Resuscitation Is Different For Toddlers

Most high school students have had an opportunity to see–and even learn–mouth-to-mouth resuscitation. But there are certain situations that require you to know more than the basics.

child-swimmingWould you, for example, give mouth-to-mouth resuscitation to an infant the same way you would administer it to a child? Is a victim who has just been pulled from icy water treated differently than a victim pulled from warmer water?

Infants Are Special People

When the victim is an infant, there are a number of changes that must be made to resuscitate him or her successfully.

* Volume. The first major difference between adults and infants is, obviously, size. Infants’ lungs are so small that only a puff of air is needed to inflate them. A full breath, given by an adult, could damage an infant’s lungs. Therefore, when giving a breath to an infant, use only the amount of air you can get into your cheeks.

* Head/neck position. Another difference relates to the position of the infant’s head when opening his or her airway. If you were to tilt back the neck of an infant the way you would tilt an adult’s head, the result would be a buckling of the infant’s trachea and a blocked airway. Instead, lay the infant down on a firm surface, keeping the infant’s head in a neutral position with no neck extension at all. You will know if the head position is correct when the air you blow causes the chest to rise. If air does not go in, check the head position. The head may be tilted too far back.

* Sealing the mouth. Since babies are so small, it is very difficult to get a good, air-tight seal if you place your mouth on the baby’s mouth alone. Therefore, when giving artificial respiration to infants, cover the infant’s nose and mouth with your mouth and blow into both openings.

* Pulse check. A baby’s pulse in the carotid artery of the neck is difficult to feel. When taking an infant’s pulse, use the brachial artery on the inside of the upper arm between the elbow and shoulder. Use your fingers, not your thumb, to feel for the pulse.

* Breathing rate. Babies take more breaths per minute than do adults. A person who is resuscitating an adult gives one breath every five seconds, but in infants, one breath should be given every three seconds, or about 20 per minute.

Children Under Age Four

* Head/neck position. As with infants, children’s airways can also collapse if their head is tilted back too far. When tilting the head of a child, start with the neutral position (no head tilt), and then try to give two breaths. If the air does not go in and out, tilt the head slightly farther back and try again. This is called the “neutral plus” position. Continue increasing the tilt until air finally goes in and the chest rises.

* Breathing rate. As you might suspect, the rate of breaths in children is half-way between the adult rate of 12 per minute and the infant rate of 20 per minute. Give a child one breath every four seconds or about 15 breaths per minute.

Cold Water Drowning

“Nobody’s dead until they’re warm and dead.” This statement was made shortly after 4-year-old Jimmy Tontlewicz fell through the ice on Lake Michigan one winter day and plunged into 32 degree F water. It was 20 minutes before divers could find him and pull him to the surface. His skin was gray, no pulse could be found, and he wasn’t breathing. Yet Jimmy recovered because his rescuers knew he was a special case.

Some believe his recovery was due to the mammalian diving reflex. This reflex, which has been tested in seals, is suspected to occur in humans when they are thrown into cold water. When a seal is plunged into cold water, it stops breathing, and its heart rate decreases, reducing the workload on the heart. At the same time, the blood that is still flowing is directed to the heart and brain allowing the mammal to remain submerged for long periods of time with no apparent ill effects. Children submerged in cold water have survived after 30 minutes and more–way beyond the 6- to 10-minute survival rate expected.

This survival rate has important implications for rescuers. If you discover a person who has been submerged in cold water and appears dead, don’t just give up. Begin resuscitation immediately and be aware that he or she may also need CPR. Continue your efforts until help arrives or the victim responds. Many people, particulary children, who appeared dead after cold water drowning, have been successfully resuscitated. Not all victims of cold water drowning can be saved. All of the factors that determine a person’s survival in icy water are not really known.

Someday you might be at the scene of an emergency that requires rescue breathing. Your knowing how to respond both quickly and correctly could literally mean a breath of life.

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  1. Absolutely essential writing here. CPR for children is just so much different. You need to remember that these are fragile creatures, and oddly tend to need CPR more often than adults!

    I hope others read this article and take it really seriously. The alternative is frightening to ponder.

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