Paediatric Basic Life Support
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Direct answer
Paediatric basic life support is the immediate care of an unresponsive child who is not breathing normally, built on early compressions, ventilation and defibrillation. Compressions are given at 100 to 120 per minute to a depth of at least one-third of the chest's anteroposterior diameter. The ratio is 30:2 for a single rescuer and 15:2 for two trained rescuers.
What you must remember
- Age definitions: an infant is under one year, a child is from one year up to puberty, and an adult is from puberty onwards.
- Sequence: compressions, airway and breathing (CAB) for most children, while ABC is preferred for drowning and respiratory arrest.
- Compression depth: at least one-third of the anteroposterior chest diameter, about 4 cm in infants and 5 cm in children.
- Compression rate: 100 to 120 per minute, with full chest recoil between compressions.
- Ratios: 30:2 for one rescuer and 15:2 for two rescuers, for both infants and children.
- Pulse check: brachial in infants and carotid or femoral in children, lasting no longer than about ten seconds.
- Technique: two-thumb encircling hand position for infants with two rescuers, and heel of one hand for children.
- Defibrillation: use paediatric attenuator pads or a manual defibrillator for young children when available, otherwise adult pads.
A stepwise CAB sequence
The sequence is the same for every rescuer, and the steps are repeated in cycles. Early compressions are the priority because the chance of survival falls with each minute of delay.
- Check safety and response: confirm the scene is safe, shake and shout gently, and call for help or the emergency response system.
- Open the airway: use a head tilt and chin lift in children without suspected spinal injury, and check for normal breathing for no more than about ten seconds.
- Start compressions: give 30 compressions for one rescuer, or 15 for two rescuers, at the rate and depth set for the child's age.
- Give rescue breaths: each breath lasts about one second and should produce visible chest rise, using a bag-mask device when it is available.
- Attach the defibrillator: apply paediatric pads or use a manual defibrillator in infants, and follow the device prompts.
- Continue cycles: resume compressions straight after each shock or breath, and change rescuers about every two minutes to avoid fatigue.
Where the exam tries to catch you
Questions on this topic usually test the ratio, depth and the difference between children and adults.
- Trap: using the adult 30:2 ratio for a child when two rescuers are present Correct: two-rescuer paediatric basic life support uses 15:2.
- Trap: compressing to a fixed depth of 5 cm for every child Correct: depth is one-third of the chest's anteroposterior diameter, about 4 cm in infants and 5 cm in older children.
- Trap: spending up to a minute checking the pulse before starting compressions Correct: the pulse check lasts no longer than about ten seconds, and compressions start when no pulse is definitely felt.
- Trap: starting with breaths in a child with cardiac arrest Correct: CAB is used for most children, while ventilation first is reserved for drowning and primary respiratory arrest.
Frequently asked questions
What compression depth is recommended in paediatric basic life support?
The recommended compression depth in paediatric basic life support is at least one-third of the anteroposterior diameter of the chest, about 4 cm in infants and 5 cm in children. Compressions are given at 100 to 120 per minute, allowing full recoil between each one.
What is the compression to ventilation ratio for a child with two rescuers?
The compression to ventilation ratio for a child with two rescuers is 15:2. A single rescuer gives 30:2 to both infants and children, so the number of rescuers changes the ratio.
Where should the pulse be checked in an infant during basic life support?
The pulse in an infant during basic life support is checked at the brachial artery, while in a child the carotid or femoral pulse is used. The check should take no longer than about ten seconds, and compressions start if a pulse is not definitely felt.
When is the ABC sequence used instead of CAB in paediatric resuscitation?
The ABC sequence, starting with airway and ventilation, is preferred for drowning and primary respiratory arrest, where hypoxia rather than a cardiac event is the main problem. Most other paediatric arrests follow the CAB sequence, which begins with compressions.