CPR and first aid for children and infants

Cardiac arrest in a child is fortunately rarer than in an adult — but when it happens the cause is often different and this means that the best first aid is slightly different from what you give an adult. Knowing the difference can make you more confident if you one day stand with a child who does not respond.

In adults, in more than half of cardiac arrests, a heart rhythm disorder (ventricular fibrillation) is the cause — the heart itself fails first. In children, the picture is often reversed: cardiac arrest occurs as a result of oxygen deprivation, e.g. because the airways are blocked, the child is drowning, or breathing fails for other reasons, and the heart stops as a consequence. This difference in cause is the background for why the procedure is slightly different in children.

Because oxygen deprivation is so often the triggering factor in children, it is recommended that you start with five insufflations before proceeding to chest compressions — unlike in adults, where you go straight into compressions. The idea is to get oxygen into the body as quickly as possible, because it is often the lack of oxygen itself that is the core of the problem.

The Danish First Aid Council has deliberately chosen 30:2 for lay rescuers — also for children. According to the council, the full paediatric algorithm with 15:2 can lead to paralysis of action: two rhythms are harder to remember than one. The most important thing is not the exact number but that you start rescue breaths and compressions at all, without hesitating.

The younger and smaller the child, the more the technique has to be adapted. With an infant (0-1 years) the head is only tilted to the neutral position, and you compress with two thumbs: encircle the chest with both hands and place the thumbs on top of each other on the lower half of the breastbone. With older children you use one or two hands. Press at least 1/3 of the depth of the chest (ERC Guidelines 2025 and the Danish First Aid Council). This is exactly where a practical exercise with a training manikin of the right size makes a big difference — theory can tell you why, but only training gives you the feel and the touch for how.

The defibrillator is also used on children. For infants, children under 8 and children weighing under approx. 25 kg, use child pads or the child setting if available — otherwise adult pads. If there is no room to place them apart, put one on the front of the chest and the other on the back.

The same precautionary principle applies to other acute conditions in children, eg foreign body in the airway: the basic principle of back blows and abdominal thrusts is the same as in adults, but the force and technique are adapted to the child's size, and in infants a special, more gentle procedure is used. Regardless of age, the same basic advice applies: if the child can still cough hard on their own, let coughing do the work and only intervene when coughing weakens or stops.

“You can read about the principles. The steady hand and proper grip only come from practicing it on a course with proper equipment in the right size.”

— First aid point