Every parent hopes they will never need to use CPR. Most never will. But the difference between knowing what to do and not knowing what to do in the first minutes of a cardiac or respiratory emergency is significant, and paediatric cardiac arrests, while rare, occur without warning.
The good news is that telephone-guided CPR from 999 dispatchers means that even parents who have never practised will receive step-by-step instructions the moment they call. The better news is that a basic paediatric first aid course covering CPR technique and choking takes only a few hours and provides a level of competence and confidence that makes a genuine difference.
Healthbooq (healthbooq.com) provides guidance on home safety and first aid throughout the early years. This article covers the principles of infant and child CPR; it does not substitute for practical training.
When to Start CPR
CPR is needed when a child is unresponsive and not breathing normally. Breathing normally means regular, easy breaths. Occasional gasps (agonal breathing), noisy breathing, or breathing that looks laboured are not normal breathing.
If a child collapses, does not respond when you call their name and tap their shoulders, and is either not breathing or only gasping, call 999 immediately and start CPR.
Do not leave the child alone to call for help if you are the only person present. Shout for others to call while you start CPR, or call 999 on speaker and put the phone down while following the dispatcher's instructions.
The Sequence for Infants (Under 1 Year)
Open the airway by gently tilting the head back and lifting the chin. In infants, use a neutral position (not the full head tilt used in adults, as over-extension can close a small infant's airway).
Give 5 initial rescue breaths. For an infant, cover the baby's mouth and nose with your mouth. Breathe in gently, just enough to see the chest rise. Remove your mouth and let the chest fall. Repeat 5 times.
Start 30 chest compressions. Place 2 fingers on the centre of the chest, just below the nipple line. Press down by about one third of the chest depth. That is roughly 4cm. Rate: 100 to 120 compressions per minute (roughly 2 per second). After 30 compressions, give 2 rescue breaths.
Continue the cycle of 30 compressions and 2 rescue breaths until the child recovers, until emergency services arrive, or until you are too exhausted to continue and someone can relieve you.
The Sequence for Children (1 Year and Older)
The technique for children from one year onward is similar to adult CPR, adjusted for the size of the child.
Open the airway by tilting the head back and lifting the chin, more firmly than for an infant.
Give 5 initial rescue breaths. For a child, seal your mouth over the child's mouth and pinch the nose. Breathe in enough to see the chest rise. Give 5 rescue breaths.
Start 30 chest compressions. For a small child, use the heel of one hand. For a larger child, use both hands as in adult CPR. Press down by one third of the chest depth (approximately 5cm for a school-age child). Rate: 100 to 120 compressions per minute. Follow with 2 rescue breaths.
Continue the cycle until the child recovers, services arrive, or you are relieved.
If You Cannot or Will Not Do Rescue Breaths
Compression-only CPR (without rescue breaths) is better than nothing for adults in cardiac arrest. For children, whose cardiac arrest is more often caused by respiratory failure than primary cardiac events, rescue breaths are particularly important and significantly improve outcomes. If circumstances make rescue breaths impossible, do compression-only CPR while the 999 dispatcher guides you.
AEDs
Automated external defibrillators (AEDs) are present in many public spaces, registered on the GoodSAM Defibrillator network, and guided by on-screen instructions. They should be used on children when available. Most modern AEDs have a paediatric mode or paediatric pads for smaller children; follow the device's instructions. If adult pads must be used on a small child, place one pad on the centre of the chest and one on the centre of the back rather than both on the front.
Get Practical Training
Reading about CPR is useful but does not confer competence. The motor skills and confidence needed to actually compress a chest correctly, to give an effective rescue breath, and to maintain the correct rate for several minutes, require hands-on practice.
Paediatric first aid courses covering CPR, choking, and common emergencies are available through organisations including St John Ambulance, British Red Cross, Bluebell First Aid, and many others. Many are available in half-day formats. Some are specifically designed for parents and grandparents rather than for professional settings.
Key Takeaways
Cardiopulmonary resuscitation (CPR) for infants and children differs from adult CPR in technique, compression depth, and the sequence of actions. The most important things parents can do are to call 999 immediately, to start CPR without delay if the child is unresponsive and not breathing normally, and to follow the instructions given by the emergency call handler who will guide them through the process. Attending a paediatric first aid course provides hands-on practice that is far more effective than reading instructions alone.
