pump smoothly at a rate of 30 compressions per 18 seconds or slightly faster as an infant's heart beats faster than an adult.

Prevention

• To help prevent an infant death, take a CPR course and practice on dummies (geared toward infants and children). These classes are offered at most Red Cross centers, hospitals and independent CPR certification companies.