CPR in Babies: Steps And Precautions by Dr Chetan Ginigeri

A parent or not; you will be surrounded by babies one way or another. Trust us, nobody has ‘perform cardiopulmonary resuscitation (CPR) on a baby’ written in their daily planner. But as we all know not everything can be pre-planned. Either your baby or your little cousin or a baby of your neighbor or a baby of a random stranger in a grocery shop might need your help breathing. Learning how to perform CPR in babies will help you save a life in unexpected times.

Baby Stops Breathing or Heart Stops Beating

The air that the lungs inhale contains oxygen and the heart supplies that oxygen along with the blood to various parts of the body. If the baby stops breathing or the heart stops beating then it can cut off the flow of oxygen to the vital organs. This can lead to brain damage within four minutes and/or even death in four to six minutes.

Unlike adults, CPR in babies is required in case of respiratory issues that can lead to cardiac arrest.

The reasons that can cause a baby’s heartbeat or breathing to stop include:

Drowning
Poisoning
Smoke Inhalation
Sudden Infant Death Syndrome (SIDS)
Electric Shock
Severe Asthma
Head Trauma
Obstructive Apnea
Injury or Illness

What is CPR?

CPR is short of Cardiopulmonary Resuscitation. It is an emergency lifesaving technique used to keep the blood flowing through a person’s body when the heart stops beating. It involves chest compressions to keep the blood flow intact and rescue-breathing to provide oxygen to the lungs.

Time becomes a factor of big concern while you are dealing with an unconscious baby. CPR is most effective when performed at the earliest. Doing CPR in babies will help deliver oxygen to the brain until help comes or the baby recovers.

Difference Between Doing CPR in Babies and Adults

CPR is performed in adults and infants for the same reason – to help lung and heart work when they cannot. But there are certain differences that one should keep in mind while performing CPR on babies:

1. Do Not Shake the Baby

While checking for responsiveness, do not shake the baby as it may cause brain damage. You should call the baby loudly while tapping the soles of their feet.

2. Checking Pulse

In an infant, one should use a bilateral brachial artery to check the pulse. To do so press 2 to 3 fingers gently on the inner side of the upper arm for 5 to 10 seconds.

3. The Depth of Compressions

In an infant should be 1/3rd the depth of their chest or 1.5 inches.

4. The Technique of Compression

Use the 2 finger technique. When there is only one rescuer present, use two fingers for chest compression. Place two fingers, just below the nipple line, in the center of the infant’s chest. Push the chest to the 1/3rd of the chest or one and a half inches. In between compression, allow the chest to regain its position. Perform the compression at the rate of 100-120 compression per minute.

5. Two Finger Encircling Hand Technique

If there are two rescuers, the compression to ventilation ratio becomes 15:2. Sit near the baby’s feet and place two thumbs side by side, just below the nipple line in the center of the chest. Encircle the chest in such a way that the fingers of both hands hold the back of the baby. Start the compression using thumbs at the rate of 100-120 compression per minute. The depth of compressions should be 1/3rd of the chest. This technique allows another rescuer to support breathing without coming in the way. This technique is preferred.

6. The Compression to Ventilation Ratio

While performing CPR in a baby this should be 30:2 in the case of one rescuer. If there are two-rescuer you can give 15 compressions and 2 breaths.

7. Calling Emergency Services

Adults require CPR when they go into cardiac arrest. However, infants need CPR when they are in a respiratory problem before going into cardiac arrest. The aim is to not let the baby go into cardiac arrest. Cardiac arrest means the baby becomes suddenly unresponsive. Hence, if you did not see the baby go into cardiac arrest then first administer CPR for two minutes before calling emergency service. And if you see a baby go into cardiac arrest then first call emergency service and then start CPR again.

When is CPR Performed in Infants?

One should only perform CPR in infants only when they are either unresponsive, unconscious, not breathing normally or there are no signs of life.

What are the Considerations Before Giving a Baby CPR?

We understand that as parents or caretakers you need to take urgent steps to make the baby responsive, but there are a few precautions & steps you need to take while giving a baby CPR:

Check the surroundings. If you are not in a safe place like you are near water then take the baby to a safe place. If you are in a safe place don’t move the baby.
Check the responsiveness in the baby by calling them out and flicking on the sole of their feet. Do not shake the baby.
Check for breathing for no more than 10 seconds.
If the baby is not responding, call someone from around for help. Do not leave the baby to call for help. If you are alone, administer two minutes of care then call emergency services. If you get help, ask them to call emergency services.
Make the baby sleep on its back and open the airway. Tilt the baby’s head slightly back and lift the chin.
If the baby is not breathing, use your mouth to seal the baby’s mouth and nose. Blow for one second and let the chest rise. Give a second rescue breath in the same way.
If the baby does not respond to rescue breathing, perform CPR.

How to Perform Baby CPR?

Keep the following steps in mind if you are performing the Baby CPR alone:

1. Sit down beside the baby. Position the baby on its back.

2. Place two fingers in the center of the baby’s chest, below the nipple line. Give 30 compressions at the rate of 100 to 120 per minute. Count as you perform the compression. Depth of compression should be 1.5 inches deep or 1/3rd the depth of the chest. Remember Push hard – Push fast.

3. Open the airway by lifting the head slightly backward and lifting the chin. Remember not to tilt the head too far back.

4. Seal baby’s nose and mouth with your mouth and give two gentle breaths of one second long each. Make sure you see the baby’s chest rising after each breath. Do not force ventilation just gently, else it can cause lung damage.

5. Continue performing CPR in the same way – 30 compression 2 breaths – until you see signs of life or help arrives.

What Should be the CPR Ratio for an Infant?

Performing CPR in a baby includes both chest compression and mouth-to-mouth ventilation (rescue breaths). CPR ratio gives infant CPR compression to ventilation rate. This shows for every breath how many compressions are required to optimize the flow of oxygenated blood through the cardiovascular system and to the brain.

When it comes to performing CPR for infants one cannot forget the CPR ratio. The CPR ratio for an infant is 30:2. That means to give 30 chest compressions followed by two rescue breaths.

If you are giving two-rescuer CPR (explained below) you can shift the ratio to 15:2.

What are One Rescuer CPR and Two Rescuer CPR For Infants?

One rescuer and two-rescuer CPR for infants simply indicates the number of rescuers who are available to perform CPR. If you are alone, perform the one rescuer for an infant. If there is another person with you or someone who comes to give help perform two-rescuer CPR for infants. The technique in two-rescuer CPR enables more steady compressions and blood flow as compared to one-rescuer CPR.

How to perform one rescuer and two-rescuer CPR is mentioned below.

One Rescuer CPR for Infants

Check if the baby is responding by calling him or her loudly while tapping the sole of the feet. Check the baby’s breathing. If it is not normal, call for help.
When someone comes, ask them to call the emergency service. In case you are alone, give the baby two minutes of CPR, then call EMS. If you see a baby that has been down for an unknown time call emergency service first and then give CPR.
Check the baby’s brachial pulse for 5-10 seconds by 2-3 fingers on the inner side of the upper arm. Do not push firmly. If you find an abnormal pulse (much less than 60 per minute) or no pulse – Start CPR. Place the baby on the back. Place two fingers in the center of the baby’s chest below the nipple line and perform 30 compressions. Don’t press on the end of the breastbone. Compression should be 100-120 per minute and the depth should be 1.5 inches. Count compression loudly.
Open the airway by tilting the head slightly up and lifting the chin. To check if the position is right – level the baby’s external ear canal with the top of the shoulder. Do not let the head fall too back. Also, do not let the chin fall back towards the neck. You can use your other hand to make sure that the head is in the right position even while you perform compression.
Give the baby two rescue breaths for one second each. Do not push too much air just enough to make the chest rise.
After two minutes or five rounds of compression. Call the emergency service and look for AED (Automated External Defibrillator). Use AED if available. Else continue performing CPR on a baby.

Two Rescuer CPR for Infants

Rescuer 1 should check for responsiveness in the baby by tapping the sole of feet and calling the baby loudly. Check for breathing. If a baby has abnormal or no breathing at all, ask Rescuer 2 to call emergency service and bring AED if available.
Rescuer 1 should check the baby’s brachial pulse for 5-10 seconds by 2-3 fingers in the inner side of the upper arm. Do not push firmly. If you find an abnormal pulse (much less than 60 per minute) or no pulse – Start CPR.
Until rescuer 2 comes back, Rescuer 1 should – Place the baby on the back. Place two fingers in the center of the baby’s chest below the nipple line and perform 30 compressions. Don’t press on the end of the breastbone. Compression should be 100-120 per minute and the depth should be 1.5 inches. Count compression loudly.
Open the airway by tilting the head slightly up and lifting the chin. To check if the position is right – level the baby’s external ear canal with the top of the shoulder. Do not let the head fall too back. Also, do not let the chin fall back towards the neck. You can use your other hand to make sure that the head is in the right position even while you perform compression.
Give the baby two rescue breaths for one second each. Do not push too much air just enough to make the chest rise.
When the Rescuer 2 returns change the compression ratio to 15: 2 that is 15 compression two breaths.
Rescuer 2 should place the thumb of both hands in the center of the baby’s chest below the nipple line. Make sure to not push the end of the breastbone. Place the fingers on the infant’s back. Use the thumb to give 15 compressions. The rate and depth of compression should be the same as above.
Rescuer 1 should give two rescue breaths as above.
Until the help arrives, continue CPR at a 15:2 ratio and switch positions every two minutes to avoid fatigue.
Use AED as soon as available.

If possible, read all the above information once again to not make any mistakes while you are in a life and death situation. Learning how to perform CPR on a baby is important as no one knows when this life-saving skill comes in handy. You can also get CPR training from certified classes as hands-on experience is always better.

References:

Child & Baby CPR , Redcross.org
Learn CPR for infants – You can do it , depts.washington.edu

CPR in Babies: Steps And Precautions by Dr Chetan Ginigeri

Baby Stops Breathing or Heart Stops Beating

What is CPR?