Understand infant and child CPR, the 2025 hand-technique update, weight-based drugs and shocks, investigations and post-arrest nursing care.
Many childhood arrests follow respiratory failure or shock. Compressions alone do not correct a severe oxygen deficit; trained rescuers should combine compressions with breaths.
| Group | BLS scope / approach |
|---|---|
| Infant | Younger than 1 year, excluding the newborn at birth. Use infant chest-depth and hand-technique guidance. |
| Child | From 1 year until signs of puberty. Use the prepubertal compression-to-breath ratios. |
| Signs of puberty | Use adult BLS. Advanced care still follows the appropriate service’s adolescent/paediatric protocol and patient size. |
| Newborn at birth | Uses neonatal resuscitation guidance, not this paediatric BLS algorithm. |
AHA/AAP 2025: Paediatric Basic Life Support · AHA/AAP 2025: Paediatric BLS, single rescuer
AHA/AAP 2025: Paediatric BLS, single rescuer · AHA/AAP 2025: Paediatric BLS, two or more rescuers · AHA/AAP 2025: Full Paediatric Advanced Life Support guideline
There is no routine blood-test contraindication to starting CPR for a recognised arrest. A valid applicable treatment-limitation plan, clear irreversible death or a seriously unsafe scene requires the local emergency/ethical process. Paediatric decisions involve senior clinicians and the relevant family/legal framework.
Do not withhold because the child is small, has a disability or may sustain a rib injury. Once circulation and adequate perfusion return, compressions stop and post-arrest care begins. Termination decisions belong to the authorised team, not one abnormal monitor value.
AHA/AAP 2025: Paediatric BLS, single rescuer · AHA/AAP 2025: Paediatric BLS, two or more rescuers · AHA/AAP 2025: Full Paediatric Advanced Life Support guideline
| Component | Infant / prepubertal child |
|---|---|
| Rate and depth | 100–120/min; at least one-third the chest’s front-to-back depth: about 4 cm in infants, 5 cm in children. |
| Infant hands: 2025 update | Use the heel of one hand or two-thumb encircling technique. If unable to encircle the chest, use heel-of-one-hand. Two-finger infant compressions are no longer recommended. |
| Child hands | One or two hands on the lower half of the sternum, depending on size and ability to achieve depth; allow full recoil. |
| Without advanced airway | One rescuer: 30:2. Two or more rescuers for a prepubertal patient: 15:2. Give visible chest rise without excessive inflation. |
| With advanced airway | Continuous compressions and 1 breath every 2–3 seconds. Confirm and monitor tracheal tube placement with ETCO₂. |
| Team quality | Keep pauses under 10 seconds; change compressor about every 2 minutes. Record shocks/doses and assess CPR quality; do not wait for a blood result. |
Give oxygen during CPR. Attach the AED promptly; use paediatric attenuation/pads when available. If unavailable, use the available AED rather than withhold defibrillation. Keep pads separate; use an anterior-posterior position if needed for space. Clear all contact for shock delivery and immediately resume CPR afterwards.
AHA/AAP 2025: Paediatric Basic Life Support · AHA/AAP 2025: Paediatric cardiac arrest algorithm · AHA/AAP 2025: Paediatric BLS, two or more rescuers
VF/pulseless VT: give an unsynchronised shock, then CPR for 2 minutes. The teaching algorithm uses 2 J/kg first, 4 J/kg second, then at least 4 J/kg, not exceeding 10 J/kg or the adult maximum dose. The full guideline permits an initial 2–4 J/kg; 2 J/kg simplifies teaching.
PEA/asystole: CPR, oxygenation/ventilation, access and early epinephrine; no shock unless the rhythm changes to VF/pVT. Check for hypoxia, hypovolaemia, acidosis, hypoglycaemia, potassium disturbance, hypothermia, tension pneumothorax, tamponade, toxins and thrombosis.
In shockable arrest, epinephrine follows initial shock attempts (algorithm: during CPR after the second shock); amiodarone or lidocaine follows persistent VF/pVT after the third shock. Do not delay an available shock to obtain a drug or line.
AHA/AAP 2025: Paediatric cardiac arrest algorithm · AHA/AAP 2025: Full Paediatric Advanced Life Support guideline
| Medicine | Paediatric IV / IO arrest dose | Key check |
|---|---|---|
| Epinephrine (adrenaline) | 0.01 mg/kg using 0.1 mg/mL concentration = 0.1 mL/kg; maximum 1 mg per dose; every 3–5 minutes. | Do not confuse 0.1 mg/mL with the 1 mg/mL preparation used for other indications. PEA/asystole: give as soon as possible. |
| Amiodarone | Shock-refractory VF/pVT: 5 mg/kg bolus, first-dose maximum 300 mg. If needed, repeat to a total of 3 doses; maximum 150 mg for each subsequent dose. | Not for routine asystole; check total dose and shock sequence. |
| Lidocaine: alternative | 1 mg/kg for shock-refractory VF/pVT. | An alternative to amiodarone under the resuscitation protocol. |
| Cause-specific treatment | Glucose for documented hypoglycaemia; electrolyte correction, antidotes or other treatment when indicated. | Calcium/bicarbonate are not routine for all paediatric arrests. Atropine is for selected bradycardia mechanisms, not a replacement for CPR in hypoxic collapse. |
| After ROSC | Prescribed fluids, inotrope/vasopressor, sedation/analgesia or antiseizure therapy as required. | Use patient-specific infusion calculations and reassess for overload, hypotension and neurological change. |
Calculation example: a 10-kg child needs 0.01 × 10 = 0.1 mg epinephrine; with 0.1 mg/mL, volume = 1 mL. A 10-kg child’s first 2-J/kg shock is 20 J. State units aloud.
AHA/AAP 2025: Paediatric cardiac arrest algorithm · AHA/AAP 2025: Full Paediatric Advanced Life Support guideline · AHA 2025: Adult and paediatric special circumstances
| Stage | Assessment / investigations | Nursing purpose |
|---|---|---|
| Before / at recognition | Rapid breathing/pulse/perfusion assessment; review available weight, history, medicines and recent results. | Detect respiratory failure/shock and select the correct age/weight pathway. There is no pre-CPR laboratory checklist to complete. |
| During CPR | ECG/AED rhythm; ETCO₂ with advanced airway; bedside glucose; blood gas, lactate and electrolytes if rapidly available. | Identify reversible problems while the team continues CPR. Interpret trends with ventilation and perfusion. |
| During CPR, selected cases | Existing invasive arterial pressure or expert ultrasound without extra pauses. | Support quality/cause assessment. Do not insert monitoring devices at the expense of compressions. |
| After ROSC | Continuous ECG, pulse oximetry, BP/core temperature; blood gas, glucose, electrolytes, lactate, renal function and other cause-directed tests. | Guide oxygen, ventilation and perfusion treatment; identify organ dysfunction. |
| After ROSC, as indicated | 12-lead ECG/echo for a cardiac cause; chest imaging for airway/lung issues; EEG with altered consciousness or seizures; CT/MRI when clinically indicated. | Clarify cause and injury. Unexpected unexplained arrest may require cardiology/genetic evaluation; not every child needs every test. |
AHA/AAP 2025: Full Paediatric Advanced Life Support guideline · AHA/AAP 2025: Paediatric post-cardiac arrest checklist
AHA/AAP 2025: Full Paediatric Advanced Life Support guideline · AHA/AAP 2025: Paediatric post-cardiac arrest checklist · AHA/AAP 2025: PALS guideline, publisher HTML version
Choose one best answer before opening the explanation. These are original Nursing Medium practice questions, not official AHA examination items.
Correct answer: B. Heel of one hand or two-thumb encircling technique
Rationale: The 2025 infant recommendation replaced two-finger compressions because adequate depth was often not achieved.
Correct answer: D. Begin CPR while the team treats the cause
Rationale: Paediatric severe bradycardia with continuing compromise can require compressions before the pulse disappears.
AHA/AAP 2025: Full Paediatric Advanced Life Support guideline
Correct answer: A. 15:2
Rationale: Two-rescuer prepubertal CPR uses 15:2. Adult CPR and single-rescuer paediatric CPR use different rules.
Correct answer: C. 30:2
Rationale: For a single rescuer, 30:2 provides a workable balance while help is obtained.
Correct answer: D. One breath every 2–3 seconds with reassessment
Rationale: A pulse does not correct respiratory failure. Paediatric rescue ventilation is about 20–30 breaths/min.
Correct answer: A. At least one-third of chest depth, about 4 cm
Rationale: The depth target scales with the chest. The approximate infant reference is 4 cm; inadequate depth reduces effective CPR.
Correct answer: C. 20 J
Rationale: The initial algorithm dose is 2 J/kg: 2 × 10 = 20 J.
Correct answer: B. 40 J
Rationale: The second dose is 4 J/kg, so a 10-kg child receives 40 J.
Correct answer: A. 0.1 mg = 1 mL
Rationale: 0.01 mg/kg × 10 kg = 0.1 mg. At 0.1 mg/mL, this is 1 mL. Verify the actual concentration.
Correct answer: D. One breath every 2–3 seconds
Rationale: Paediatric advanced-airway CPR uses a higher ventilation rate than adult advanced-airway CPR.
Correct answer: B. Escalate and titrate prescribed support above the 10th percentile
Rationale: The updated paediatric post-arrest goal is age-dependent. ROSC alone does not guarantee adequate organ perfusion.
AHA/AAP 2025: Full Paediatric Advanced Life Support guideline
Correct answer: C. Give about 2 minutes of CPR first, then obtain help/AED
Rationale: For this unwitnessed, alone-without-ready-communication situation, initial CPR precedes leaving. Witnessed sudden collapse has a different AED priority.
Checked 22 October 2026 against the 2025 AHA CPR/ECC guidelines; paediatric recommendations are jointly developed with the AAP. These independent Nursing Medium study notes are not an AHA course, endorsement or certification. Practise CPR through hands-on training; clinical teams follow the current local protocol and patient-specific orders.
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