1. Check out the child
· Determine if the child responds (moves, grumbles).
· Nudge her gently or shake her shoulder while asking: “Are you ok?”
· Call for help.
· Place the child on her back.
2. Keep the air ducts open.
· Kneel near the child’s shoulders and lightly lift its chin with one of your hands, while pressing his forehead downwards with the other. This brings the head back, to a neutral position.
3. Check the breathing.
· Put your ear near the nose and the mouth of the child.
· Keep the airway open.
– Check if the chest is moving.
– Listen if the child is breathing from the mouth or the nose.
– Feel the breathing at your ear.
4. Give two (2) breaths, if he is not breathing
· Keep the upward position of the head.
· Close the child’s nostrils with the fingers of the hand that holds the forehead.
· Place your mouth on the child’s mouth.
· Give 2 breaths per 1 to 1.5 seconds.
· Check if the child’s chest is lifted. If it does not lift, the airway shows blockage. Place the child again to a position for air duct opening, and try again with breaths.
· Remove your mouth from the child’s mouth between breaths, so that the child can exhale.
5. Check for signs of circulation
· The child has circulation if she is breathing or responding to rescue breathing, cough or movement.
· Ten (10) seconds are enough for you to check the circulation (pulsation in the neck).
· If there are no signs of circulation or if you are not completely certain, begin chest compressions.
6. Do chest compressions.
· Put the lower part of your palm to the lower part of the child’s chest.
· Press downwards the chest by 1/3 to 1/2 of the chest’s depth. Repeat with a frequency of 100 times per minute.
· Do 15 chest compressions and 2 breaths. Repeat this cycle.
7. Check for signs of circulation and breathing.
· After about 1 minute, check for signs of circulation and breathing. If circulation and breathing have returned, stay with the child. If there are no signs of injury, place the child in a lateral position.
· If circulation has returned, but the child is not breathing, begin with breaths every 1 to 3 seconds.
· If circulation has not returned, continue the cycle of breaths and compressions, beginning with compressions.
8. Call for help
· If you are alone when you begin CPR, continue it for 1 minute (20 cycles or rescue breathing). Interrupt the resuscitation for as long as you need to call First Aid (166), and begin immediately after that. Continue CPR until the child starts to breathe and shows signs of circulation or until help arrives.
Stelios Papaventsis Paediatrician MRCPCH DCH IBCLC 2010