Mountainland Pediatrics: Emergencies

Cardiopulmonary Resuscitation (CPR)

In rare instances, a child may require CPR to help him breathe and to provide assistance in pumping the blood throughout the body. We often speak of the ABC's of CPR because this reminds us that there is a very specific order in which a person should be resuscitated.

Airway Positioning the head and neck so that the air flows easily into the lungs.

Breathing You may have to breathe for your child if he is unable to do so.

Circulation Chest compressions may be necessary to pump blood to the body.

CALL FOR HELP. Have someone dial 911.

EVALUATE your child's condition. Shout or gently shake your child to see if he will awaken. Put your ear next to his nose and listen for breathing. Look at the chest to see if it rises with each breath.

IF YOUR CHILD IS NOT BREATHING:

POSITION your child. Put him on his back on a firm surface. If you think he could have injured his neck, support his head in order to keep the neck from twisting as you roll him over.

TILT THE HEAD BACK so that his nose is "in the air". Check the mouth to make sure your child has not choked on anything.

(see CHOKING procedures)

BEGIN MOUTH-TO-MOUTH breathing. For an infant, place your mouth over his mouth and nose. Breathe once every 3 seconds (20 breaths per minute). For a child, pinch the nose, and place your mouth over his mouth. Breathe once every 4 seconds (15 breaths per minute). In each case, start with two breaths, and blow enough air into the mouth to make the chest rise. Remove your mouth so the air can escape.

FEEL FOR A PULSE. In infants, place your right hand on the upper left arm, with the fingers touching the inside of the arm between the elbow and the shoulder. In children over one year, place your fingers under the ear and just below the jawbone (beside the windpipe). You should be able to feel a pulse if the heart is beating properly.

BEGIN CHEST COMPRESSION IF THERE IS NO PULSE. With an infant, place three fingers on the breastbone, with your index finger at the height of the nipples. The area for compression is where your middle and ring fingers are. Compress at a depth of 1/2 to 1 inch at a rate of 100 per minute. For children over one year, place the heel of one hand over the lower third of the breastbone. Compress at a depth of 1 to 1 1/2 inches at 80/minute. Give the child one breath for every five compressions.

*Continue breathing and/or chest compressions until paramedics arrive.

CHOKING, Under age 1

Prevention of Choking

Choking is the most common cause of accidental death in children under age 1. Please avoid giving your child the following items:

Chokeable foods: We restrict the following foods until children are 4 years of age:

nuts

raw carrots

popcorn

seeds

corn chips

hard candy

Hot dogs, sausage, grapes and meat must be cut into small pieces before serving.

Chokeable objects: In general, any item with a diameter less than 1.25 inches may be dangerous to your child. Older siblings may have toys with removable parts that can be swallowed. Rubber balloons are the leading cause of choking deaths from objects other than food. Try mylar balloons! Keep coins out of reach. Waste baskets often contain other small items that can find their way into small mouths.

Note: If your child is coughing and remains pink, let her try to cough out the object on her own. Choking on liquids is rarely harmful, and your child should be able to clear the fluid by herself.

If your child cannot breathe and is turning blue:

CALL FOR HELP. Have someone call 911 immediately if your child is choking on a solid object.

POSITION YOUR INFANT. Sit down. Place your child face down on your forearm with your hand stabilizing his head and neck. Keep the head lower than the rest of the body.

GIVE 5 BACK BLOWS between the shoulder blades. Use the heel of your hand.

TURN YOUR CHILD OVER if she still cannot breathe. Lay her on her back on a firm surface and deliver four rapid chest thrusts over the middle of the breastbone using only two fingers.

CHECK THE MOUTH for foreign objects or food if your child is still not breathing. Do not attempt to pull out the object unless you can see it clearly and it is easy to sweep out with a finger.

BEGIN MOUTH-TO-MOUTH BREATHING. Give two breaths through the mouth or mouth and nose. See the guidelines on resuscitation. If she still is not breathing, repeat all of the above steps.

CHOKING, Over age 1

Prevention of Choking

Note: If your child is coughing and remains pink, let him try to cough out the object on his own. Choking on liquids is rarely harmful, and your child should be able to clear the fluid by himself.

If your child cannot breathe and is turning blue:

CALL FOR HELP. Have someone call 911 immediately if your child is choking on a solid object.

POSITION YOUR CHILD. Stand behind your child. Put your arms around him so that they are just below the lower ribs. Make a fist with your right hand and grab that fist with your left hand.

BEGIN ABDOMINAL THRUSTS. (The "Heimlich Maneuver"). Give a sudden inward and upward jerk of your hands. You want to try to dislodge the object from the windpipe by giving 6 to 10 abdominal thrusts in quick succession. Note: Small children can be placed on their back on the floor. Kneel at their feet and place a fist on the abdomen above the navel yet below the ribs. Place the other hand on top of the fist, and give 6-10 inward and upward abdominal thrusts. Try to do this gently if the child is small.

CHECK THE MOUTH for foreign objects or food if your child is still not breathing. Do not attempt to pull out the object unless you can see it clearly and it is easy to sweep out with a finger.

If your child does not start breathing:

BEGIN MOUTH-TO-MOUTH BREATHING. Give two breaths through the mouth or mouth and nose. See the guidelines on Cardiopulmonary Resuscitation. If they are still not breathing, repeat all of the above steps.

Illustrations in this section are used with permission of the American Medical Association, JAMA, June 6, 1986. Vol. 255, No. 21.

The following information is provided in a brief format in order to aid you in the event that your child is choking or requires resuscitation. We strongly recommend that parents review a more thorough explanation of choking and resuscitation in a medical book such as:

Your Child's Health; Barton Schmitt M.D., pp 9-12 Caring for your Baby and Young Child; The American Academy of Pediatrics, pp 449-454.