BLS - Pediatric Resuscitation 

Updated: Mar 21, 2014
  • Author: James J Lamberg, DO; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Basic Life Support (BLS): Pediatric Algorithm

1. Check responsiveness; if none, follow steps below [1, 2, 3]

  • Activate emergency response system
  • Get automated external defibrillator (AED)

2. Check pulse for < 10 seconds; if no pulse, follow steps below

  • If alone, start high-quality cardiopulmonary resuscitation (CPR) at a compressions-to-breaths ratio of 30:2
  • If not alone, start high-quality CPR at a compressions-to-breaths ratio of 15:2
  • Every 2 minutes, check pulse, check rhythm, and switch compressors
  • In infants, start CPR if heart rate (HR) < 60 bpm and poor perfusion despite adequate oxygen and ventilation
  • High-quality CPR and changing rescuers every 2 minutes improves a victim’s chance of survival

3. Attach AED as soon as available (for child); if shockable rhythm, defibrillate and then immediately start CPR

Compressions in children aged 1 year to adolescence

  • Check pulse at carotid artery
  • Compression landmarks: lower half of sternum between the nipples
  • Compression method: heel of one hand, other hand on top if needed
  • Depth: At least one-third anteroposterior (AP) chest diameter
  • Depth: At least 2 inches (5 cm)
  • Allow complete chest recoil after each compression
  • Compression rate: At least 100/min
  • Compressions-to-ventilations ratio: 30:2 if single rescuer, 15:2 if multiple rescuers
  • Continuous compressions if advanced airway present
  • Rotate compressor every 2 minutes
  • Minimize interruptions in compressions to < 10 seconds
  • Avoid excessive ventilation

Compressions in infants (< 1 year)

See the list below:

  • Check pulse at brachial artery
  • Compression landmarks: Lower half of sternum between the nipples
  • Compression method: Two fingers or thumb-encircling if multiple providers
  • Depth: At least one-third AP chest diameter
  • Depth: At least 1.5 inches (4 cm)
  • Allow complete chest recoil after each compression
  • Compression rate: At least 100/min
  • Compressions-to-ventilations ratio: 30:2 if single rescuer, 15:2 if multiple rescuers
  • Continuous compressions if advanced airway present
  • Rotate compressor every 2 minutes
  • Minimize interruptions in compressions to < 10 seconds
  • Avoid excessive ventilation

Airway

See the list below:

  • Children: Head tilted, chin lifted
  • Infants: Sniffing position
  • Jaw thrust if trauma suspected (children and infants)

Breathing

See the list below:

  • Ventilation with advanced airway every 6-8 seconds asynchronous with compressions
  • Rescue breathing every 3-5 seconds
  • Deliver at about 1 second/breath
  • Watch for visible chest rise

Defibrillation

See the list below:

  • In children, attach and use AED as soon as available
  • In infants, there are currently no defibrillation recommendations
  • Minimize interruptions in chest compressions before and after shock
  • Resume CPR beginning with compressions immediately after each shock
  • In children, use dose attenuator, if available; otherwise, adult pads may be used