Push down on the center of a child’s chest at roughly 2 inches deep, delivering 100 to 120 compressions per minute and pausing after every 30 to give 2 rescue breaths. The full sequence, calling 911, checking responsiveness, cycling compressions and breaths, and applying an AED as soon as one arrives, takes only minutes, and practiced hands give a child the best chance of surviving sudden cardiac arrest.
The walkthrough below covers child CPR steps from your first tap on the shoulder to the moment EMS takes over, with pediatric CPR guidelines from the American Heart Association as the backbone.
Understanding Child CPR and Why the Guidelines Differ
A child’s body is not a small adult’s body. Airways are narrower, oxygen reserves run out faster, and the heart is still developing. Pediatric resuscitation follows its own rules, calibrated for a patient between 1 year old and puberty. Outside that range, the steps shift again.
Who Counts as a “Child” in CPR
CPR training programs split patients into three age buckets, and the bucket determines nearly every motion you make. Infants are under 1 year old. Children range from about 1 year old through the signs of puberty, breast development in girls, underarm hair in boys, or roughly up to age 8 for practical purposes. Adults are everyone beyond puberty.
Splitting the categories this way is not arbitrary. Compressions that are safe for an adult chest can fracture a small sternum, and breaths that fill an adult lung can overinflate a child’s. The American Heart Association and the American Red Cross publish separate algorithms for each age group, and current BLS courses spend dedicated time on each one.
Why Children’s Hearts Stop Differently
Adult cardiac arrest usually starts with the heart, a rhythm problem, a heart attack, a chronic condition that finally tips over. Children’s arrests more often start with breathing. Drowning, choking, asthma, respiratory infection, or a sudden airway obstruction can starve the blood of oxygen until the heart gives up. Because the trigger is usually respiratory, rescue breaths carry extra weight in pediatric CPR.
Hands-only CPR, the technique popularized for adult bystanders, falls short for most child arrests. The child often needs oxygen pushed in, not just circulated. That single fact is why child CPR steps always include a breaths-and-compressions cycle, not compressions alone.
Because the breathing piece sets child CPR apart, the harder question becomes knowing when to actually start.
Recognizing the Moment CPR Is Needed
Cardiac arrest in a child often looks different from what movies show. There’s no dramatic gasp and clutch of the chest. You’ll see a child who suddenly looks wrong, quiet, limp, or breathing in a way that doesn’t seem real. Your first job is to confirm what’s happening without losing precious seconds.
Checking Responsiveness Safely
Tap the child’s shoulder and shout their name. Stay gentle, small shoulders bruise easily, and a sharp shake can injure the neck. If there’s any chance of a fall or trauma, resist the urge to shake or roll the child roughly. Watch for any purposeful movement, eye opening, or sound. A child who squeezes your hand or turns toward your voice is not in arrest and does not need CPR.
Yell louder if you need to. A child who was playing a minute ago and is now silent deserves your full voice. Five to ten seconds is plenty; longer delays only cost the brain.
Breathing and Pulse in the First Ten Seconds
Once responsiveness is unclear, lean in close and watch the chest for no more than 10 seconds. You’re checking for normal breathing, a steady rise and fall, like the child is simply sleeping with effort. Agonal gasps look different. They appear as a sudden snort, snore, or short, fish-like opening of the mouth, and they happen irregularly, sometimes once every several seconds. Treat agonal gasps as no breathing at all.
Checking the pulse happens at the same time. On a child, the carotid artery in the neck or the femoral artery in the groin is the fastest place to feel. Use two fingers flat against the side of the neck just below the jaw. If you can’t find a pulse within 10 seconds, and especially if there’s no breathing, start CPR. Don’t wait for certainty.
A child whose heart has stopped can lose meaningful brain oxygen in four to six minutes, and damage begins long before that.
With that clock already running, the priority shifts to getting backup on the line while you set up to push.
Special situations change the urgency. Drowning, choking, severe allergic reaction, electric shock, or known congenital heart disease all push you toward starting CPR faster, because these collapses almost always involve a respiratory trigger where seconds compound.
Calling for Help and Positioning the Child Safely
The moment you confirm an unresponsive child who isn’t breathing normally, the plan splits in two: someone calls 911 while someone else begins CPR. If you’re alone, you have a decision to make, and it depends on the child’s age and the cause of the arrest.
Calling 911 First or Compressions First
For a child who collapses from a presumed cardiac cause, call 911 on speakerphone and start compressions within the same minute. The American Heart Association’s pediatric BLS guidelines tell a lone rescuer to perform 2 minutes of CPR first when the arrest is likely respiratory, drowning, choking, asthma, because pushing fresh oxygen into the blood is what buys time for that child.
If another adult is nearby, point at them and tell them to call 911 and grab an AED. Use a direct command: “You in the blue shirt, call 911 and come back.” Specific direction works better than a general plea.
Positioning for Effective Compressions
Place the child flat on a firm surface, the floor works better than a bed or couch. Kneel beside the child’s chest so your shoulders sit directly above your hands. The head should be in line with the spine, neither tilted back dramatically nor tucked under. For a small child, you may end up close enough that your hip nearly touches their shoulder.
Activate speakerphone on the 911 call so dispatch can coach you while your hands stay free. Tell them the child’s age, what you observed, and that you’ve started CPR. Dispatchers in most US counties are trained to walk you through the rest of the steps.
Performing Compressions at the Correct Depth and Rate
Once the child is flat and 911 is rolling, compressions begin in earnest. Done right, they buy the brain time until a defibrillator or advanced care arrives.
Hand Placement and Compression Depth
Place the heel of one hand on the lower half of the breastbone, between the nipples. For a smaller child, one hand is usually enough. For a larger child or one whose chest feels small under your palm, stack the second hand on top and interlock the fingers, keeping them off the ribs so force goes straight down into the sternum.
Push straight down to about 2 inches deep, roughly one-third of the chest’s front-to-back depth. Let the chest come all the way back up between pushes. Partial recoil means less blood returns to the heart, which means less blood leaves the heart on the next compression. The motion is a clean piston: down hard, all the way back up, then down again.
Rate and the Fear of Broken Ribs
Aim for 100 to 120 compressions per minute. A useful mental song is the beat of “Stayin’ Alive,” which lands right in that range. Count out loud if it helps, “one, two, three, four…”, so a second rescuer or the dispatcher can hear your rhythm and keep time for you.
Steady rhythm matters, but the air the child still needs has to come from somewhere, which is where rescue breaths re-enter the cycle.
Cracked ribs sound worse than they are. A broken rib heals. A brain without oxygen does not. If you hear or feel a snap, keep going. Most pediatric cardiac arrest survivors who received bystander CPR have at least one bruised or fractured rib, and they’re alive to show it.
Delivering Rescue Breaths and Cycling at the Right Ratio
Compressions alone keep some oxygen moving. Rescue breaths actually add oxygen. In pediatric arrest, where the cause is usually respiratory, breaths may be the deciding factor.
Opening the Airway and Giving Breaths
After every 30 compressions, tilt the head back gently with one hand on the forehead and lift the chin with two fingers under the jawbone. The motion should look like the child is sniffing a flower that’s slightly above them, not like their neck is being craned. Pinch the soft part of the nose closed, seal your mouth over theirs, and give one breath lasting about one second. Watch the chest rise. If it rises, the breath went in.
Give a second breath the same way, then return immediately to compressions.
A child’s lungs hold far less air than yours. Gentle puffs, delivered until you see the chest clearly rise, beat hard breaths every time. If the chest doesn’t rise, reposition the head and try again. If it still doesn’t rise after a second attempt, the child may have an airway obstruction, go to the choking steps below.
Ratios for One Rescuer Versus Two
| Situation | Compression-to-Breath Ratio | Notes |
|---|---|---|
| Single rescuer, child 1 to puberty | 30:2 | Same as adult; standard until help arrives |
| Two rescuers, child 1 to puberty | 15:2 | One rescuer compresses, the other gives breaths |
| Switch roles every | 2 minutes (about 5 cycles of 30:2) | Fatigue drops compression depth faster than you’d notice |
Switching out is not optional in a long resuscitation. Compressions at the right depth are physically exhausting, and rescuers commonly deliver shallow pushes for a full minute before they realize they’re tiring. A two-minute rotation keeps the quality high.
Integrating an AED and Handling Choking Into Unresponsiveness
An automated external defibrillator (AED) is a small, voice-guided device that analyzes the heart rhythm and, if needed, delivers a shock. For a child whose arrest has a cardiac cause, the AED is the single most important piece of equipment a bystander can bring to the scene.
Using an AED on a Child
Turn the AED on as soon as it arrives and follow the voice prompts. Most modern AEDs have pediatric pads or a pediatric key that lowers the energy level. Use pediatric pads for children under 8 when available. If only adult pads are on hand, use them, adult pads on a small chest still work better than no pads at all.
Place one pad on the upper right chest and the other on the lower left side, making sure the pads don’t touch each other.
The AED will either announce “Shock advised” or “No shock advised.” Stand clear, announce that you are clear, that everyone else is clear, and that you are all clear, then press the shock button if directed. Resume compressions immediately after the shock, starting with chest pushes. Don’t wait. Don’t check for a pulse. The next cycle of CPR begins right where the shock ended.
When Choking Becomes Unresponsiveness
A child who was choking and then goes limp is now in cardiac arrest. Lay them flat and begin CPR, but with one extra step: before each set of breaths, open the mouth and look for a visible object. If you can see and grasp it with a finger sweep, remove it. Never perform a blind finger sweep, pushing an unseen object deeper is worse than leaving it alone.
Continue cycles of CPR until the child shows signs of life, breathing, movement, coughing, or until EMS arrives and tells you to stop. If an AED becomes available, attach it. Some choking-induced arrests eventually develop a shockable rhythm.
Child CPR Versus Infant and Adult Protocols at a Glance
Three protocols, one set of principles. Side-by-side, the differences are small but consequential.
| Feature | Infant (under 1 year) | Child (1 to puberty) | Adult |
|---|---|---|---|
| Compression technique | Two fingers, or two thumbs encircling the chest | One hand, or two hands for larger children | Two hands, heel of one on sternum |
| Compression depth | About 1.5 inches (4 cm) | About 2 inches (5 cm) | At least 2 inches, no more than 2.4 inches |
| Compression rate | 100 to 120 per minute | 100 to 120 per minute | 100 to 120 per minute |
| Ratio (single rescuer) | 30:2 | 30:2 | 30:2 |
| Ratio (two rescuers) | 15:2 | 15:2 | 30:2 |
| Breaths | Critical, infant arrests are usually respiratory | Critical, most pediatric arrests start with breathing | Optional for trained bystanders; hands-only OK otherwise |
| AED pads | Pediatric preferred; infant attenuator if available | Pediatric under 8; adult if no pediatric | Adult pads |
Rescue breaths gain importance as the victim gets younger, because the underlying cause of arrest shifts from cardiac to respiratory. That’s the single biggest mental model to hold onto, and it explains why adult hands-only CPR is a poor fit for children.
For an infant younger than 1, swap one-hand compressions for two fingers placed just below the nipple line, or encircle the chest with both hands and use the two thumbs. For an adult, push harder and let the compressions do most of the work. The mental rehearsing of all three is best done in a certified BLS course with a manikin, that’s where the muscle memory lives.
Putting It Together
The single most important thing to walk away with is this: a child in cardiac arrest needs your hands on their chest within seconds, not minutes. Compressions at 2 inches deep, 100 to 120 times per minute, alternating with two rescue breaths, continue until an AED arrives or EMS takes over. Cracked ribs heal. A brain without oxygen doesn’t.
Practice on a manikin, take a BLS course through the American Heart Association or American Red Cross, and keep the steps fresh in your body.
FAQ
What is the correct compression-to-ventilation ratio for a child?
Use a 30:2 ratio when you are the only rescuer, and a 15:2 ratio when a second rescuer is available. Both ratios deliver 100 to 120 compressions per minute with breaths in between, and the smaller ratio for two-rescuer CPR reflects the extra help available to deliver breaths without long pauses.
How deep should chest compressions be on a child?
Push to about 2 inches (5 cm) deep, roughly one-third of the chest’s front-to-back depth. Let the chest fully recoil between pushes so blood can refill the heart before the next compression.
When should you call 911 before starting CPR on a child?
If you are alone, call 911 on speakerphone immediately for any child collapse and start CPR within the same minute. For a likely respiratory cause such as drowning or choking, perform 2 minutes of CPR first, then call if no one else has done so.
Can you use an AED on a child?
Yes. Use pediatric pads for children under 8 when available, and follow the AED’s voice prompts. Adult pads are acceptable when pediatric ones are not on hand, a shock that lands is better than no shock at all.
How do you check for a pulse on a child before performing CPR?
Feel for a carotid pulse on the side of the neck or a femoral pulse in the groin, using two fingers. Spend no more than 10 seconds. If you don’t feel a pulse and the child is unresponsive and not breathing normally, begin CPR.
What should you do if a child is unresponsive but breathing normally?
Do not start CPR. Place the child in the recovery position on their side, keep the airway clear, and call 911. Monitor breathing continuously until EMS arrives, and be ready to start CPR if breathing stops.
