This post is to address choking and unresponsiveness in CHILDREN 1 YEAR AND UP only. If your infant is unresponsive or you need instruction to relieve choking in infants, please review Infant CPR and Choking.
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Basic Life Support Terms for Children
These types of posts are the most important ones I will ever write.
I choose to write posts like these (Infant CPR/Choking & Child CPR/Choking) because it is so important that we have the necessary skills for our kids thrive in a safe and healthy environment. That means being prepared for the worst.
You can do your best to read up on how to install your carseat properly and learn what shouldn’t be allowed with the carseat (aftermarket pillows/strap covers/body supports/seat protectors), how to properly check your baby’s temperature in event of a fever, feeding organic whenever possible, using eco-friendly products, fully vaccinate them so they are equipped with the best possible immune system to ward off threatening illnesses, or even buy the coolest stroller with all the bells and whistles. But what’s most important? Keeping them alive.
None of the other great things you have done for your child will flash before your eyes when your child stops breathing. When your child is turning pale and won’t seem to respond to your voice.
What WILL flash before your eyes? Your child’s short and happy life. Panic will spread over you.
The sheer thought of their little lives escaping yours is truly terrifying and horrifying.
We become panicked because we don’t know what to do next.
So as a nurse, public health advocate, mom, carer of the community, I want you to have easy access to this vital information. If you take anything away from LittleSproutings.com, please let it be how to restart your child’s heart. Let it be how to help your child see the many years ahead. Life is too short, and little ones’ lives are just too precious to not know what to do in a scary situation.
After a 9-1-1 call, an ambulance may arrive on the scene between 5 and 30 minutes. It depends where you live, it depends what traffic is like, it depends on the operator hearing the necessary information to determine what you need, during a frantic and panicked call. Those 5 to 30 minutes are far too long for your child to lie there in front of you without life-saving help. Those minutes are VITAL.
Imagine going into your baby’s room in the morning and seeing them lying unresponsive in their crib.
**Knowing that waiting to dial 9-1-1 AFTER you give 2 minutes (5 cycles) of chest compressions and rescue breaths on this baby means the difference between surviving and not.**
Learn the steps below so you know what to do in immediate response, without delay.
Basic Child (Age 1 to Puberty) Life Support – Terms
Pulse Check: Carotid or Femoral sites after 2 minutes of chest compressions and breaths. Feel for the pulse for 10 seconds maximum. You don’t want to spend too long checking for a pulse. If it is there, you should feel it. If it’s not there and you spend a long time feeling for it, you’re wasting precious time from chest compressions.
- Femoral: Two fingers on the inner thigh midway between the hip bone and the pubic bone, just below the crease where the leg and abdomen meet (groin area).
- Carotid: About 2 inches below the jawbone on the neck
Compressions on Children 1 year and up:
Done with one hand on smaller children and 2 hands on bigger kids. This is NOT the chest encircling technique, this is the standard position of adult CPR but the depth for compressions is a little different. ***To make sure each compression is EFFECTIVE, make sure you are allowing the child’s chest to recoil/bounce back after each push. If you do not do this, the heart will not have enough time to re-fill in between compressions***
Compression Rate is 100 compressions/minute, which means 30 compressions and 2 breaths (if you are by yourself) or 15 compressions and then 2 breaths (if you have someone helping you). Do not interrupt compressions. It is so important to continue chest compressions for the full 2 minutes (aside from when 2 breaths are given each 15 or 30 compressions) to oxygenate the brain.
Stayin’ Alive by the BeeGees is the beat you should follow when giving compressions. Too fast can lead to an under-filled heart. Too slow means you’re not beating the heart quick enough to oxygenate the brain.
1-person Rescuer Technique: If you are alone, this means you are performing chest compressions and rescue breaths. If your child does not have a pulse or if the pulse is really slow or hard to feel, you will want to start chest compressions first. Using the technique shown in photo A and perform rescue breaths after each set of 30 compressions in a row. Continue this cycle of compressions and breaths for 5 times (about 2 minutes).
2-person Rescuer Technique: If you have someone helping you, always have them call 9-1-1 while you do what is necessary. Make sure they come back to you FAST. One person is in charge of chest compressions and the other person stays by the head to provide breaths after the count of 15 compressions is up. Continue for 5 total cycles, about 2 minutes before you take a moment to check if they have a pulse again.
Compression Depth: About 2 inches, which is approximately one-third of the depth of the chest from front to back. Remember after each compression, allow the chest to recoil. This means you want to allow your hand(s) to come up entirely after each push.
Rescue Breaths: Remember how Infant CPR required your mouth to cover the nose AND the mouth? Not anymore. (You can, of course, but you don’t have to) Pinch the nostrils closed with your thumb and fore/pointer finger on one hand, tilt the chin up with your 2nd and 3rd fingers with your other hand, and create a seal between your mouth and your child’s.
- Give regular (not deep) breaths for about 1 full second and check that the chest is rising in response.
- If you give a big deep breath or give breaths too fast, you could be filling their tummy with air instead of their lungs.
- If you didn’t see your child’s chest rise, repeat the head tilt/chin lift technique and try again.
- If no chest rise after 2 breaths, continue back to chest compressions
A Complete Cycle of Compressions and Breaths is approximately 2 minutes–> 5 complete cycles (compressions/breaths, compressions/breaths, compressions/breaths, compressions/breaths, compressions/breaths, pulse check). It may feel like an eternity in the real event, but it is very important.
If a Child is Found Unresponsive (No one witnessed it)
You first want to make sure that the child is unconscious, by tapping the child’s foot firmly asking loudly, “Are you awake? Can you hear me?” If they are gasping or breathing irregularly and unresponsive, make sure the child is lowered safely to the ground, away from any water on the ground, AND CHECK FOR A PULSE (10 seconds max)
- Check for a pulse for 10 seconds MAXIMUM.
- If there is a DEFINITE pulse, give the child rescue breaths and call 9-1-1.
- If there is NO PULSE or you’re not sure you feel one, continue with the next bullet point below.
- Chest Compressions & Breaths:
- If no one is with you, FIRST perform 30 chest compressions in a row (count out loud so you don’t lose track) and then give 2 rescue breaths. DO NOT CALL 9-1-1 YET! Repeat for a total of 5 times, about 2 minutes.
- If someone can help, have them first call 911 while you start chest compressions (30 and then 2 breaths) and have them on speaker phone. Make sure they return to help you.
- Once they return, instruct them to stay at the child’s head. They will be in charge of giving breaths after every 15 compressions you do.
- One person is near the child’s head and one person is near the chest. Perform 15 chest compressions in a row (since you have someone assisting you now), counting out loud. After 15 compressions, the other person should give two (2) effective rescue breaths making sure that the chest rises with each breath.
- Repeat for a TOTAL OF 5 ROUNDS of compressions + breaths.
- AFTER 5 cycles of compressions/breaths are complete, check the child’s femoral or carotid pulse for 10 seconds maximum.
- If were ARE ALONE, now is the time to call 9-1-1. Stay by the child and follow instructions. In the meantime, if there was NO PULSE, continue 5 more cycles of compressions and breaths.
- The 911 operator will help with the remainder of the call until emergency personnel arrive. During this time you will continue to repeat these cycles of compressions and breaths and pulse checks until the pulse returns.
*The reason why you start compressions and breaths for 2 minutes BEFORE calling 9-1-1 is because you do not know how long the child has been down and unresponsive. Since you don’t know how long it’s been since their heart was beating normally, the likelihood is great that their brain doesn’t have enough oxygen for you to make the call. Effective CPR is VERY VERY VERY VERY important to start immediately, to get the heart pumping oxygenated blood to the brain.
If a Child Becomes Unresponsive but Someone Witnessed it then and there:
Verify the child is unconscious by tapping them firmly on the foot or shoulder, yelling “Are you awake? Can you hear me?”If unarousable, call 9-1-1 immediately!!! Have the phone on speaker close to you, make sure the child is safely on the ground away from any water, and CHECK A PULSE FOR 10 SECONDS MAXIMUM. If no definite pulse, BEGIN CHEST COMPRESSIONS.
Follow the remainder of the instructions above, with 30 chest compressions then 2 breaths (if you are alone) or 15 chest compressions and 2 breaths (if someone is helping you).
*The reason why you do not delay calling 9-1-1 is because if the child just became unresponsive, it bought you a quick moment to call them. Their heart was working fine just a moment ago, to oxygenate their brain.
Relief of Choking in Children 1 year and older
Choking occurs when there is an object that blocks the child’s airway. If there’s a mild obstruction (you can see something in their mouth) that you can’t get out by sweeping their mouth with a finger and the toddler/child is able to cough (but it is a weak cough) and breathe but can’t cough forcefully enough to remove the object, call 911.
If the child is severely choking – they can’t breathe or make sounds, is turning blue, clutching their neck, unable to cry, is making a choking face but no sound or air is coming out, you will need to perform the heimlich.
Heimlich/Abdominal Thrusts:
- Stand or kneel behind your child (whichever is more appropriate for their size) and wrap your arms around them from behind.
- Find their belly button and with one clenched fist (thumb-side against their abdomen), place against their abdomen between the breastbone and belly button.
- Grasp your fist with your other hand and use steady but quick forceful thrusts in toward the abdomen with the intent of dislodging the object that is choking them.
- If the choking victim is too large to wrap your arms around their waist, overweight, or pregnant perform chest thrusts instead of abdominal thrusts.
- Continue doing this until the object is dislodged.
If the child becomes unresponsive during this (due to the object blocking the airway for too long), you will have to perform CPR*
*CPR is slightly different with choking since you know the cause is a respiratory incident – so you do not check for a pulse. Do the following:
- Begin chest compressions immediately. Do not attempt to give rescue breaths at this time.
- Continue 30 effective compressions in a row, count out loud so you don’t lose track.
- ALWAYS CHECK THE MOUTH FOR THE OBJECT BEFORE GIVING BREATHS. Open the child’s mouth and look to see if you can find the object. If you see an object, sweep inside the mouth with your fingers to remove it if it can be done easily. If you do NOT see the object, give 2 rescue breaths, while watching the chest to rise in response to your breaths.
- Repeat chest compressions. Continue this cycle for a total of 5 minutes.
- Check for a pulse for 10 seconds maximum.
- If there is a pulse, yay! See if the child is breathing OK. Have someone call 9-1-1 so the child can be seen following the incident.
- Check the mouth for object. Remove the object if you can.
- Note if there is a chest rise/respirations. If shallow or very slow breathing, give 2 breaths.
- Seek immediate follow up care with a physician to ensure the child is ok, especially after abdominal thrusts and chest compressions.
- If no pulse:
- If there is a pulse, yay! See if the child is breathing OK. Have someone call 9-1-1 so the child can be seen following the incident.
- Call 9-1-1.
Again, I really really REALLY hope you NEVER ever have to put these skills into practice and that you are only viewing this post to educate yourselves and NOT because you desperately need the information. If you have any specific questions about this post or the Infant CPR post, please comment below. That is the fastest way to get in touch with me about a particular post. Also, please leave a comment if you have ever had to put these skills into action and saved your little!
It is an absolutely terrifying circumstance to be faced with having to save your baby’s life.
Just realize that if YOU ACT FAST you can do much better than waiting for an ambulance to come. TIME IS TISSUE (brain, heart, lung)!!!!
Sources:
http://circ.ahajournals.org/content/122/18_suppl_3/S640.full
BLS for Healthcare Providers @ onlineaha.org
To find a CPR class near you, to become certified, visit: www.onlineAHA.org
Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. It is not intended on being used as a certification in Basic Life Support. All content, including text, graphics, images and information, contained on or available through littlesproutings.com is for general information purposes only. Little Sproutings makes no representation and assumes no responsibility for the accuracy of information contained on or available through this website, and such information is subject to change without notice. You are encouraged to confirm any information obtained from or through this website with the American Heart Association or the American Red Cross. This information is current at the time this post was published. LITTLE SPROUTINGS (AS WELL AS ITS AUTHOR) IS NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION THAT YOU OBTAIN THROUGH THIS WEBSITE. As a Registered Nurse and mom, I feel it is my duty to post information that can potentially save a little one’s life. My hope is that this information will help save babies’ lives when there is no healthcare personnel present.
Thank you to Chrystelle for helping with Jia’s CPR photos!