Paediatric Basic Life Support
We have discussed what you should do when you are confronted with a child and there are signs of life. We are now going to look at what to do when there are no signs of life.
The management of a cardiorespiratory arrest in children will depend on their age. We will firstly look at how to resuscitate a child before discussing the differences that should be noted when resuscitating an infant.
Approach
Check for hazards
Gently stimulate the child (age appropriate)
Do not shake infants and children
Shout for help
Child is unresponsive, shout for help
As soon as help arrives, ask them to phone/radio for assistance and state the location of the incident
Open the airway
Open the airway using the correct techniques for the child's age
For a child a partial head tilt, chin lift may be required
Rescue breaths
If there is no breathing, or they are not breathing normally, give the patient five rescue breaths.
Signs of life
Look for signs of life for up to 10 seconds.
Start CPR
If there are no signs of life, start CPR.
Continue CPR
Continue CPR: 15 chest compressions, then 2 rescue breaths.
One minute of CPR
If no help arrives, complete one minute of CPR before raising the alarm yourself.
Infant Basic Life Support
When resuscitating an infant the initial approach remains the same as when resuscitating a child. You must always check for hazards, gently try to stimulate the child and, if there is no response, call for help early.
Select the images below to review resuscitation guidelines for an infant.
Open the airway
The infant’s head should be in a neutral position.
Check the airway for any obstructions.
Check breathing
Look for chest movement
Listen for breath sounds
Feel for breath on your cheek
For a maximum of 10 seconds. If in doubt, assume they are not breathing.
Five rescue breaths
Give five rescue breaths to make sure that the chest rises and falls with each breath. Reassess signs of life and commence chest compressions.
Chest compressions
Locate the lower half of the sternum. If you are on your own, use two fingers. If there are others, use the encircling technique:
Place both thumbs flat, side by side on the lower half of the sternum with the tips pointing towards the infant’s head
Spread the rest of both hands, with the fingers together, to encircle the lower part of the infant’s rib cage with the tips of the fingers supporting the infant’s back
Depress the lower sternum by at least 1/3 the depth of the chest - 4 cm for an infant
Do not be afraid to push to the correct depth
Release the pressure completely, then repeat at a rate of 100-120/min
After 15 compressions, give two rescue breaths
Child Basic Life Support
Select the images below to review resuscitation guidelines for a child.
Open the airway
Open the airway with a slight head tilt, chin lift.
The airway position for the child is known as 'sniffing the morning air' or 'snobby child'.
Check for breathing
Look for chest movement
Listen for breath sounds
Feel for breath on your cheek
For a maximum of 10 seconds. If in doubt, assume they are not breathing.
Five rescue breaths
Pinch the nostrils together to prevent air escaping and then cover their mouth with yours
Slow breaths at low pressure to achieve normal chest movement
Sudden collapse in children and infants is commonly of respiratory origin and rescue breaths alone may be effective
Chest compressions
Locate the lower half of the sternum
Use one or two hands to deliver chest compressions
Depress the lower sternum by at least 1/3 the depth of the chest - 5 cms for a child
Don’t be afraid to push too hard
Release the pressure completely, then repeat at a rate of 100-120/min
After 15 compressions, give two rescue breaths
Continue Resuscitation and Recovery
Continue resuscitation until:
The child shows signs of life:
Coughing
Opening eyes
Speaking
Moving purposefully
Breathing normally
Further qualified help arrives
Don’t stop unless you absolutely have to.
If the infant or child starts to show signs of life, reassess their airway and breathing and, if present, place them in the recovery position (as can be seen on the diagram).
Choking
Infants and children are at a high risk of choking due to their inquisitive nature. Knowing how to deal with this life-threatening emergency is important as it could happen in any place at any time.
In both scenarios, if the infant or child has an effective cough (productive, they can breathe between, not turning blue), do not intervene. Instead encourage coughing, stay with them and make sure they are in a place of safety (for example, take them out of a highchair or buggy).
If the cough becomes ineffective (no noise, colour change, see-saw breathing, panic-stricken look), then intervention is required. Shout for help - request a bystander/colleague to call 999 ambulance or to call 2222 for the paediatric cardiac arrest team. Managing a choking infant is slightly different from managing a choking child or adult and both management strategies will be discussed below.
Choking Infant (If the infant becomes unresponsive at any point, start CPR.)
Back blows
Use gravity to help you (see image)
Using the heel of your hand between the shoulder blades, deliver up to five back blows
If the obstruction comes out at any stage, reassess the infant’s airway and breathing
If they are still choking after five back blows, move on to chest thrusts
Chest thrusts
Chest thrusts are to be used in children under 1 year of age
Use gravity to help you (see below)
Deliver up to five chest thrusts by placing two fingers in the centre of the chest and use a short, sharp inward and upward motion to try and remove the obstruction
If they are still choking, alternate between five back blows and five chest thrusts
Choking Child (If the child becomes unresponsive at any point, start CPR.)
Back blows
If they will let you, lean the child forwards and stand or kneel behind them
Using the heel of your hands between the shoulder blades, deliver up to five back blows
If the obstruction comes out at any stage, reassess the child’s airway and breathing
If they are still choking after five back blows, move on to abdominal thrusts.
Abdominal thrusts
Abdominal thrusts should only be used in children over 1 year of age
Give the child five abdominal thrusts - stand behind the child, hold a fist against the abdomen and press sharply inwards and upwards
If the obstruction comes out at any stage, reassess the child's airway and breathing
If they are still choking, alternate between five back blows and five abdominal thrusts until the obstruction comes out.
Do Not Attempt Cardiopulmonary Resuscitation Order (DNACPR)
Although it is less common to have a DNACPR form for a child, it is your responsibility to know and comply with your organisation’s Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policy, as all organisations' forms may be different.
A signed form must be available to all concerned with the patient’s care. You need to ensure that the notes and form accompany the patient if they go to a different department or care setting.
You should also familiarise yourself with the treatment escalation plan or the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process which creates individualised recommendations for a person’s clinical care in emergency situations.
Session Summary
Key Points
Immediate action, which includes calling for help early and starting CPR, is the most effective way to increase the chances of survival for a child
Your first impression is important. Look at the child in general to see if they ‘look unwell’
If the child is responsive or showing signs of life, perform an ABCDE assessment
If the child is unconscious, unresponsive and is not breathing normally, start the paediatric basic life support sequence
The management of a cardiorespiratory arrest in children will depend on their age
If a child under 1 year of age is choking, deliver up to five back blows. If the obstruction has not moved, alternate back blows with five chest thrusts
If a child over 1 year of age is choking, deliver up to five back blows, If the obstruction has not moved, alternate back blows with abdominal thrusts
Next Steps
Continue to the Resuscitation Paediatric Level 2 eAssessment.
This should be completed to demonstrate the required knowledge and understanding and to complete the training.
Remember to also familiarise yourself with local procedures.
