When a child is found unresponsive, quickly assessing circulation is essential, as delays in recognizing cardiac arrest decrease survival chances. Since anatomy and size change with age, the most reliable location to check for a pulse varies across different age groups. Following established guidelines ensures an accurate assessment before initiating life support measures.
Defining Pulse Check Locations by Age
Standard medical protocols categorize patients by age to determine the appropriate pulse check site. For an infant (under one year of age), the recommended site is the brachial artery, located on the inside of the upper arm between the shoulder and the elbow.
The brachial pulse is preferred because it is easily accessible and palpable on their small limbs. Its location prevents the rescuer from having to manipulate the infant’s head and neck, which can be unstable.
In contrast, a child (ages one year up to puberty), including a seven-year-old, requires a different approach. For this age group, the circulation check should be performed at a central site like the carotid or femoral artery. The carotid artery provides a stronger, more reliable pulse in older children compared to peripheral sites like the wrist, ensuring that even a weak pulse can be accurately assessed.
Proper Technique for Assessing the Pulse
The technique for assessing circulation must be precise to avoid damaging tissue or missing a faint pulse. Rescuers should use the pads of their index and middle fingers, avoiding the thumb, which has its own noticeable pulse that could lead to a false reading. Apply gentle yet firm pressure to the artery, taking care not to press too hard, especially in infants, where excessive pressure can obstruct blood flow completely.
The pulse must be checked for a minimum of five seconds but no longer than ten seconds. For the carotid pulse on a seven-year-old, the fingers should be slid into the groove beside the trachea (windpipe), near the side of the neck closest to the rescuer.
Only check one side of the neck at a time when assessing the carotid pulse to prevent reducing blood flow to the brain. Once the pulse is located, the rescuer focuses only on the presence or absence of the beat, not attempting to count the rate during this initial emergency check.
Emergency Response After Pulse Assessment
The pulse assessment dictates the immediate next steps in the emergency protocol. If a pulse is present but the child is not breathing, the rescuer should immediately begin rescue breathing, administering one breath every three to five seconds. This supports oxygenation while the heart continues to circulate blood.
If the child is unresponsive and no pulse is detected within the ten-second check, or if the pulse rate is less than 60 beats per minute with signs of poor perfusion, immediate action is required. The rescuer must begin chest compressions and cardiopulmonary resuscitation (CPR) right away.
Emergency medical services must be activated by calling 911 or the local emergency number as soon as possible. If a lone rescuer finds an unwitnessed collapse, they should perform two minutes of CPR before pausing to call for help and retrieve an Automated External Defibrillator (AED).