Pediatric CPR and infant CPR are not the same. “Pediatric” is the umbrella category that covers everyone from newborns through puberty, and within it, there are two distinct sets of techniques: one for infants (under 1 year old) and one for children (age 1 through puberty). The differences matter because an infant’s body is significantly smaller and more fragile, requiring different hand positions, compression depths, and airway techniques than those used for an older child.
How Age Groups Are Defined
The 2025 American Heart Association and American Academy of Pediatrics guidelines draw a clear line at approximately 1 year of age. Infant CPR applies to babies younger than 1 year (excluding newborns in the delivery room, who have their own separate protocol). Child CPR applies from about age 1 until puberty, which for training purposes is defined as breast development in females and the presence of axillary hair in males. Once a young person shows signs of puberty, adult CPR guidelines apply.
These cutoffs aren’t arbitrary. They reflect real differences in body size, chest wall stiffness, and the most common reasons a child’s heart stops, all of which change how effective each technique is.
Chest Compressions: Technique and Depth
This is where infant and child CPR differ the most. For both groups, the goal is to compress the chest at least one third of its front-to-back depth. In practice, that works out to about 1.5 inches (4 cm) for infants and about 2 inches (5 cm) for children.
For infants, the 2025 guidelines recommend either a one-hand technique or the two-thumb encircling hands technique, where you wrap both hands around the baby’s torso and press with your thumbs on the breastbone. The older two-finger method, which many people learned in previous classes, has been eliminated from the guidelines because it consistently failed to reach adequate compression depth.
For children, you use one or two hands placed on the lower half of the breastbone, the same positioning as adult CPR but scaled to the child’s size. A smaller child may only need one hand. A larger child approaching puberty may need two. The key difference from infant CPR is that you’re pressing with the heel of your hand rather than your thumbs or fingers, and you can generate significantly more force.
Rescue Breaths and Airway Position
Infants and children both receive rescue breaths during CPR, but the delivery differs in two important ways. For an infant, you tilt the head to a neutral position (imagine the baby looking straight at the ceiling) and seal your mouth over both the baby’s mouth and nose at the same time. For a child, you tilt the head slightly past neutral, a bit further back, and deliver breaths mouth to mouth with the nose pinched shut, just as you would for an adult.
Each breath should last about 1 second and deliver just enough air to make the chest visibly rise. Overinflating is a real risk with infants because their lungs are tiny. If the first breath doesn’t produce a chest rise, retilt the head and check your seal before trying again.
Where to Check for a Pulse
Before starting compressions, you need to check whether the heart is still beating. For children, you check the carotid pulse on the side of the neck, the same spot used in adults. For infants, the neck is too short and chubby to reliably find a carotid pulse, so you check the brachial pulse on the inside of the upper arm, between the elbow and shoulder. In either case, take no more than 10 seconds. If you can’t feel a pulse or aren’t sure, start compressions.
Compression-to-Breath Ratios
The ratio of compressions to breaths is actually the same for infants and children, and it depends on how many rescuers are present rather than the patient’s age. A single rescuer performs 30 compressions followed by 2 breaths. When a second rescuer arrives, the ratio shifts to 15 compressions and 2 breaths, allowing for more frequent ventilation. This 15:2 ratio for two rescuers is one of the key ways pediatric CPR (both infant and child) differs from adult CPR, which stays at 30:2 regardless of how many people are helping.
Calling for Help: The Two-Minute Rule
If you’re alone with an infant or child who isn’t breathing, you perform CPR first, then call 911. Specifically, you complete five cycles of compressions and breaths (about two minutes) before stopping to call for help or grab an AED. This is the opposite of adult CPR, where you call 911 first. The reasoning is that cardiac arrest in children and infants is usually caused by a breathing problem rather than a heart rhythm issue, so getting oxygen circulating immediately gives them the best chance.
If someone else is with you, one person should call 911 right away while the other starts CPR. The 2025 guidelines also recommend using an AED with a pediatric dose attenuator as soon as one is available, for both infants and children.
Choking Response Also Differs
The updated 2025 guidelines also clarify a difference in how to handle a choking infant versus a choking child. For infants with a severe airway obstruction, you alternate 5 back blows with 5 chest thrusts. Abdominal thrusts (the Heimlich maneuver) are never used on infants because of the risk of injuring internal organs. For children, you alternate 5 back blows with 5 abdominal thrusts, similar to the adult approach.
Quick Comparison
- Age range: Infant CPR covers birth to 1 year. Child CPR covers age 1 to puberty.
- Compression technique: One hand or two-thumb encircling for infants. Heel of one or two hands for children.
- Compression depth: 1.5 inches (4 cm) for infants. 2 inches (5 cm) for children.
- Rescue breaths: Mouth over mouth and nose for infants. Mouth to mouth for children.
- Head tilt: Neutral position for infants. Slightly past neutral for children.
- Pulse check location: Inside of the upper arm for infants. Side of the neck for children.
- Choking response: Back blows and chest thrusts for infants. Back blows and abdominal thrusts for children.
- Compression-to-breath ratio: Identical for both. 30:2 with one rescuer, 15:2 with two.
Both infant and child CPR fall under the pediatric umbrella, and they share the same core principles: compress hard, ventilate early, and don’t delay. But the specific techniques are adapted to the size and anatomy of the patient. Using child techniques on an infant, or vice versa, can mean compressions that are too shallow, too forceful, or delivered in the wrong spot. If you’re getting certified or recertified, make sure your course covers both sets of skills separately.