Basic life support for the child and infant

Cardiorespiratory arrest is uncommon in children and therefore nurses are unlikely to be involved in the practice of paediatric basic life support  (Bardai et al, 2011; Maconochie et al, 2015). Nonetheless, knowledge and skills in providing paediatric basic life support remain essential, particularly given that the Nursing and Midwifery Council standards of proficiency state:

The majority of cardiorespiratory arrests in children and infants are a result of respiratory insufficiency rather than cardiac problems (Cocks, 2006). Children and infants are at risk of becoming respiratory compromised and experiencing subsequent hypoxia for a number of reasons including birth asphyxia, inhalation of foreign bodies, bronchiolitis, asthma, convulsions, or neurological damage. Therefore, the order of delivering resuscitation differs between paediatrics and adults. In unresponsive adults, chest compressions

SAFE approach

Within an emergency, the rescuer must use the SAFE approach:

• Shout for help
• Approach with care
• check if the area is Free from danger
• Evaluate the patient using ABC (Cocks, 2006)

Following the SAFE approach, an initial assessment of responsiveness and a check for signs of life is required. To ascertain this, the rescuer should talk loudly to the child/infant to assess responsiveness, followed by gently stimulating the child/infant—shaking a shoulder for a child or tickling a foot for an infant. Signs of life may be assessed through considering if there is any movement, coughing or normal breathing but should not include abnormal gasps or infrequent, irregular breaths (Skellett et al, 2021).

If the child/infant is responsive, this demonstrates that they do not require CPR. If the cause of the collapse is unknown, or the injury requires further treatment, the rescuer should leave them in the position they

Points for good practice

Counting inflation breaths aloud may improve the speed of rescuers resuming chest compressions during two-person paediatric cardiopulmonary resuscitation (Lee et al, 2018).

Studies have shown that when administering chest compressions to infants and children, rescuers frequently do not compress the chest as deep as the recommended depth or compress quick enough to meet the recommended rate of compressions (Everett and Weiner, 2012; Gregson et al, 2017).

Parents and carers of the child or infant will undoubtedly be in shock, therefore it is important to ensure that appropriate and timely information is shared. Responders will understand the urgency, and can often help if they are included and receive simple instructions (Stewart, 2019).

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

2.16 recognise and manage seizures, choking and anaphylaxis, providing appropriate basic life support

Part 2: Procedures for the planning, provision and management of person-centred nursing care

8. Use evidence-based, best practice approaches for meeting needs for respiratory care and support, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

8.6 manage airway and respiratory processes and equipment

Bardai A, Berdowski J, van der Werf C et al. Incidence, causes, and outcomes of out-of-hospital cardiac arrest in children. A comprehensive, prospective, population-based study in the Netherlands. J Am Coll Cardiol. 2011;57(18):1822–1828. https://doi.org/10.1016/j.jacc.2010.11.054 

Cocks AJ. Basic life support. In: Cameron P, Jelinek G, Everitt I, Browne G, Raftos J (eds.). Textbook of paediatric emergency medicine. Edinburgh: Elsevier; 2006

Everett MF, Weiner GM. Paediatric chest compressions, can we practice what we teach? Resuscitation. 2012;83(3):277–278. https://doi.org/10.1016/j.resuscitation.2011.12.032 

Greenland KB, Eley V, Edwards MJ et al. The origins of the sniffing position and the three axes alignment theory for direct laryngoscopy. Anaesth Intensive Care. 2008;36(Suppl 1):23–27. https://doi.org/10.1177/0310057X0803601s05 

Gregson RK, Cole TJ, Skellett S et al. Randomised crossover trial of rate feedback and force during chest compressions for paediatric cardiopulmonary resuscitation. Arch Dis Child. 2017;102(5):403–409. https://doi.org/10.1136/archdischild-2016-310691 

Hoo AF. The respiratory system in infancy and early childhood. In: Neil S, Knowles H (eds). The biology