To perform chest compressions on a child, place the heel of one hand on the center of the breastbone just below the nipple line, lock your elbow, and push down about 2 inches at a rate of 100 to 120 compressions per minute. The technique is similar to adult CPR but uses less force and, in many cases, only one hand. Here’s how to do it step by step.
Who Counts as a “Child” for CPR
CPR guidelines define a child as anyone from age 1 up to the onset of puberty. The physical markers matter more than a specific birthday: puberty is defined as breast development in females and the presence of armpit hair in males. Once a child shows those signs, you follow adult CPR guidelines instead. For anyone younger than 1 year, infant CPR techniques apply, which use two fingers rather than a full hand.
Check for Responsiveness First
Before starting compressions, tap the child’s shoulders and shout their name. If they don’t respond, call 911 (or have someone else call) and check for breathing and a pulse at the same time. You have 10 seconds to feel for a pulse. If you can’t find one within that window, or you’re not sure, begin chest compressions immediately. Waiting longer than 10 seconds delays the blood flow the child’s brain and organs need.
Hand Placement on the Chest
Place the heel of one hand on the child’s breastbone, just below the nipple line. Make sure your hand isn’t at the very tip of the breastbone, where the bone tapers off toward the belly. That lower tip can break or press into internal organs if compressed. The heel of your hand should sit squarely on the flat, firm part of the sternum in the center of the chest.
For most children between 1 and 8, one hand provides enough force. For larger or older children, you can place your second hand on top of the first, interlocking your fingers, just as you would for an adult. The deciding factor is whether you can push deep enough with one hand. If you can’t reach the right depth, use two.
How to Compress
Position yourself directly over the child’s chest so your shoulder is above your hand. Lock your elbow straight. This “elbow-lock” technique lets you use your upper body weight rather than arm strength alone, which reduces fatigue and keeps your compressions consistent. Push straight down, as close to a 90-degree angle to the chest as possible.
Each compression should push the chest down about 2 inches, which is roughly one-third the depth of the child’s chest. Push hard enough to hit that depth on every compression. People performing CPR for the first time commonly push too gently out of fear of hurting the child, but compressions that are too shallow won’t generate enough blood flow to keep the brain alive.
Compress at a rate of 100 to 120 times per minute. That’s roughly two compressions per second, or about the tempo of the song “Stayin’ Alive.” Count out loud if it helps you keep rhythm.
Why Full Chest Recoil Matters
After each compression, let the chest come all the way back up to its normal position before pushing down again. This full recoil is what draws blood back into the heart between compressions. If you lean on the chest or don’t fully release, the heart can’t refill, and the next compression pumps less blood. Think of it as a two-part action: push hard, then completely release. Your hand can stay in contact with the chest, but it shouldn’t put any weight on it during the release phase.
Compressions and Breaths Together
If you’re alone with the child, perform 30 compressions followed by 2 rescue breaths. Tilt the child’s head back slightly, lift the chin, seal your mouth over theirs, and give two breaths, each lasting about one second. Watch for the chest to rise with each breath. Then immediately resume compressions. Each cycle of 30 compressions and 2 breaths takes roughly 24 seconds.
If a second rescuer arrives, switch to a ratio of 15 compressions to 2 breaths. The shorter cycle means the child gets ventilation more frequently, which is important because cardiac arrest in children is more often caused by breathing problems than by heart rhythm issues. Swap roles every 2 minutes or whenever the compressor gets tired. Fatigue causes compression depth to drop, often without the rescuer noticing.
If you’re unwilling or unable to give rescue breaths, continuous chest compressions alone are still far better than doing nothing.
The Surface Under the Child
A firm, flat surface gives you the best compression quality. If the child is on the floor, you’re in good shape. If they’re on a bed or couch, the mattress absorbs some of your force, which means your compressions may not reach the full 2-inch depth. You can compensate by pushing harder, but moving the child to the floor is the simplest fix when possible. In hospital settings, backboards placed under the patient offer only a marginal improvement in depth, so if you’re at home and can’t easily move the child, just increase your effort and keep going.
Using an AED on a Child
If an automated external defibrillator is available, use it as soon as possible. Turn it on and follow the voice prompts. Place one pad on the upper right chest and the other on the lower left chest. For smaller children, the pads may be too close together in this position. If that happens, place one pad on the front of the chest and one on the back between the shoulder blades.
Many AEDs come with pediatric pads or a pediatric dose setting that delivers a lower energy shock appropriate for a child’s smaller body. Use these if they’re available. If only adult pads are available, use them anyway. An AED shock with adult pads is better than no shock at all. Resume compressions immediately after the AED delivers a shock or advises that no shock is needed.
Minimizing Interruptions
The single most important thing you can do during child CPR is keep compressions going with as few pauses as possible. Every time you stop pressing, blood flow to the brain drops to near zero, and it takes several compressions to build pressure back up. Limit pauses for breaths to under 10 seconds. If an AED is analyzing the heart rhythm, that’s a necessary pause, but start compressing again the instant the machine clears you. The goal is to spend at least 80% of total CPR time actively compressing the chest.