Child CPR follows a specific sequence: check for responsiveness, call for help, give 30 chest compressions followed by 2 rescue breaths, and repeat. The technique differs from adult CPR in important ways, including hand placement, compression depth, and when to call 911. These guidelines apply to children from age 1 through puberty (or up to about 120 pounds). Below age 1, infant CPR protocols apply instead.
Witnessed vs. Unwitnessed Collapse
The very first thing you do depends on what happened. Most cardiac arrests in children stem from breathing problems rather than a sudden heart rhythm issue, so the priority is getting oxygen to the brain as fast as possible.
If you find a child already unresponsive, or if the collapse wasn’t sudden, start CPR immediately. Do 2 minutes of CPR (about 5 cycles of compressions and breaths) before pausing to call 911 or send someone else to call. This “CPR first” approach gives the child the best chance because the arrest likely started with an airway or breathing problem.
If you witness a child suddenly collapse, especially during sports or physical activity, the cause is more likely an electrical problem in the heart. In that case, call 911 first (or shout for someone else to call) and grab an AED if one is nearby, then begin CPR. The AED may be what saves that child’s life.
If another person is with you, one of you should start CPR while the other calls 911 and retrieves an AED. This eliminates the need to choose.
Check for Responsiveness and Breathing
Tap the child’s shoulders firmly and shout, “Are you okay?” If the child doesn’t respond, look at their chest for normal breathing for no more than 10 seconds. Gasping is not normal breathing. If the child is unresponsive and not breathing normally, they need CPR.
Place the child on their back on a firm, flat surface. If you suspect a spinal injury, move them as little as possible while still getting them flat.
Chest Compressions: Depth, Rate, and Hand Position
Place the heel of one hand in the center of the child’s chest, right on the breastbone. Put your other hand on top with fingers interlaced and lifted off the chest. Position your shoulders directly above your hands, lock your elbows, and keep your arms straight. For a smaller child, one hand is enough. Use whichever approach lets you push hard enough.
Push down hard and fast, compressing the chest about 2 inches (roughly one third of the chest depth). The rate should be 100 to 120 compressions per minute. That’s slightly faster than one push per second. A common reference is the beat of the song “Stayin’ Alive.”
Let the chest come all the way back up between each compression. This full recoil lets the heart refill with blood. Leaning on the chest between pushes, even slightly, reduces how much blood gets circulated. After every 30 compressions, give 2 rescue breaths.
How to Give Rescue Breaths
Tilt the child’s head back by placing one hand on the forehead and lifting the chin with two fingers of your other hand. This opens the airway. Pinch the child’s nose shut, seal your mouth over theirs, and blow steadily for about 1 second. Watch for the chest to rise. If it does, that breath was effective.
If the first breath doesn’t make the chest rise, retilt the head and check your seal before giving the second breath. If the chest still doesn’t rise, something may be blocking the airway. Continue compressions, which can help dislodge an obstruction, and check the mouth for visible objects before your next attempt at breaths.
Give 2 breaths, then go right back to compressions. Each cycle of 30 compressions and 2 breaths should take roughly 24 seconds. Don’t over-inflate the lungs. You’re aiming for a visible chest rise, not a full adult-sized breath.
The Compression-to-Breath Ratio
If you are alone, use a 30:2 ratio: 30 compressions, then 2 breaths. Complete 5 full cycles (about 2 minutes), then call 911 if you haven’t already.
If two trained rescuers are present, the ratio changes to 15:2. One person delivers compressions while the other gives breaths. This higher ventilation rate reflects the fact that children’s cardiac arrests are often caused by breathing failure, so more frequent breaths improve outcomes. Switch roles every 2 minutes to avoid fatigue, since tired rescuers deliver shallower compressions.
Using an AED on a Child
The 2025 American Heart Association guidelines recommend applying an AED as soon as one is available, without delay. Turn the AED on and follow the voice prompts. Use pediatric pads (sometimes called a pediatric attenuator) if the AED has them. These deliver a lower energy shock sized for a child’s heart. If pediatric pads aren’t available, use standard adult pads.
Place one pad on the upper right chest and the other on the lower left chest. For smaller children, if the pads risk touching or overlapping, place one pad on the center of the chest and the other on the center of the back. The AED will analyze the heart rhythm and tell you whether a shock is advised. Don’t touch the child during analysis or shock delivery. Resume CPR immediately after the shock, starting with compressions.
Choking That Leads to Cardiac Arrest
If a child is choking and becomes unresponsive, the 2025 guidelines recommend repeated cycles of 5 back blows alternating with 5 abdominal thrusts (the Heimlich maneuver) for children over age 1. If the child loses consciousness, lower them to the ground and begin CPR. Each time you open the airway to give breaths, look in the mouth for the object. Remove it only if you can see it clearly.
How Long to Continue CPR
Keep performing CPR until one of three things happens: the child starts breathing or moving, emergency medical services arrive and take over, or an AED delivers a shock and the child responds. If you’re exhausted and alone, even imperfect compressions are better than stopping entirely. Compression quality tends to decline after about 2 minutes of continuous effort, so if a second person is available, switch off regularly.
What to Expect Physically
Effective chest compressions require real force, and it’s normal to feel anxious about pushing too hard on a child. Cracked or bruised ribs can happen even with correct technique. This is a known and accepted possibility during CPR, not a sign you’re doing something wrong. Good Samaritan laws in every U.S. state protect bystanders who provide emergency care in good faith, including situations where a rib is fractured during compressions. If a parent is present, get their verbal consent before starting. If no parent is available and the child is unresponsive, consent is implied by the emergency.
The single most important thing you can do is push hard, push fast, and minimize any pauses. Even brief interruptions in compressions cause blood pressure to drop rapidly. Every second of chest compression keeps oxygenated blood flowing to the brain and vital organs, and that circulation is what gives the child the best chance of survival.