I figured after a few weeks of fun posts like diaper bags and baby goodies, I would publish one on a more serious note.

Recently, one of my friends from nursing school posted on Facebook about how she just performed the Heimlich maneuver on her choking toddler, who accidentally swallowed a screw. Now, Heather is a really attentive and caring mom (who is also an ICU nurse) so I figured well if this can happen to her, it can happen to anyone!

I myself am not sure I would be able to witness my baby choking or cardiac arrest without completely losing it, so I figured I would brush up on my infant CPR and guidelines in response to choking and share them on Little Sproutings. After all, my Basic Life Support (BLS) certification online training has expired, so I need to review it for work anyway. Plus, if anything, readers can familiarize themselves with an overview so they can try on their own if they are ever put in this scary position, instead of freak out and call 911, resulting in delayed treatment. 

So here goes… (the below information is what I have learned from onlineAHA.org through my own BLS certification)

Basic Infant (up to 12 months old) Life Support

CPR: Cardio-Pulmonary Resuscitation

Pulse Check for Baby: You check for a brachial pulse, above the elbow on the inside of their upper arm, with 2 fingers:

Sequence of Life Support: Compressions, Airway, Breathing

Chest Compressions: For infants, each compression should be 1.5 inches deep, to approximately the 2nd knuckle on your index finger. For every 15 compressions, give baby 2 breaths if you’re alone, 30 compressions then 2 breaths if you have someone to help. Compressions should continue for 2 minutes (at least 100 compressions per minute) or 5 cycles before checking for baby’s pulse. Your fingers (for compressions) should be at the center of the baby’s chest, just below the nipple line on the lower half of the breastbone. Compress to a steady beat, like in the chorus of the song “Stayin’ Alive,”  by the BeeGees,  which is not too fast or slow. 

Single Rescuer Compression Technique: 

2-Rescuer Compression Technique: (one person at baby’s head keeping airway open, one person with thumbs encircling rib cage):

Rescue Breaths: Tilt the baby’s chin up using one hand to lift the baby’s jaw so baby’s head is in the “sniffing” position (be sure not to hyperextend baby’s neck, because this can close off the airway) and the other fingers to tilt the chin up.  Place your mouth over baby’s nose and mouth to make a tight seal and give 2  breaths  lasting 1 second (not too fast or long) that make the chest rise. Do not give a big breath and do not over extend the baby’s neck. (Jia wasn’t a fan of demonstrating rescue breaths)

 

********* WHAT TO DO IF YOUR BABY BECOMES UNRESPONSIVE************

Do a quick check to see if baby is responsive and breathing. Tap their foot quickly to elicit a response. Check to see if baby is breathing. If not breathing and unresponsive, check for a pulse for ONLY 10 SECONDS. If s/he does not have a pulse or you can’t feel a pulse:

• If you witnessed baby go unresponsive: Have someone call 911.  Start chest compressions. If you are alone, call 911 immediately then return to baby to start compressions.
• If you did NOT witness baby go unresponsive and you are alone, begin compressions right away (for every 30 compressions give 2 breaths). Repeat for 2 minutes, then call 911. If someone was with you, have them call 911 while you start compressions.
• Begin CPR right away for 2 minutes. Every 15 compressions, give 2 breaths if someone is with you. If you are alone, give 30 compressions and then give 2 breaths.  Do this for 2 minutes (5 rounds of compressions and breaths) before re-checking for a pulse.
• Repeat this until you feel a pulse. Once you feel a pulse (yay!!) check to see if it’s more than 60 beats per minute. If not, continue chest compressions to make sure baby is getting enough blood flow.
• Hopefully you have 911 on the phone so the operator can help walk you through this, too!

Relief of Choking in Infants:

Choking occurs when there is an object closing the airway. If there’s a mild obstruction (you can see something in their mouth) that you can’t get out and the baby is able to cough and breathe but can’t cough forcefully enough to remove, call 911. If baby is severely choking – the baby can’t breathe or make sounds, is turning blue, unable to cry – you need to perform back slaps and chest thrusts. NEVER PERFORM THE HEIMLICH MANEUVER ON AN INFANT! They are too little and performing it can be fatal. 

1. Kneel or sit down in a chair
2. Hold baby face down with head slightly lower than her chest (like pictured below) with baby’s body resting on your forearm.
3. Support baby’s head and jaw with the same hand making sure you are not wrapping your fingers or resting your hand on their throat. Rest your arm on your thigh.
4. Deliver 5 back slaps between the baby’s shoulder blades with the heel part of your hand. 
5. Next, place your free forearm on the baby’s back and cradle her head with your hand. The baby will be held between both forearms. Rotate baby as a unit, so that she is on her back but her head is still supported with the other hand.
6. Perform 5 firm downward chest thrusts as pictured below, with your fingers on the lower half of the baby’s breastbone just below the nipple line (like chest compressions).
7. If this does not relieve choking, repeat the sequence of 5 back slaps and 5 more chest thrusts until relieved or baby is unresponsive (then place infant on flat surface, start CPR without checking for a pulse, and rescue breath sequence checking the mouth for the object for 2 minutes, then call 911 if you are alone. If someone is with you, have them call 911 immediately and then start CPR). You start CPR without a pulse check because you know choking was the reason for baby becoming unresponsive, not because of a heart problem.

Good luck and I hope you NEVER have to put these skills to practice!!!

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. 

No infants were harmed in the making of this or any post on Little Sproutings 🙂 

Next Week’s Topic: EV-D68 – The Respiratory Virus that is Causing a Stir