This is the article you hope you never need. Most parents never will. But the gap between knowing roughly what to do in the first two minutes of a paediatric arrest and not knowing is enormous, and dispatchers can only guide you through what your hands already remember how to do. Read this. Then book a 3-hour AHA HeartSaver Pediatric or Red Cross Infant/Child CPR class — the muscle memory only sticks when you have actually pushed on a manikin. For more on home safety and first aid, visit Healthbooq.
The Chain: Recognise, Call, Compress, Defibrillate
The American Heart Association calls it the paediatric chain of survival. It is the same four moves every time:
- Recognise the child is unresponsive and not breathing normally.
- Shout for help and get someone to call EMS (911 in the US, 999 in the UK, 112 across most of Europe). If you are alone, start CPR for about 2 minutes, then call yourself — putting the phone on speaker and laying it next to the child.
- Start CPR. Push hard, push fast, give breaths.
- Use an AED as soon as one arrives.
"Not breathing normally" is the part parents miss. Occasional gasps every 10 or 15 seconds (agonal breathing) are not breathing — they are a sign the brain is shutting down. Treat them as no breathing.
How to Tell If You Need to Start
Tap the bottom of an infant's foot or shake a child's shoulder and shout their name. No response, no normal breathing — start CPR.
If you are trained, you can also check a brachial pulse on an infant (inside of the upper arm, between elbow and shoulder) for no more than 5 to 10 seconds. If you cannot feel a pulse with confidence in that window, assume there isn't one and start. Untrained rescuers should skip the pulse check and just start.
CPR for an Infant Under 1 Year
Lay the baby on a firm, flat surface — a table, the floor, the changing pad pressed onto the floor. Tilt the head to neutral (a small folded cloth under the shoulders helps); do not over-extend the neck, it closes a small airway.
If you are alone, use a 30:2 ratio. If you have a second trained rescuer, switch to 15:2.
Compressions. Place 2 fingers on the lower half of the sternum, just below an imaginary line between the nipples. Push straight down about 4 cm (1.5 inches) — about a third of the chest depth. Rate 100 to 120 per minute. The "Stayin' Alive" tempo is right; so is "Baby Shark." Let the chest fully recoil between compressions, that is how blood refills the heart.
If two trained rescuers are present, the better technique is the two-thumb encircling hands method: thumbs side by side on the lower sternum, fingers wrapping the chest. It produces better blood flow than the two-finger technique.
Breaths. After 30 compressions (or 15 with a partner), open the airway, cover the baby's nose AND mouth with your mouth, and give 2 small puffs — just enough that you see the chest rise once. A full adult breath will overinflate an infant. If the chest does not rise, reposition the head and try once more before going back to compressions.
Keep going. 30:2, 30:2, 30:2 — until the baby moves or cries, until EMS takes over, or until you physically cannot continue and someone can swap in. If a second rescuer is available, swap compressors every 2 minutes; tired hands compress shallow and slow without realising it.
CPR for a Child 1 Year and Up
Same chain, slightly different mechanics for a bigger body.
Open the airway with a head-tilt, chin-lift — more firmly than for an infant.
Compressions. Heel of one hand (small child) or two stacked hands (older child) on the lower half of the sternum. Push down about 5 cm (2 inches), or roughly a third of chest depth. Same rate, 100 to 120 per minute, full recoil.
Breaths. Pinch the nose, seal your mouth over the child's mouth, give 2 breaths just sufficient to see the chest rise.
Same ratios: 30:2 alone, 15:2 with a second trained rescuer.
When You Cannot or Will Not Give Breaths
For an adult collapse, hands-only CPR is acceptable. For a baby or child, breaths matter more — paediatric arrests are usually respiratory in origin (drowning, choking, severe asthma, suffocation), not cardiac. The heart often stops because the lungs stopped first, so giving the child air back is a bigger part of the fix than it is in adults.
That said, compressions-only CPR is still vastly better than nothing. If you cannot bring yourself to give breaths or have no barrier device and a real concern, push hard and push fast on the chest until help arrives, and ask the dispatcher to coach you.
AEDs
Automated external defibrillators are designed to be used by people who have never seen one before. Open the lid, follow the spoken instructions, do not be afraid of them. Modern AEDs analyse the rhythm and only deliver a shock if one is needed.
For infants and children under 8, use paediatric pads or paediatric mode if the device has one. If only adult pads are available, use them anyway — one pad on the centre of the chest, one on the centre of the back (anterior-posterior), so they do not touch each other on a small body. A correctly placed adult pad is better than no shock.
Choking: Different from CPR
A choking baby who is conscious but cannot cry, cough, or breathe needs back blows and chest thrusts, not CPR.
For an infant under 1: lay them face down along your forearm, head lower than chest, supporting the jaw. Give 5 firm back blows between the shoulder blades with the heel of your hand. Flip them over, two fingers on the lower sternum, give 5 chest thrusts (slower and deeper than compressions). Alternate 5 and 5. Check the mouth between rounds — only sweep something out if you can see it. Never blind-finger-sweep an infant.
No abdominal thrusts (Heimlich) under 1 year — the liver sits high and unprotected; you can rupture it.
For a child over 1, the sequence is 5 back blows, then 5 abdominal thrusts (Heimlich), repeat.
If the child becomes unresponsive at any point, lower them to the floor, shout for help, call EMS, and start CPR.
Take a Class
Reading this article is a starting point. It is not a substitute for compressing a real chest manikin under an instructor's eye. The motor skill of pressing 4 cm into a baby-sized chest at 110 per minute for two minutes straight is something hands learn, not eyes.
In the US: AHA HeartSaver Pediatric First Aid CPR AED, or American Red Cross Infant and Child CPR. Both are widely offered, often in 3–4 hour formats, and many are designed for parents and grandparents rather than professionals. In the UK: St John Ambulance, British Red Cross, or any RC UK-aligned provider. Recertify every 2 years — the technique drifts faster than people think.
Key Takeaways
If a baby is unresponsive and not breathing normally: shout for help, start CPR, call EMS (911/999/112) on speaker. For an infant alone, use 30 compressions to 2 breaths, two fingers on the lower sternum, ~4 cm deep, 100–120/min. This article is educational — book a hands-on AHA or Red Cross course.
