The recommended compression-to-ventilation ratio for infant and child CPR is 30:2 for a single rescuer and 15:2 when two rescuers are present. These ratios, established by the American Heart Association, apply to all pediatric patients from infancy through puberty. Understanding which ratio to use, and how the technique changes based on the situation, can make the difference in keeping blood and oxygen flowing until help arrives.
Single Rescuer: 30 Compressions to 2 Breaths
If you are alone with an infant or child who is unresponsive and not breathing normally, the ratio is 30 compressions followed by 2 breaths. This is the same ratio used in adult CPR, and the reasoning is practical: a lone rescuer needs a simple, consistent rhythm to maintain effective compressions without frequent pauses. Each cycle of 30 compressions and 2 breaths counts as one round, and you continue cycling without stopping until emergency medical services arrive or a second rescuer joins you.
Before starting compressions, check for a pulse for no more than 10 seconds. If you don’t feel a pulse, or you’re not sure, begin CPR immediately. For infants (under 1 year old), use two fingers placed on the center of the chest. For children (roughly age 1 through puberty), use one or both hands on the center of the chest, depending on the child’s size.
Two Rescuers: 15 Compressions to 2 Breaths
When a second trained rescuer is available, the ratio drops to 15:2. One person performs chest compressions while the other keeps the airway open and delivers breaths. The lower ratio means the child receives more breaths per minute relative to compressions, which matters because cardiac arrest in children is more often caused by a breathing problem than a heart rhythm problem. More frequent ventilation helps address that underlying cause.
The AHA’s pediatric algorithm spells this out clearly: the first rescuer begins with cycles of 30 compressions and 2 breaths, and when the second rescuer returns (for example, after calling 911), they switch to 15:2 cycles. The rescuers should swap roles roughly every two minutes to prevent fatigue, since compression quality drops quickly when someone is tired.
Compression Depth and Rate
The ratio is only effective if the compressions themselves are high quality. For infants, push to a depth of about 1½ inches (approximately 4 cm) using two fingers on the breastbone, just below the nipple line. For children, compress at least one-third the depth of the chest, which works out to roughly 2 inches (5 cm). In both cases, the target rate is 100 to 120 compressions per minute.
Let the chest fully recoil between each compression. Incomplete recoil reduces the heart’s ability to refill with blood, which means less oxygen reaches the brain and organs. Push hard, push fast, and come all the way back up.
When an Advanced Airway Is in Place
In a hospital or advanced prehospital setting, once a breathing tube or similar device is placed, the approach changes. Compressions become continuous at the same 100 to 120 per minute rate, and breaths are delivered independently at a rate of 20 to 30 breaths per minute. The rescuers no longer pause compressions to deliver breaths, because the airway device allows both to happen simultaneously. This protocol comes from the 2025 AHA and American Academy of Pediatrics guidelines.
Rescue Breathing Without Compressions
If a child or infant has a pulse but is not breathing normally, you provide rescue breaths only. The recommended rate is 20 to 30 breaths per minute for infants and children, which works out to roughly one breath every 2 to 3 seconds. Recheck the pulse approximately every 2 minutes. If the pulse disappears or you’re no longer confident it’s there, begin full CPR with compressions.
Why Ventilations Matter More in Pediatric CPR
In adults, sudden cardiac arrest usually stems from an electrical problem in the heart, and compression-only CPR can be effective in the first minutes. Children are different. Most pediatric cardiac arrests start as respiratory events: choking, drowning, asthma, or infection. By the time the heart stops, the child’s oxygen levels have already been low for some time. That’s why breaths are a critical part of pediatric CPR across all guidelines, and why two-rescuer teams use the 15:2 ratio to deliver ventilations more frequently.
Quick Reference by Scenario
- One rescuer, infant or child: 30 compressions, then 2 breaths
- Two rescuers, infant or child: 15 compressions, then 2 breaths
- Advanced airway in place: Continuous compressions at 100 to 120 per minute, with 20 to 30 breaths per minute delivered separately
- Pulse present, not breathing: 20 to 30 breaths per minute (no compressions)
These ratios apply from birth through puberty. Once a child shows signs of puberty, adult CPR guidelines take over, and the ratio becomes 30:2 regardless of the number of rescuers.