High-quality CPR on a child means pushing hard, pushing fast, and allowing the chest to fully spring back between compressions. The target rate is 100 to 120 compressions per minute, each one pressing the chest down at least one-third of its depth (about 2 inches). These numbers, drawn from the 2025 American Heart Association guidelines, are the foundation of effective child CPR, and every other detail builds on them.
For CPR purposes, a “child” is anyone older than one year who has not yet reached puberty. Younger than one year counts as an infant, and anyone showing signs of puberty or older follows adult protocols. The techniques below apply specifically to the child age range.
Compression Depth and Hand Placement
Each compression should push the breastbone down at least one-third of the chest’s front-to-back diameter. In most children, that works out to roughly 2 inches (about 5 cm). Research on pediatric anatomy shows that compressing to this depth does not damage organs inside the chest, and an observational study found that children whose compressions consistently reached this depth had better rates of return of circulation and 24-hour survival.
Place the heel of one hand on the lower half of the breastbone, between the nipples. For smaller children, one hand is typically enough to reach the right depth. For larger or older children, you may need to use two hands, just as you would for an adult, stacking one hand on top of the other and interlocking your fingers. The deciding factor is whether you can consistently compress deep enough. If one hand isn’t getting the job done, switch to two. Position your shoulders directly over your hands and keep your arms straight so your body weight does the work rather than your arm muscles alone.
Compression Rate and Chest Recoil
Aim for 100 to 120 compressions per minute. A common reference point: the beat of the song “Stayin’ Alive” falls right in this range. Going faster than 120 per minute tends to make compressions shallower, which defeats the purpose.
Between each compression, let the chest come all the way back up to its normal position. This full recoil is what allows the heart to refill with blood before you push down again. Leaning on the chest, even lightly, between compressions reduces how much blood the heart can pump. It’s a subtle mistake that’s easy to make when you’re tired or anxious, so stay conscious of lifting your weight completely off the chest after every push.
Minimizing Interruptions
Every second you stop compressing, blood flow to the brain and heart drops sharply. Keep pauses as short as possible. When you stop to give breaths, the break should last no more than a few seconds. If you’re switching roles with a second rescuer, coordinate the handoff so the gap is minimal.
Fatigue is one of the biggest reasons compression quality degrades. Even fit adults start losing depth and speed after about two minutes of continuous CPR. The guideline recommendation is to swap the person doing compressions every two minutes, or sooner if you feel fatigued. If you’re alone, this obviously isn’t an option, but being aware of fatigue can help you consciously maintain your effort.
Compression-to-Breath Ratios
If you’re the only rescuer, perform cycles of 30 compressions followed by 2 rescue breaths. Once a second rescuer arrives, the ratio changes to 15 compressions and 2 breaths. The shorter cycle with two people means the child receives more frequent ventilation, which matters because most cardiac arrests in children start as breathing problems rather than heart rhythm problems.
Each rescue breath should last about one second. Deliver just enough air to make the chest visibly rise. Overinflating the lungs forces air into the stomach, which can cause vomiting and make ventilation harder. If the chest doesn’t rise, reposition the head by tilting it back slightly and lifting the chin, create a tighter seal over the mouth, and try again. Both rescuers should watch the chest during breaths to confirm they’re effective.
Checking for a Pulse
If you’re trained to check for a pulse, feel for the carotid artery on the side of the neck (the groove between the windpipe and the neck muscle). You have a maximum of 10 seconds to decide whether a pulse is present. Research shows that even healthcare professionals frequently misjudge pulse checks when they take longer than this, so don’t second-guess yourself. If you’re not confident you feel a pulse within 10 seconds, start compressions.
For untrained bystanders, checking a pulse isn’t expected. If a child is unresponsive and not breathing normally, that’s your signal to begin CPR.
Putting It All Together
High-quality child CPR comes down to five things happening at once: compressions deep enough (at least one-third of chest depth), compressions fast enough (100 to 120 per minute), full chest recoil between pushes, minimal pauses, and effective breaths that make the chest rise. Missing any one of these significantly reduces the child’s chances.
The sequence when you find an unresponsive child: confirm they’re not responding and not breathing normally, call for emergency help (or have someone else call), then start compressions immediately. Compressions come before breaths. If you’re alone with no phone nearby, perform two minutes of CPR first, then go call for help and return. If an AED is available, use it as soon as possible, following the device’s voice prompts, then resume compressions immediately after a shock is delivered.