Stable lateral position for 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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The stable side position in children should ensure that the airways remain free and not blocked by a tongue that has fallen back when unconscious. Vomit and blood from internal injuries can also obstruct the trachea if an unconscious child is not brought into the stable side position. You can find out how to do this and what to watch out for here.

Brief overview

• What is the stable side position in children? A stable position of the body on its side to keep the airways clear.
• This is how the stable side position works with children: put the child's arm close to you at an angle, grab the other arm by the wrist and place it over the chest, grasp the thigh further away from you and bend the leg, pull the child into the side position.
• In what cases? In children who are unconscious but still breathe on their own.
• Risks: Damage such as broken bones or spinal injuries can worsen if the child is moved. In addition, in the stable side position, a possible interruption of breathing may only be noticed (too) late. Overstretching the head can narrow the airways, especially in infants and young children.

Caution!

• There have been two variants of the (stable) side position for a number of years. Both have advantages and disadvantages. There is no wrong, do what you have learned in the course and with which you feel (more) confident.
• You can also bring an unconscious baby or toddler into the prone position (instead of the stable side position) and turn his head to one side. Vomit and blood in the mouth can then also flow outwards.

How does the stable side position work with children?

When a child loses consciousness, their muscles relax and the protective reflexes come to a standstill. This allows the tongue to tip down into the throat and block the windpipe. Vomit, blood and saliva can also easily get into the airways and block them in an unconscious person. In the stable side position, however, the airways remain free.

There are two variants of the stable side position for children and adults. Since the new variant is less stable, but easier to learn and remember, it is presented here. You can read how the classic (old) variant works in the article Stable lateral position in adults.

To ensure that the handgrips are secure in an emergency, it is advisable to take a first aid course for children and to refresh their knowledge regularly.

Stable side position with the child (new version): Instructions

1. If the child is not already on their back, place them on their back.
2. Kneel to the side and place the child's arm, which is closest to you, at an angle and upwards, with the palm facing up.
3. Take the other arm by the wrist and place it over the child's chest. Place the hand of this arm on the little patient's cheek.
4. Grasp the thigh further away from you and bend the leg.
5. Grab the child by the shoulders and hips and roll them onto their side toward you.
6. Align the leg on top so that your hips and thighs form a right angle. You can also support babies in their backs with a blanket or pillow.
7. In children older than twelve months, slightly hyperextend the head to clear the airways. Position the hand on the child's cheek so that the neck remains slightly hyperextended. In infants (babies up to 12 months), overstretching the head can also narrow the airways. So leave the small head in a normal (neutral) position.
8. Open the child's mouth to allow fluids such as saliva to drain.
9. Check the child's pulse and breathing regularly until the emergency doctor arrives.

Special case: the prone position

An alternative to the stable side position for children in the first two years of life (infants and toddlers) is the prone position. This is how it works:

1. Place the baby or toddler on their stomach on a warm surface (e.g. blanket).
2. Turn the child's head sideways. With small children you can also tilt it very slightly backwards.
3. Open the child's mouth.
4. Check the child's breathing and pulse until the emergency services arrive.

When do I do the stable side position for children?

Put a child on their side if they are losing consciousness but are still breathing on their own. If there is no more breathing and / or no heartbeat, the stable side position is not required. You must then start resuscitation (chest compressions and resuscitation) immediately!

Risks of a stable lateral position in the child

In a study from 2017, scientists came to the conclusion that the stable side position (in children as in adults) can make it difficult to recognize irregular or intermittent breathing. This could delay immediate life-saving measures (cardiac pressure massage, mouth-to-mouth / mouth-to-nose resuscitation).

If you hyperextend an infant's head too much, the airways narrow. To be on the safe side, you should avoid overextending your baby.

In the event of broken bones or spinal injuries, the stable side position can cause additional damage to the child: Moving the child can make the injury worse.

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