7.2 Pediatric and Infant T-CPR: Technique Variations & Rescue Breathing
Key Takeaways
Respiratory failure or shock commonly precedes pediatric cardiac arrest, so CPR with breaths is especially important when the rescuer can provide them.
For CPR without an advanced airway, the AHA pediatric ratio is 30:2 for one rescuer and 15:2 for two healthcare rescuers. Compression-only CPR is appropriate when a lay rescuer cannot or will not give breaths.
For a child from about age 1 to puberty, use one or two hands on the lower half of the sternum, at 100–120 compressions per minute and at least one-third chest depth, approximately 5 cm.
AHA 2025 infant CPR uses the heel of one hand or the two-thumb encircling-hands technique on the sternum, at least one-third chest depth, approximately 4 cm; the two-finger technique is no longer recommended.
Pediatric and Infant CPR: 2025 Guideline Overview
Scope: This section summarizes the 2025 AHA/AAP pediatric BLS guidelines for learning. It does not claim to reproduce the current MPDS telephone script. EMDs must use their agency's licensed instructions and medical direction. Newborn resuscitation immediately after birth is a separate clinical pathway.
Why breaths matter
Respiratory failure or shock often precedes cardiac arrest in infants and children. CPR with breaths improves pediatric outcomes compared with compressions alone. If a lay rescuer is unable or unwilling to provide breaths, compression-only CPR is still reasonable; do not imply that compressions have no benefit.
Compression technique
| Patient | Hand technique | Depth |
|---|---|---|
| Infant, under approximately 1 year | Heel of one hand or two-thumb encircling-hands technique on the sternum | At least one-third the chest's front-to-back depth, about 4 cm / 1.5 inches |
| Child, approximately 1 year to puberty | One or two hands on the lower half of the sternum | At least one-third chest depth, about 5 cm / 2 inches |
For both age groups, aim for 100–120 compressions per minute, allow full recoil, and minimize interruptions. The 2025 update eliminated two-finger infant compressions because of inadequate achieved depth. If the rescuer cannot encircle the infant's chest, use the heel of one hand. The two-thumb technique is not limited to a two-rescuer situation.
Coordinate compressions and breaths
Without an advanced airway, one rescuer uses 30 compressions to 2 breaths; two healthcare rescuers use 15:2. These ratios do not describe rescue breathing for a patient who still has a pulse or CPR with an advanced airway.
Open the airway with a head tilt–chin lift unless suspected cervical injury calls for the trained rescuer's spinal-injury approach. Use sufficient air to produce visible chest rise and avoid excessive ventilation. Do not teach a fixed cheek-puff volume or claim that a particular head angle always blocks the infant's trachea. Actual telephone coaching must follow the authorized dispatch instructions.
Attach an AED as soon as available, using pediatric attenuation and pads when available. Follow its prompts and resume compressions promptly after analysis or a shock.
Source: AHA/AAP 2025 pediatric BLS, sections 6–7. For operational oversight, see IAED principles of medical control.
Why are breaths especially important during CPR for infants and children?
Air delivered to the lungs travels directly into the coronary vessels
Breaths unlock a diaphragm spasm present in every arrest
Pediatric arrests are usually spontaneous ventricular fibrillation
Respiratory failure or shock often precedes pediatric arrest, so ventilation helps correct the oxygen deficit
Which infant chest-compression technique is included in the 2025 AHA/AAP guidelines?
The heel of one hand or the two-thumb encircling-hands technique
Two fingers as the required single-rescuer technique
A fist over the abdomen
Two thumbs restricted exclusively to situations with two rescuers
Which compression technique and depth are appropriate for a child from approximately age 1 to puberty?
Two fingers on the upper sternum, 3 inches deep
One or two hands on the lower half of the sternum, at least one-third chest depth, approximately 5 cm
Both palms on the lower ribs, 1 inch deep
The heel of one hand on the abdomen
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