Chapter 6: Child CPR, AED, and Choking
Video 6a: Child CPR
Script: Welcome to the introduction to Child CPR. In this video, we will discuss what to do when giving CPR to a child, that is one year to puberty.
Children have breathing difficulties more often than they have actual heart problems. Therefore, it is important to begin CPR quickly and perform five sets of CPR before going to get additional help. One set of CPR consists of 30 compressions and two breaths.
When giving CPR to a child, make sure the scene is safe. Tap the child’s shoulders and ask if they’re okay, and yell for help.
Check their breathing. If the child is not responding and not breathing or only gasping, then give five sets of 30 compressions and two breaths. The term “unresponsive” or “not responding” includes any child who does not move, blink, speak, make a sound, or otherwise react to your efforts to awaken them.
This concludes our lesson on introduction to CPR. Next, we will review the steps of Chest Compressions in Child CPR.
Video 6b: Chest Compressions in Child CPR
Script: Welcome to Chest Compressions in Child CPR. In this video, we will discuss the steps of how to do chest compressions in children.
The steps of CPR in children are similar to those in adults. The main goals are early administration of CPR and pushing hard and fast on the chest, and giving breaths. Children who appear adult-size can be treated as adults for the purposes of CPR.
As a rescuer, if you are untrained in CPR, then give the “hands-only” CPR. The “hands-only” CPR is when you give continuous compressions but no breaths.
To do CPR on a child, first position them on their back on a firm, hard surface.
Move any clothing away from the chest.
Place the heel of one hand on the lower half of the breastbone.
Push straight down approximately at least one third the depth of the chest. In most children, this is about two inches, that is 5 cm. Compressions should be delivered at a rate of 100 to 120 beats per minute.
Let the chest recoil to its normal position after every compression.
Either one- or two-handed compressions can be used in child CPR. Performing CPR can be tiring. If someone else is available to help, change roles every two minutes and work to minimize the pause in between compressions.
This concludes our lesson on Chest Compressions in Child CPR. Next, we will review the steps of Giving Breaths in Child CPR.
Video 6c: Giving Breaths in CPR
Script: Welcome to Giving Breaths in Child CPR. In this video, we will discuss the steps of how to give breaths in children.
Most children who need CPR have had a breathing problem that caused the heart to beat irregularly or to stop beating altogether.
Signs of ineffective breathing include slow breathing, very shallow or sporadic breathing, and absence of any breaths altogether. Give rescue breaths to children who appear to be struggling to breathe. A good breath will cause the child’s chest to rise.
Before actually giving breaths, first open the child’s airway by putting one hand on their forehead and placing your fingers on the bony part of their chin. Then, gently tilt the head back while lifting the chin.
Now you’re ready to deliver breaths. First, hold the child’s airway open as described previously and pinch the nose shut.
Take a deep breath and seal your mouth around the child’s mouth.
Gently exhale into their mouth for one second using enough force to cause the chest to rise.
Repeat for a second breath.
This concludes our lesson on Giving Breaths in Child CPR. Next, we will review Mask Use in Children.
Video 6d: Mask Use in Children
Script: Welcome to Mask Use in Children. In this video, we will discuss the steps of mask use in children.
Giving breaths in CPR is generally safe. However, if a mask is available, it should be used. The mask fits over the child’s mouth and nose. Many masks have a pointed end, which should go over the bridge of the nose.
Make sure the mask fits properly; if it’s too large, a proper seal cannot be obtained and efforts to deliver breaths will be ineffective.
To give breaths using a mask, first place the mask over the child’s mouth and nose.
Then, open the airway by performing the head-tilt-chin-lift maneuver.
Ensure a good seal between the mask and the face.
Give a breath for more than one second and watch the chest rise.
Deliver the second breath.
This concludes our lesson on Mask Use in Children. Next, we will review AED for Children.
Video 6e: AED for Children
Script: Welcome to the lesson on AED for Children. In this video, we will discuss AED use in children and go over step-by-step directions to use it.
An AED can deliver a pediatric shock to restart the heart. The steps for using an AED in children are the same as those in adults. Always check the AED when it arrives on the scene. If the child is younger than eight years, then use pediatric pads. If pediatric pads are not available, standard, that is adult pads, may be used. If you are using standard pads, make sure that the pads do not overlap each other. If needed, put one of the pads on the child’s back.
Some AEDs have a switch that can be set to deliver a pediatric shock. If available, turn this switch on when using AED for children younger than eight years. If the AED cannot deliver a pediatric shock, an adult shock should be given.
To use an AED on a child, first, turn the power on.
Expose the child’s chest. Then, apply the pads. Ensure that the pads do not touch.
Connect the pads to the AED.
Clear the child and analyze the rhythm.
Follow the prompts on the AED. If the AED prompts for shock delivery, then clear the child again and press the shock button once the AED has charged. After shock delivery, resume CPR starting with chest compressions. If there is no shock to be delivered, then resume CPR starting with chest compressions.
This concludes our lesson on AED for Children. Next, we will review Activating EMS for Children.
Video 6f: Activating EMS for Children
Script: Welcome to the lesson on Activating EMS, or emergency medical services, for Children. In this video, we will discuss the steps to call 911 when attending to ill or injured children.
Always make sure that the scene is safe when approaching a child.
Tap the child’s shoulders and ask them if they are okay. If they don’t respond, they are considered unresponsive. Immediately yell for help and send somebody to call 911 and to get an AED.
If you witnessed the child’s arrest, are alone, and must leave the child to activate 911, you should call 911 and get an AED before beginning CPR. If you didn’t witness the child’s arrest, first give five sets of compressions and breaths before leaving the child.
After determining that the child is unresponsive, check their breathing. If they are barely breathing or only gasping, begin CPR. Gasping maybe forceful or weak, but it is generally ineffective. This is abnormal and often occurs during cardiac arrest.
This concludes our lesson on Activating EMS for Children. Next, we will review Choking in Children.
Video 6g: Choking in Children
Script: Welcome to the lesson on Choking in Children. In this video, we will discuss choking in children and signs of choking that you should look for.
Choking can be mild or severe. If the child can make sounds and cough, the airway is mildly blocked. In this case, stand near them and encourage them to cough. Call 911 if you are worried about their breathing.
Severe signs of blockage include the inability to breathe, coughing without making a sound, inability to speak, or the universal choking sign of holding the neck with one or both hands.
Refer to Table 2 in the CPR manual for details on degrees of obstruction, signs of choking, and actions you should take to help children in choking situations.
This concludes our lesson on Choking in Children. Next, we will review Relief of Choking in Children
Video 6h: Relief of Choking in Children
Script: Welcome to the lesson on Relief of Choking in Children. In this video, we will discuss the steps of the Heimlich maneuver.
To relieve a child who is choking, first, ask them if they are choking and tell them that you will help.
Stand behind the child and wrap your arms around their body right below the rib cage.
Make a fist with one hand and place it just above the navel.
Grab the fist with your other hand and deliver quick upward thrusts.
Continue performing thrusts until the obstruction comes out and breathing is possible, coughing or speaking is restored, or until the child stops responding.
Watch and feel for breathing to begin. If the child does not respond or begin breathing, then lay them down and yell for help. Begin CPR and continue it until additional help arrives. After 30 compressions, open the airway and look for a foreign object.
If you can see a foreign object in the child’s mouth and can easily remove it, then do so. Avoid blindly sweeping the mouth with a finger as it may push the object deeper into the airway. Continue CPR until the child recovers or until more advanced help arrives.
Large children may require chest thrusts if you cannot wrap your arms fully around their waist. In this case, perform the Heimlich maneuver with your fist on the breastbone.
Any child who has had a severe choking event should see a health care professional.
This concludes our lesson on Relief of Choking for Children. Next, we will look at introduction to Infant CPR.
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