Since the anatomical proportions of a baby are significantly different than that of children and adults, this section will focus on those differences as they relate to performing CPR on an infant.
When Assessing an Infant
An infant is considered any child under the age of one. When assessing and treating an infant who is in cardiac or respiratory distress, there are a few things to first consider.
First, let's look at the signs of a healthy baby. The lips are nice and pink, as is the mucous membrane. The nail beds are also pink. The baby is moving around and appears to be physically fine and healthy.
A baby in respiratory distress would likely be unresponsive and have some signs of circumoral cyanosis – blue around the lips – as well as the mucous membrane. The nailbeds might also appear blue.
Pro Tip #1: Don't confuse cold hands with signs of respiratory distress. When an infant's hands are cold, they might also appear bluish.
Important Infant Landmarks
Compression Point and Depth
As you open an infant's clothing to expose the chest, you'll want to find the nipple line. Put two fingers on the center of the infant's chest, directly on the sternum, and slightly below the nipple line.
The depth of compression for infants is about 1½ inches (or 1/3 the anterior-posterior diameter of the chest). However, the rate of compressions is the same as adults and children – 100-120 compressions per minute.
Finding a Pulse
Since infants don't have much of a neck, finding the carotid artery can be difficult, which is why we have to use the brachial artery instead.
To find the brachial artery, remove the infant's clothing enough to expose one arm. The brachial artery is located on the inside of the arm between the bicep and tricep against the humerus bone. Place your two fingers on the artery to check for a pulse, just as you would for other victims.
Pro Tip #2: The reason we don't use our thumbs to check for a pulse is that a thumb has its own detectable pulse, which could easily give a false reading.
Opening the Airway
There's another thing to keep in mind. Babys have large heads that are disproportionate to the rest of their bodies. Combined with a lack of a neck, this results in a chin that rests on the chest.
Before performing compressions, place something firm under the infant's shoulder blades to lift the neck and help tilt the head into a neutral or slightly sniffing position. It's important that this be a firm enough object so the infant doesn't sink down and the head is held in the correct position as you perform compressions.
Warning: An infant's airway is only about the size of one of their pinky fingers, which makes the airway much tighter than children and adults. If using the standard head tilt, chin lift, this could actually occlude the airway, making it much more difficult for the baby to breathe. This can also happen when an infant's chin is resting on their chest.
When performing compressions, the infant's head and neck should be in a slightly sniffing position. In other words, just a slight upturn of the nose; very close to neutral. (Imagine walking into a room and smelling a fresh apple pie and how your head rises ever so slightly as you sniff.)
Compression Variation Technique
There is one variation that can be used when doing compressions on a baby, which is known as circumferential compressions.
To perform circumferential compressions, wrap your fingers around the sides of the infant's chest, placing both thumbs over the compression point just below the nipple line. One of your thumbnails should be resting on top of the other.
An Infant's Heart
The size of an infant's heart is approximately the size of one of their fist. It's located right under the sternum in the center of their chest. Because of its small size, finding the right compression point is critical.
A Word About Infant Assessment
When assessing the level of consciousness in a baby, it helps if you can shout the baby's name. When tapping, use the bottom of the feet rather than the shoulder, as part of your shout-tap-shout sequence.
Also, rather than use AVPU (Alert, Verbal, Pain, Unresponsive) to measure and record a patient's level of consciousness, when treating an infant, it's more accurate to use the pediatric assessment triangle:
- Appearance
- Effort of breathing
- Circulation
As recognizing an unresponsive infant is your first priority to providing treatment, the assessment triangle should provide you with a better reading of the infant's condition.