Airway – infants
It is important to note that an infant’s airway is different from a child and adult, and is more likely to become blocked because an infant’s:
- head is relatively larger
- neck is relatively shorter
- tongue is larger
- windpipe is softer and more easily compressed.
Backward head tilt should not be used with infants, as it stretches and compresses the soft tissue, which may block the airway. Instead, the head should be kept in the neutral position, with the lower jaw lifted at the point of the chin. If the neutral position does not provide a clear airway, it may be necessary to tilt the head back very slightly. Due to the relatively larger size of their head compared to their body it may be necessary to pad an infant’s shoulders to maintain good head tilt.
Assess infants on their back on a firm and flat surface to check their airway and breathing. Start CPR as per adult recommendations.
Lateral / Recovery position – infants can be rolled onto their side or rolled onto your arm (slightly facing downwards) to drain regurgitation or vomit. Remember to keep infants warm – as they are prone to rapid heat loss if they are left uncovered.
Airway – children
Children’s heads should be tilted slightly backwards to maintain their airway. The level of tilt is sometimes referred to as ‘the sniffing position’. Due to the relatively larger size of their head compared to their body it may be necessary to pad a small child’s shoulders to maintain good head tilt.
Lateral / Recovery position – children should be rolled into the lateral or recovery position the same way as an adult.
Rescue breaths for children and infants
The guidelines for performing rescue breaths on children are the same as those for adults, except for the volume of air to be blown into the patient. Great care must be taken in judging the volume of air to be blown into the lungs of a child and infant, as over-inflation increases the risk of regurgitation and trauma to the lungs. The airway operator should blow only until the patient’s chest is seen to rise, and then stop.
When performing rescue breaths on an infant:
- place your mouth over the infant’s nose and mouth
- puff in just enough air through your slightly open mouth to see the chest begin to rise
- use an infant resuscitation mask where available.
Note:
- If an infant resuscitation mask is not available, an adult mask may be used upside-down (rotated by 180 degrees with the nose part over the chin)
- The volume of air required is very small and practice should be carried out on infant manikins.
CPR – infants and children
Bystander CPR for infants and children involves the same ratio of compressions and rescue breaths as adults. Effective compression for both children and infants are similar to adults, compressing one third of the depth of the chest, with pressure applied at lower half of the sternum, at a rate of 100–120 compressions per minute. You will usually use two fingers to compress infants and one or two hands to compress children, size-dependent.
As per adults, CPR is to be performed on a firm surface.
Remember to provide full chest recoil for both infants and children.
If an infant or child vomits or regurgitates during CPR, roll them into the lateral position away from you to allow the contents to drain and check their airway for any foreign material that needs to be cleared. After the airway is clear, check to see if the young patient is breathing normally again.
