5.2 Infant Compression Techniques: 2025 Methods & Ratios

5.2 Infant Compression Techniques: 2025 Methods & Ratios

The 2025 AHA/American Academy of Pediatrics Pediatric Basic Life Support Guidelines made a major practical change: the two-finger infant chest-compression technique was eliminated. The current recommended techniques are the heel-of-one-hand technique and the two-thumb-encircling-hands technique. This update applies to infant CPR, not only to a particular rescuer count.

Core infant CPR quality targets

For an infant younger than 1 year, excluding a newly born infant in the delivery setting:

Place the infant supine on a firm, flat surface. Expose the chest enough to identify the lower half of the sternum, and avoid the xiphoid process and upper abdomen. Deliver force vertically and allow full recoil without losing the landmark.

Heel-of-one-hand technique

Place the heel of one hand on the lower half of the sternum. Keep the hand centered and the force perpendicular to the chest. Use controlled pressure to reach at least one-third of the chest's anterior-posterior diameter, then release completely.

The rescuer must match the technique to the infant's size and their own hand size. The objective is not to copy adult two-hand positioning; it is to use the heel of one hand while maintaining the infant landmark, depth, rate, and recoil. Real-time feedback during training helps confirm that compressions are deep enough without drifting onto the ribs or abdomen.

Two-thumb-encircling-hands technique

Encircle the infant's chest with both hands, place both thumbs together on the lower half of the sternum, and support the back with the fingers. Press with the thumbs to the required depth, then allow full recoil. If the rescuer cannot physically encircle the chest, the heel-of-one-hand method is the appropriate alternative.

The two-thumb method provides a stable landmark and can help rescuers deliver consistent depth. In a multirescuer setting, it also allows one rescuer to remain at the chest while the second manages the airway and breaths. The ratio is still determined by the number of healthcare rescuers: 15:2 for 2 or more rescuers without an advanced airway.

Why the two-finger technique is no longer taught

The 2025 pediatric guideline reports that two-finger compressions were ineffective at consistently achieving appropriate depth. The guideline now recommends the heel-of-one-hand or two-thumb-encircling-hands technique and specifically states that the two-finger method was eliminated.

This creates an important study rule:

Do not confuse CPR compressions with choking chest thrusts. The 2025 infant foreign-body airway obstruction sequence also changed, and its chest thrusts use the heel of one hand. Choking thrusts are delivered as 5 distinct thrusts in an obstruction-relief cycle; CPR compressions are delivered continuously at 100-120/min in the appropriate compression-to-ventilation ratio.

Ratios and rescuer transitions

A single healthcare rescuer uses 30:2 when no advanced airway is in place. When a second healthcare rescuer joins, change to 15:2. The compressor and airway rescuer should coordinate aloud so 2 breaths occur promptly after the compression count and compressions restart without delay.

Switch the compressor about every 2 minutes when enough rescuers are available, or sooner if the compressor cannot maintain quality. Plan the change near a rhythm analysis or scheduled pause so the handoff does not create an extra interruption.

If an advanced airway is placed by an appropriately trained team, the ratio stops: compressions continue at 100-120/min and pediatric breaths are delivered every 2-3 seconds without pausing compressions.

When to start compressions

Healthcare professionals check an infant's brachial or femoral pulse while assessing breathing, taking no more than 10 seconds. Start CPR when no definite pulse is felt. Also start CPR when the heart rate is below 60/min with signs of poor perfusion despite oxygenation and ventilation. A weak but definite pulse above that threshold with absent or inadequate breathing calls for rescue breaths and reassessment, not automatic compressions.

Skills-test self-check

Before beginning a cycle, confirm five points: firm surface, correct lower-sternum landmark, a current 2025 hand technique, correct ratio, and visible chest rise with breaths. During compressions, keep the rate in range, reach the target depth, release fully, and avoid pauses. Those observable behaviors matter more than reciting the rule.