Cardiac arrest in children is most commonly caused by respiratory failure — a blocked airway or breathing emergency — rather than a heart attack as in adults. This fundamental difference means that rescue breathing is especially important in paediatric CPR, and the technique must be adapted for a smaller body.
Infant CPR (Under 1 Year)
Check responsiveness by tapping the foot gently. If the infant is unresponsive and not breathing, shout for help and call 999. Begin 30 chest compressions: place two fingers on the centre of the chest, just below the nipple line. Press down about 4 cm — roughly one-third the depth of the chest. Do this at a rate of 100–120 per minute. After 30 compressions, give 2 rescue breaths: cover both the infant's mouth and nose with your mouth and puff gently until you see the chest rise — use only the volume of air in your cheeks, not a full breath.
Child CPR (1 Year to Puberty)
For a child, use the heel of one hand on the centre of the chest, pressing down about 5 cm. The ratio remains 30 compressions to 2 rescue breaths. If you can feel a pulse but the child is not breathing, give one rescue breath every 3 seconds. Use gentle but firm breaths — enough to see the chest rise, but not so forceful as to cause injury.
Choking in Children
For a child over one year who is choking and cannot breathe or cough effectively: give up to 5 firm back blows between the shoulder blades, then check the mouth and remove any visible object. If the obstruction remains, perform up to 5 abdominal thrusts — stand behind the child, make a fist above the navel, and thrust inward and upward. Alternate back blows and abdominal thrusts.
For infants under one year, never perform abdominal thrusts. Instead, give 5 back blows face-down along your forearm, then 5 chest thrusts with two fingers on the centre of the chest, alternating until the object is dislodged.
When to Use an AED
If an automated external defibrillator (AED) is available and the child is over 1 year, use it. For infants, paediatric pads or a paediatric mode should be used if available. The AED will analyse the heart rhythm and advise whether a shock is needed. Follow its voice instructions precisely and do not touch the child while it delivers a shock.