How is a Child Defined in Terms of CPR/AED Care?

CPR and AED care play an important role in saving a child’s life during a cardiac emergency. Unlike adult cardiac care, CPR and AED techniques must be adapted based on the patient’s age. A child’s smaller body and developing organs require different compression depths, rescue breathing methods, and shock energy levels to ensure safe and effective treatment.

In CPR and AED care, a child is defined as anyone between 1 year of age and the onset of puberty, typically around 12-14 years old. This age group needs specific pediatric protocols that differ from both infant (under 1 year) and adult (post-puberty) emergency care techniques.

But there is more than just knowing who counts as a child in terms of CPR/AED care. Knowing how to provide CPR and use the right AED technique for a child can make all the difference. Keep reading to learn how to use an AED and provide CPR on a child.

Why is It Important to Define “Child” in CPR/AED Care?

It is crucial to define a child in CPR/AED care because the treatment methods and medication dosing differ according to the age group. For example, using adult-level chest compressions on a child can break ribs and damage internal organs, while using child techniques on an adolescent may not provide adequate blood circulation to vital organs.

Age classification directly determines compression depth, hand placement, AED energy levels, and rescue breathing volume. According to the latest AHA guidelines, chest compressions for children should be at least one-third the depth of the chest, which is about 5 cm (2 inches). On the other hand, compressions for infants should be around 4 cm (1.5 inches). Meanwhile, post-pubertal individuals need compressions similar to adults, around 5 to 6 cm deep.

How is CPR Different in a Child and an Adult?

While the chest compression rate is similar for adults and children (100 to 120 per minute), the key differences in CPR lie in the compression depth and hand placement for children. Children also need gentler compressions to reduce the risk of rib fractures and internal injuries.

CPR on a Child:

1. Hand placement: Use two hands placed on the lower half of the breastbone, depending on the child’s size.
2. Compression depth: Press down about 2 inches (5 cm) deep, which is about one-third the depth of the chest.
3. Compression rate: Deliver 100-120 compressions per minute with complete chest recoil between compressions.
4. Compression-to-breath ratio: Use a 30:2 ratio for a single rescuer or a 15:2 ratio when two rescuers are present.
5. Rescue breaths: Give gentle breaths that make the chest rise visibly, avoiding overinflation that can cause stomach distension.

CPR on an Adult:

1. Hand placement: Use both hands interlocked, with the heel of the bottom hand on the lower half of the breastbone.
2. Compression depth: Press down at least 2 inches (5 cm) but no more than 2.4 inches (6 cm) deep.
3. Compression rate: Deliver 100-120 compressions per minute with complete chest recoil between compressions.
4. Compression-to-breath ratio: Always use a 30:2 ratio regardless of single or multiple rescuers.
5. Rescue breaths: Give normal-volume breaths that make the chest rise, typically one breath per second.

How is AED Use Different in a Child Than in an Adult?

The primary differences in AED use between children and adults are the pad size and energy delivery levels. Children need specialized pediatric equipment to prevent delivering too much electrical energy to their smaller bodies.

AED Use on a Child:

• AED pad size: Use pediatric pads specifically designed for children under 8 years old or weighing less than 55 pounds (25 kg).
• Energy level: The energy level of AED in children is 2 joules per kilogram, and 4 J/kg if another shock is needed.
• Pad placement: Place one pad on the chest and one on the back (anterior-posterior positioning) to avoid pad overlap.
• Equipment maintenance: Pediatric AED pads have a shelf life of 2-4 years and must be replaced before expiration.

AED Use on an Adult:

• AED pad size: Use standard adult-sized pads for patients 8 years and older or weighing more than 55 pounds (25 kg).
• Energy level: For biphasic defibrillators, the initial shock energy level is between 120 and 200 joules, and for monophasic defibrillators, the energy level is typically set at 360 joules.
• Pad placement: Place one pad on the upper right chest and one on the lower left side of the chest (anterior-lateral positioning).
• Equipment maintenance: Adult AED pads typically have a shelf life of 2-7 years, depending on the manufacturer.

How to Provide CPR for a Child?

Providing CPR for a child includes checking responsiveness, calling for help, performing chest compressions, and giving rescue breaths in specific cycles until emergency services arrive. Before providing CPR, you must check for scene safety, obtain consent from the parent or guardian, and use personal protective equipment (PPE).

Step 1: Assess the Scene and Patient

You should start by checking the surrounding area for hazards like traffic, fire, or electrical dangers before approaching the child. Tap the child’s shoulders firmly and shout if they are okay to check for responsiveness.

Step 2: Call for Emergency Help

If the child is unresponsive and not breathing normally, immediately call 911 or have someone else do it. As you start CPR, you’ll also want to ask someone to find an AED (automated external defibrillator).

Step 3: Position the Child

Place the child on their back on a firm, flat surface such as the floor or ground. Then, you should tilt the head back slightly by lifting the chin to open the airway.

Step 4: Hand Placement for Compressions

Place the heel of one or both hands on the lower half of the child’s breastbone, between the nipples. Also, keep your arms straight and shoulders directly over your hands.

Step 5: Perform Chest Compressions

Push hard and fast at least 2 inches deep at a rate of 100-120 compressions per minute. You must allow complete chest recoil between compressions without lifting your hands from the chest for effective compressions.

Step 6: Give Rescue Breaths

After 30 compressions, tilt the head back, lift the chin, and pinch the nose closed. Then, create a seal over the child’s mouth and give two breaths, each lasting 1 second and making the chest rise visibly.

Step 7: Continue CPR Cycles

Repeat cycles of 30 chest compressions followed by two rescue breaths without interruption. Continue until emergency medical services arrive, an AED is available, or the child begins breathing normally.

What are the Legal Responsibilities When Treating a Child With CPR/AED?

Good Samaritan laws in most states protect individuals who provide emergency care in good faith from legal liability when helping a child in cardiac arrest. These laws encourage bystanders to act without fear of lawsuits, as long as the provided care is reasonable and within the person’s training level.

While good Samaritan laws protect you from any legal liability, you must make some key legal considerations, including obtaining consent from a parent or guardian when possible. However, you won’t need parental consent in life-threatening emergencies when no guardian is present. Most healthcare professionals have a higher duty of care and must follow their scope of practice, while lay rescuers should only perform techniques they’ve been trained to use. Always stay within your certification level and continue care until professional medical help takes over.

Conclusion

A clear definition of a child in CPR/AED care ensures you apply the correct life-saving techniques that match their physical development and medical needs. The distinction between infant, child, and adult protocols can mean the difference between successful resuscitation and causing additional harm during a cardiac emergency.

Understanding key concepts, like how a child is defined in CPR/AED care, can feel overwhelming. At Defib Hawaii, we break down every aspect of CPR, from basic terms to advanced techniques. We offer an AHA authorized PALS course to increase child and infant survival rates from life-threatening emergencies. Our comprehensive CPR certification courses in Hawaii make it easy to learn with confidence.