Sequence of actions for paediatric BLS

An infant is considered to be a child under the age of 1 year whilst a child is aged between 1 and 8 years of age. Small children over the age of 8 years may still be treated as for a younger child but may require different techniques to attain adequate chest compression.

In the following sequence a ‘child’ includes an ‘infant’ unless otherwise specified

Check that it is safe to approach, ensuring safety of rescuer and client	To ensure safety of rescuer and child
Check the child’s responsiveness. Gently stimulate the child and ask loudly: ‘Are you all right?’	To make sure that the child has not just fainted
Infants, and children with suspected cervical spinal injuries, should not be shaken	Shaking can cause paralysis and head trauma
If the child responds by answering or moving, leave the child in the position in which you find him (provided he is not in further danger). Check his condition and get help if needed. Reassess him regularly	To monitor condition
If the child does not respond, shout for help. Open the child’s airway by tilting his head and lifting his chin	To alert others and to increase the child’s chances of recovery
If possible with the child in the position in which you find him, place your hand on the child’s forehead and gently tilt his head back. At the same time, with your fingertip(s) under the point of the child’s chin, lift the chin to open the airway.	To maintain airway
Do not push on the soft tissues under the chin. If you have any difficulty in opening the airway, carefully turn the child on to his back and then open the airway as described above	This may block the airway
Avoid head tilt if trauma or injury to the neck is suspected	If neck injury is suspected use the jaw thrust method of opening the airway (see Figure 1.2)
Keeping the airway open, look, listen and feel for breathing as described in Chapter 1	To ensure absence of breathing
If the child is breathing normally, turn the child on his side and send or go for help. Check for continued breathing
If the child is not breathing or is making occasional gasps, carefully remove any obvious airway obstruction as described in Chapter 1.
Send for or summon help, then commence rescue breathing (see Chapter 1), remembering to take breaths yourself between rescue breaths	To maximize the oxygen you deliver
While performing the rescue breaths, note any gag or cough response to your action	You may stimulate the child to breathe spontaneously
For an infant Take a breath and cover the mouth and nasal apertures of the infant with your mouth, making sure you have a good seal. In a larger infant, if the mouth-to-mouthand- nose method is difficult, try the mouth-to-nose technique. In this, the adult’s mouth is placed over the infant’s nose and rescue breathing attempted. It may be necessary to close the infant’s mouth during rescue breathing to prevent air escaping. If you have difficulty achieving an effective breath, the airway may be obstructed. Recheck the infant’s mouth and remove any obstruction. Recheck that the head is in the neutral position and mthat the neck is not over-extended. The jaw thrust method may be attempted if you are unable to establish an open airway (see Figure 1.2). Make up to five attempts in all to achieve at least two effective breaths	Failure to restore circulation if absent will increase the potential for cerebral damage
Assess the child for signs of a circulation. Look for any movement including swallowing, coughing or breathing (more than an occasional breath)
For trained health care providers only: check the pulse Child – feel for the carotid pulse in the neck. Infant – feel for the brachial pulse on the inner aspect of the upper arm. Take no more than 10 seconds to do this
If you are confident that you can detect signs of a circulation (or a pulse over 60 beats per minute if you have been trained to do so) within 10 seconds, continue rescue breathing, if necessary, until the child starts breathing effectively on his own.	To maintain oxygenation
Recheck regularly for signs of a circulation, taking no more than 10 seconds.	To monitor condition
If the child starts to breathe normally on his own but remains unconscious turn him into the recovery position. Be ready to turn him onto his back and restart rescue breathing if he stops breathing	To maintain airway
If there are no signs of a circulation, or you are at all unsure (or the pulse rate is very slow – less than 60 beats per minute), start chest compression. Combine rescue breathing and chest compression	To restore adequate circulation
For a child Locate and place the heel of one hand over the lower half of the sternum (breastbone) ensuring that you do not compress on or below the xiphisternum. Lift the fingers to ensure that pressure is not applied over the child’s ribs.	To prevent fracture or dislocation
Position yourself vertically above the chest and, with your arm straight, press down on the sternum to depress it approximately one-third to one-half of the depth of the child’s chest. Release the pressure, then repeat at a rate of about 100 times a minute. After five compressions tilt the head, lift the chin and give one effective breath. Return your hand immediately to the correct position on the sternum and give five further compressions. Continue compressions and breaths in a ratio of 5:1. In children over the age of approximately 8 years, it may be necessary to use the ‘adult’ two-handed method of chest compression to achieve an adequate depth of compression at a ratio of 15:2	To achieve effective compression
For an infant and a single or non-professional rescuer Locate the sternum and place the tips of two fingers, one finger’s breadth below an imaginary line joining the infant’s nipples.
With the tips of two fingers, press down on the sternum to depress it approximately one-third to onehalf of the infant’s chest. Release the pressure, then repeat at a rate of about 100 times a minute. After five compressions tilt the head, lift the chin and give one effective breath. Return your hands immediately to the correct position on the sternum and give five further compressions. Continue compressions and breaths in a ratio of 5:1	Rationale as for child
Continue resuscitation until the client shows signs of life (spontaneous respiration, pulse), qualified help arrives or you become exhausted