4.1 Pediatric BLS Overview

Definition of a Child or Infant

The American Heart Association (AHA) defines a child as anyone from about 1 year of age to the onset of puberty, typically marked by secondary sex characteristics. An infant is a child under 1 year old, excluding newborns in the first few hours after birth.

Initial Assessment & Response

Pediatric BLS begins with a structured assessment and immediate action. The following steps apply to a single rescuer:

Single Rescuer Pediatric BLS

1. Verify Scene Safety: Ensure the area is safe for both you and the victim.
2. Check for Responsiveness:
   • Child: Tap the shoulder and shout, “Are you okay?”
   • Infant: Tap the bottom of the foot and shout, “Are you okay?”
3. Call for Help: If the victim is unresponsive, shout for assistance.
4. Activate the Emergency Response System (ERS): Call 911 or mobilize an ALS team if available.
5. Retrieve AED and Emergency Equipment: If available, retrieve the AED and emergency supplies or send someone to do so.

Breathing and Pulse Assessment

Scan the Chest

Before checking for a pulse, observe the chest to assess whether the child or infant is breathing normally. Look for consistent rise and fall, which indicates effective ventilation.

Child: Chest Rise & Fall

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Child: Chest Rise & Fall

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1. Position yourself at eye level with the child's chest.
2. Look for visible rise and fall of the chest, which indicates normal breathing.
3. Observe for no more than 10 seconds.

Infant: Chest Rise & Fall

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Infant: Chest Rise & Fall

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1. Watch the infant’s entire torso, as movement may be subtle.
2. Gasping or irregular breathing is not considered normal.
3. If there is no normal breathing and no pulse after 10 seconds, begin CPR immediately.

Locating the Pulse

Child: Carotid Pulse

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Child: Carotid Pulse

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1. Use two or three fingers to locate the trachea on the side of the neck.
2. Slide into the groove between the trachea and neck muscles to feel for the carotid pulse.
3. Feel for at least 5 seconds, but no more than 10 seconds.

Infant: Brachial Pulse

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Infant: Brachial Pulse

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1. Place two fingers on the inside of the upper arm, between the elbow and shoulder.
2. Press gently to feel for the brachial pulse.
3. Feel for at least 5 seconds, but no more than 10 seconds.

When to Begin CPR

If the victim is unresponsive, not breathing, and has no pulse, begin CPR immediately, starting with chest compressions.

CPR Approach: Lay Rescuers vs. Healthcare Providers

Important Notes

• Hands-only CPR is acceptable for lay rescuers who are untrained or unwilling to give rescue breaths.
• Healthcare providers should perform full CPR, including ventilations, unless an advanced airway is in place.