Rescue Breaths for Child: Pediatric BLS Algorithm Guide

Basic Life Support (BLS) is critical for rescuers to understand, including how to provide rescue breaths for a child. The difference in anatomy and risks faced by a child are different than adults. Knowing the specific best practices for pediatric BLS can make an incredible difference in protecting the life of a child.

The First Step: Knowing How to Provide Rescue Breaths for Child

As a rescuer, it is critical to know what to do and what order to do so in order to provide a child with the life-saving support they need. Consider the following strategies:

Initial Support

• Ensure the scene is safe. Protecting yourself is always the first priority.
• Call for help nearby.
• Activate any available emergency response system, such as using a mobile phone to dispatch emergency care, following facility protocol, or other required first steps based on location.

In situations where a child falls to the ground and stops responding, and you see that happen, call for an emergency response first and then get an AED to use prior to providing CPR.

If you did not see what occurred and just found the child on the ground, provide CPR for 2 minutes. Then, leave the child and call for emergency response.

In either situation, obtain an AED or other available emergency equipment or send someone else to get it. Then, assess the child for breathing and pulse.

Depending on what you find, consider the following strategies.

• Normal Breathing and a Pulse: In this situation, you can definitely feel the heartbeat and see the chest rising and falling. Monitor those circumstances until more help arrives.
• No Breathing with a Pulse: If the child is not breathing or is only gasping for air, complete the following steps: 
  • Provide rescue breathing immediately, apply breath every 2 to 3 seconds, resulting in between 20 and 30 breaths a minute.
  • If the pulse is less than 60 beats per minute, but there is poor perfusion of oxygen, start chest compressions at that time. This includes cool extremities, lack of responsiveness, weak pulse, mottling, cyanosis, or paleness.
  • If the pulse is over 60 beats per minute, recheck the pulse every 2 minutes. If that changes to no pulse, follow the steps to provide pediatric CPR.
  • After two minutes, activate emergency response if not doing so.
  • In some situations of abnormal breathing like this, the child may have suffered an opioid overdose. If there is potential for this, consider the use of naloxone and then follow an opioid overdose protocol.
• No Breathing and No Pulse: If the child is not breathing and there is no detectable pulse, follow these steps: 
  • Alone: If you are alone, start by providing high-quality cardiopulmonary resuscitation at a rate of 30 compressions to 2 breaths.
  • Not alone: If you are not alone, start CPR at a rate of 15 compressions per 2 breaths, splitting the task with the other person.
  • 2 minutes: Every two minutes, check the pulse and heartbeat. Then, switch out who is engaging in the compressors.
  • Use AED: Once an AED is available, follow the prompts provided by the device. If there is a shockable rhythm, defibrillate and then restart CPR. If there is not a shockable rhythm, resume CPR for 2 additional minutes and then reassess.

What Is High-Quality CPR for Children?

High-quality CPR can significantly improve a child’s ability to survive a wide range of conditions with the least defects. Studies reported in the National Library of Medicine indicate the quality of CPR can enhance outcomes for all patients. When providing rescue breaths for child patients, it is critical to provide the highest accuracy of care. Consider the following strategies to provide high-quality CPR when providing rescue breaths for child with pulse or without a pulse.

• Chest recoil: Enable the chest to completely recoil after each compression before attempting another
• Compression rate: Aim for 100 to 200 per minute when there is no pulse detected
• Compression to ventilation: Aim for a ratio of 30:2 for a single rescuer, or 30 compressions for two breaths, or a rate of 15:2 if more than one rescuer is present
• Continuous compressions: In situations where there is an advanced airway present and asynchronous ventilation, provide continuous compressions.
• Rotate: Rotate out the compressor every two minutes or in any situation where one is fatigued.
• Limit interruptions: Ideally, there should be no interruptions in compressions that are more than 10 seconds.
• Avoid excessive ventilation: This can cause additional difficulties for patients and limit the overall success of compressions.

Compression Rates in Infants Under the Age of 1

Children who are very young or very small may require different support to help them start breathing properly. To provide rescue breaths for child care at this age, for any child that is under one year old, excluding newborns, follow these specific steps:

• Use the brachial artery to check for a pulse.
• Compression landmarks are different. The lower third of the sternum between the nipples is ideal.
• Compression methods are also different. Use two fingers if alone or a thumb-encircling method if multiple providers are present.
• Depth of compressions is also much smaller. Aim for at least one-third AP chest diameter. This is about 1.5 inches in most children.

Establishing an Airway

To be successful with rescue breaths for child patients, it is critical to establish an airway and ensure the child has the ability to breathe from a structural standpoint. To do this in a child, follow these steps:

• Infants under the age of 1: Sniffing position.
• Children over the age of 1: Head tilted and chin lifted position.
• Trauma situations: If there is any suspected trauma to the child’s head or neck, limit any neck movement possible. Use the jaw thrust process without head tilt to provide care.

Breathing in Children

To provide rescue breaths for child patients, follow these guidelines:

• Rescue breathing or compressions to ventilation: If there is 1 rescuer, a 30:2 ratio. If there are multiple rescuers: 15:2
• Ventilation with advanced airway: In situations where there is a supraglottic airway or endotracheal tube present, follow these steps. Deliver one breath every 2 to 3 seconds, resulting in 20 to 30 breaths per minute. Use waveform capnography or capnometry whenever possible.
• Notice the child’s chest: Ensure there is a rise in the child’s chest for each breath.

How and When to Defibrillate a Child for Rescue Breaths for Child

Rescuing breaths should always focus on the very best tools and resources available, and an AED may be applicable in many situations. However, there are specific guidelines to follow when attempting to use an AED on a child.

• Use it now: As soon as the AED is available and the child does not have a pulse, use it to restore a heartbeat.
• Dose attenuator and pads: Whenever possible, if a child is under the age of 8, use pediatric pads, especially in infants. However, if pediatric pads are not available, use adult pads (do not forgo applying AED treatment if the patient needs it)
• Manual defibrillator: In infants, it is best to use manual defibrillators. This applies to children under the age of 1.
• Adult defibrillators: These devices are not endorsed by most AED devices for use on a patient that has a shockable rhythm; however, doing so can provide life-saving support when there is a need to take immediate action. (It is critical for rescuers to know that it is not uncommon for infants to express VT and VF. This is not uncommon in infants.)
• After Shock: After shocking the child, immediately begin CPR. Do this after each shock provided to the child. Provide CPR for at least two minutes before attempting another shock.
• Limit interruptions: Avoid any type of interruption in chest compressions. This includes both before and after the shock occurs.

Rescue Breaths for Child with Pulse

In situations where the child has a pulse but is not breathing, there are several specific steps rescuers must take. Rescue breaths for a child should not be delayed. In these situations, follow this guidance:

• Provide 1 breath every 2 to 3 seconds, resulting in 20 to 30 breaths per minute
• With a pulse that is under 60 beats per minute, with signs of poor perfusion, start chest compressions at the same time.
• If there is a pulse that is over 60 beats per minute, continue to check that pulse every 2 minutes while providing breaths every 2 to 3 seconds.

How Many Rescue Breaths for a Child?

In the ideal situation, you should provide:

• 1 breath for every 2 to 3 seconds.
• Assess pulse rate no longer than 10 seconds.
• Aim for 20 to 30 breaths each minute.
• Apply chest compressions if the child does not have a heart rate of 60 beats per minute or higher.

Know the Signs of Cardiac Arrest in Children

It is not as uncommon as many expect for a child to enter into cardiac arrest, warranting the need for rescue breaths for child patients. The Children’s Hospital of Philadelphia notes that over 2,000 children die each year from sudden cardiac arrest. That is about 3 to 5 percent of all deaths in children between the ages of 5 and 19 years of age.

The key to saving a child’s life is acting quickly. Knowing the signs of cardiac arrest in a child is a first step. They include:

• Increasing chest pain when exercising, including running, playing, or otherwise engaged in activities
• A racing heart
• Fainting or a dizzy spell after engaging in physical activity
• Change in ability to exercise
• Shortness of breath during exercise that seems excessive or new
• Excessive fatigue when exercising

In these situations, a child needs support immediately. In situations where a child’s heart stops, brain damage can begin to occur within just a few minutes since there is no oxygen flow to the brain. However, the use of proper rescue breaths for child victims can significantly increase their chance of survival especially when those incidents occur out of a hospital. By acting quickly, rescuers can save a child’s life.

Common Causes of Respiratory and Cardiac Failure in Children

Numerous factors can cause a child to stop breathing or their heart to stop beating. Every situation in which there is no pulse and no breathing requires immediate rescue care for the child. Some of the most common causes of this in children include:

• Chocking on food, toys, or other items
• Head trauma or another serious injury
• Drowning, including not obvious drowning incidents, such as incidents when the child seems fine initially
• Excessive bleeding
• Suffocation
• Poisoning
• Electrical shock
• Lung disease
• Undiagnosed or untreated heart conditions

How to Learn to Provide Rescue Breaths for Child Victims

There are various ways to learn to provide basic life support to pediatric patients. Taking action to immediately care for a person at risk is critical. With advanced training and certification, you gain the ability to react quickly, potentially preserving the child’s life in doing so.

To achieve this, explore the Pediatric Advanced Life Support (PALS) courses offered at Advanced Medical Certification. When you do, you will learn exactly what to do, when to do so, and how to support your patient as you provide them with the specific care they need.

With PALS certification, you will learn a wide range of critical tools and methods to provide care for victims. This includes:

• What PALS is and when to use it
• How to perform PALS Basic Life Support
• Pediatric Advanced Life Support Strategies
• How to use resuscitation tools
• What to do when there is respiratory distress or failure
• How to handle various heart rhythms such as bradycardia and tachycardia
• How to handle shock and cardiac arrest

With support and guidance for all aspects of pediatric care, you can be confident in your ability to meet the needs of a child in an emergency situation.

Who Should Take a PALS Certification?

Anyone who wants to be able to provide a child with emergency care should consider the value of PALS certification. That could include:

• Licensed medical professionals, especially those who provide care to pediatric patients
• Family members of children with noted concerns
• Community members that engage with children frequently, such as teachers and coaches
• Any provider of childcare, including grandparents, professional childcare providers, and friends and family

Mastering the PALS algorithm enables children to receive the very best care possible in some of the worst conditions. If you have not done so, enroll in PALS certification. You can complete our BLS online certification now to get started, or you can renew your PALS certification if you already have one. To find the care you need, turn to Advanced Medical Certification for Guidance.