4.2 Child High-Quality CPR: Rate, Depth & Ratios

4.2 Child High-Quality CPR: Rate, Depth & Ratios

Child CPR uses the same rate and quality principles as adult CPR, but depth is based on chest size and the compression-to-ventilation ratio changes when a second healthcare rescuer is present.

Position and hand placement

Place the child supine on a firm, flat surface. Position the heel of one hand on the lower half of the sternum. Use either one hand or two hands depending on the child's size and the rescuer's ability to produce adequate depth with control.

For a smaller child, one hand may be sufficient. For a larger child, place the second hand on top as in adult CPR. Keep pressure off the ribs and xiphoid process. Align the shoulders above the hands and compress vertically.

Hand count is not the quality endpoint. The correct technique is the one that consistently reaches the target depth while avoiding excessive force.

Rate, depth, recoil, and interruptions

The child high-quality CPR targets are:

• Rate: 100-120 compressions per minute.
• Depth: at least one-third the anterior-posterior diameter of the chest, approximately 2 inches (5 cm).
• Recoil: release all pressure after each compression.
• Interruptions: keep pauses under 10 seconds.
• Ventilation: give each breath over about 1 second with visible chest rise.

Avoid leaning on the chest. Do not compress so deeply that technique becomes uncontrolled. If a feedback device is available, use it and adjust promptly to its rate, depth, or recoil prompts.

One-rescuer ratio: 30:2

A lone healthcare provider gives 30 compressions followed by 2 breaths. Open the airway, deliver the 2 breaths within a pause of less than 10 seconds, and resume compressions immediately.

If alone with an unwitnessed collapse and no phone, provide about 2 minutes of CPR before leaving to activate emergency response and obtain an AED. If the collapse was sudden and witnessed, activate and obtain the AED first. A phone on speaker allows activation without leaving.

Two-rescuer ratio: 15:2

When 2 or more healthcare rescuers are present, use 15 compressions to 2 breaths. One rescuer compresses while the other manages the airway and breaths. This provides more frequent ventilation for a patient whose arrest may have followed respiratory failure.

The rescuers switch compressor roles about every 2 minutes or sooner if quality declines. Plan the switch during AED analysis and finish it in under 10 seconds. Use closed-loop communication so the compressor knows when the airway rescuer is ready for the next two breaths.

Advanced-airway pattern

If an advanced airway is in place, give continuous compressions at 100-120/min without pausing for breaths. Deliver 1 breath every 2-3 seconds for an infant or child. The ventilation rescuer times breaths independently and watches for visible chest rise.

BLS providers should not create a long compression pause for advanced-airway placement. Support the higher-level provider while preserving compressions and AED timing.

AED integration

Apply the AED as soon as it is available. Use pediatric pads and attenuation for a child younger than 8 years when available, but use an adult AED if pediatric capability is not available. Place pads so they do not touch, clear everyone for analysis and shock, and resume CPR immediately afterward.

Common errors

• Automatically using one hand even when depth is inadequate.
• Using two hands with so much force that depth is excessive.
• Changing to 15:2 when the second person is a lay rescuer who is not participating as a healthcare-provider team.
• Giving shallow compressions to avoid injury.
• Omitting breaths.
• Pausing more than 10 seconds for ventilation or role changes.

On the exam, first identify the patient as a child and count the healthcare rescuers. Then apply the correct ratio while preserving rate, one-third depth, complete recoil, and effective breaths.

Skill rehearsal

Practice on child manikins of different sizes. Begin with one hand, check the feedback, and add the second hand when needed to reach one-third chest depth with control. Alternate a 30:2 one-rescuer round with a 15:2 two-rescuer round, keeping every ventilation pause under 10 seconds. The exercise should show that hand choice follows size and performance, while the measurable targets and the rescuer-count rule determine whether care is high quality.

Repeat until the ratio changes without any loss of compression depth or recoil.