Resuscitation in children

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

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As with adults, resuscitation in children includes chest compressions and resuscitation. If carried out in good time, it can save the life of the child in the event of a respiratory or circulatory arrest! Find out here how to proceed with resuscitation of children and the differences between resuscitation in adults!

Brief overview

• Procedure: Check whether the child is reacting and breathing, make an emergency call. If the pulse and breathing are absent, perform chest compressions and resuscitation until the ambulance arrives or the child is breathing alone again.
• Special features: The frequency of chest compressions should be slightly higher for children (120 / min) than for adults (100 / min). In addition, experienced helpers are recommended a 15: 2 cycle (15 chest compressions and 2 alternating breaths) instead of the 30: 2 cycle used in adults. In babies, only two fingers are used for chest compressions. In babies and small children, breath is donated through the mouth and nose at the same time.
• Risks: Chest compressions can break ribs and injure internal organs.

Caution!

• Objects that are swallowed are often the reason why children can no longer breathe. Check your mouth and throat to see if you can see anything.
• Never shake an unconscious / non-breathing child, especially a baby! You could seriously injure it by doing so.
• To clear the airways, do not overstretch the child's head too far or, in the case of babies, not at all, otherwise the airways will narrow.
• Alert the emergency services as soon as possible!

How does resuscitation work in the child?

If a child loses consciousness and is not breathing properly or at all, you must start resuscitation (cardiopulmonary resuscitation) immediately! It is normal for you to feel nervous or almost panic about this. But remember: It is better to risk a resuscitation mistake (perhaps out of panic) than to do nothing at all!

Resuscitation: baby

With "baby" or "infant" we mean children up to the end of the first year of life. For resuscitation, proceed as follows:

1. Check reaction: Check whether the baby is reacting, preferably with a slight pain stimulus. For example, you can gently pinch the baby's inside of the upper arm.
2. Supine position: Lay the baby flat on its back, preferably on a hard surface (such as the floor).
3. Head in neutral position: Bring the baby's head into a normal, i.e. neutral position (do not overstretch!).
4. Check breathing: Hold the baby's chin with two fingers. Then, with the airway open, place your ear over the baby's mouth and nose so that you can hear any breathing sounds. While listening, direct your gaze to the child's chest in order to recognize any breathing movements.
5. 5 x respiratory donation at the beginning: If the baby is not breathing or breathing properly or you are unsure about it, you should ventilate it immediately, through your mouth and nose at the same time: Start with five breaths.
6. 15 x chest compressions: After the five breaths, place two fingers in the middle of the baby's sternum and press them down, but no deeper than 2 to 4 centimeters. Repeat this 15 times at a frequency of about 120 per minute (to do this, press on the baby's sternum about twice per second). So it is recommended for experienced helpers. Untrained helpers who are only familiar with resuscitation of adults can, under certain circumstances, also perform chest compressions 30 times, as is recommended for adults.
7. Alternating respiratory donation and chest compressions: Donate breath twice more before doing another chest compressions (experienced helpers: 15 times; untrained helpers possibly 30 times). Continue this 15: 2 cycle (or 30: 2 cycle) until either the emergency doctor arrives or the baby is breathing again on its own. In the second case, if they are still unconscious, put them on their side if they are still unconscious.

The emergency doctor should be alerted as quickly as possible! Ask someone present to call 911 while you begin the baby's resuscitation. If you are alone with the child, call emergency services after resuscitating the baby for about a minute. Immediately resuscitate after the call.

Resuscitation: child (from one year)

Cardiopulmonary resuscitation (chest compressions and ventilation) in children from one year of age is similar:

• Open airways and check breathing: Do this as you would with babies. However, if you are a child over the age of one, you can stretch your head very slightly.
• 5 x respiratory donation at the beginning: start ventilation (as with babies) with five breaths. Use the mouth and nose at the same time for small children and mouth or nose for older children.
• 15 x chest compressions: Perform chest compressions 15 times (as an untrained helper, possibly 30 times) by pressing rhythmically with the ball of your hand on the center of the child's chest. As with babies, a frequency of about 120 per minute is recommended, i.e. about twice per second.
• Alternating respiratory donation and chest compressions: alternate between resuscitation and chest compressions. Experienced helpers, like medical staff, should adhere to the 15: 2 cycle (15 chest compressions and 2 alternating breaths). Untrained helpers can also use the 30: 2 cycle known from adult resuscitation. Do not stop resuscitation until the ambulance arrives or the child begins to breathe again. In the second case, you should place the child on their side if they are still unconscious.

The 15: 2 cycle (15 chest compressions alternating with twice ventilation) is recommended as a priority for resuscitation of children. If a helper, out of ignorance or inexperience, instead uses the 30: 2 cycle recommended for adults, that is still better than not resuscitating the little patient at all!

When do I do resuscitation in children?

As with adults, you need to resuscitate a child if they are unconscious and are not breathing (adequately). In children, the reason for this is usually impaired breathing, for example because a swallowed object is blocking the windpipe. Therefore, the resuscitation of the child begins with the respiratory donation before doing chest compressions.

In adults, on the other hand, the heart is more often responsible for respiratory and circulatory arrest as well as unconsciousness. Therefore, you start the resuscitation with chest compressions (followed by ventilation).

Risks of resuscitation in children

Chest compressions can break some of the child's ribs and even injure internal organs. But remember: the consequences of being too hesitant or not resuscitating at all are worse than injuries you might inflict on the child from pressure on the chest. Therefore, do not be afraid to resuscitate children in an emergency!

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