Pediatric CPR is cardiopulmonary resuscitation performed on infants and children, using techniques specifically adapted for smaller bodies. The core principles are the same as adult CPR (chest compressions and rescue breaths to maintain blood flow), but the compression depth, hand placement, and breathing techniques differ significantly based on the child’s age and size.
Age Groups in Pediatric CPR
Pediatric CPR covers two distinct age groups, each with its own set of techniques. According to the 2025 American Heart Association and American Academy of Pediatrics guidelines:
- Infants: younger than approximately 1 year old (not including newborns immediately after birth, who fall under separate neonatal guidelines)
- Children: approximately 1 year old until puberty, which is generally defined as breast development in females and the presence of axillary hair in males
Once a child shows signs of puberty, adult CPR guidelines apply. This matters because the transition point isn’t a specific birthday. A large 10-year-old who has entered puberty would be treated with adult techniques, while a small 12-year-old who hasn’t would still fall under pediatric guidelines.
When to Start Pediatric CPR
If a child is unresponsive and not breathing normally, CPR should begin immediately. For trained healthcare providers, there’s an additional threshold: if an infant or child has a heart rate below 60 beats per minute and is showing signs of poor blood flow (pale or bluish skin, mottled coloring) despite receiving oxygen, chest compressions should start even though the heart hasn’t fully stopped. That 60 beats-per-minute cutoff exists because a heart beating that slowly in a child often can’t circulate enough blood to sustain organ function.
For bystanders without medical training, the simpler rule applies: if the child is unresponsive and isn’t breathing, call emergency services and begin CPR right away.
Compression Technique for Infants
Infant chests are small and flexible, so the technique looks very different from adult CPR. The target compression depth is about 4 centimeters (roughly 1.5 inches), which works out to about one-third the depth of the chest from front to back.
When one rescuer is performing CPR alone, the standard method is the two-finger technique: you place two fingertips on the center of the chest, just below the nipple line, and press down. This works but has a known limitation. Because your fingers are different lengths, it takes more effort to push evenly, and rescuers tend to fatigue quickly, leading to compressions that become too shallow over time.
When two rescuers are available, the preferred method is the two-thumb-encircling technique. You wrap both hands around the infant’s torso and use your thumbs, placed side by side on the breastbone, to compress the chest. This produces more consistent depth and is less tiring. If neither finger-based method achieves adequate depth on a larger infant, using the heel of one hand is an acceptable alternative.
Compression Technique for Children
For children over 1 year old, compressions are performed on the lower half of the breastbone using the heel of one hand. For larger children, you can use two hands, just like adult CPR. Position yourself directly above the child’s chest with your arm straight, and compress to a depth of about 5 centimeters (2 inches), again roughly one-third the chest depth. The goal is the same regardless of the child’s size: push hard enough to generate meaningful blood flow without causing injury.
The compression rate for all pediatric CPR is 100 to 120 compressions per minute. That’s the same rate used for adults. A helpful reference is the tempo of the song “Stayin’ Alive,” which hits about 104 beats per minute.
Rescue Breaths and Compression Ratios
Unlike some simplified adult CPR protocols that focus on hands-only compressions, pediatric CPR includes rescue breaths. Children are more likely than adults to experience cardiac arrest from breathing problems rather than heart rhythm issues, so delivering oxygen matters more.
The compression-to-breath ratio depends on how many rescuers are present:
- One rescuer: 30 compressions followed by 2 breaths
- Two rescuers: 15 compressions followed by 2 breaths
The two-rescuer ratio delivers breaths more frequently because one person can focus entirely on compressions while the other handles breathing, making the faster cycle sustainable.
For infants, rescue breaths are given by covering both the baby’s mouth and nose with your mouth, creating a seal over the entire area. You deliver gentle puffs, just enough to make the chest visibly rise. Overinflating an infant’s lungs can cause harm, so the breaths should be small and controlled. For children, you tilt the head back slightly, lift the chin, pinch the nose, and breathe into the mouth, similar to adult technique but with less forceful breaths.
Choking That Leads to Cardiac Arrest
Choking is one of the more common reasons a child might need CPR. The 2025 guidelines updated the protocol for severe airway obstruction in children: rescuers should now alternate cycles of 5 back blows followed by 5 abdominal thrusts, repeating until the object is dislodged or the child becomes unresponsive.
If the child loses consciousness during choking, the protocol shifts to CPR. You place the child on a firm, flat surface, call emergency services on speakerphone so your hands stay free, and begin compressions and breaths. Before each set of rescue breaths, open the child’s mouth and look inside. If you can clearly see the object and can easily grasp it, remove it. Do not blindly sweep a finger through the mouth, as this can push the object deeper.
Key Differences From Adult CPR
Several differences set pediatric CPR apart from adult protocols, and they all stem from the fact that children’s bodies are smaller, their bones are more flexible, and the underlying cause of their cardiac arrest is usually different.
- Compression depth: About 4 cm for infants and 5 cm for children, compared to at least 5 cm (2 inches) for adults. The one-third chest depth rule is the simplest guide for pediatric patients.
- Hand placement: Fingers or thumbs for infants, one hand for smaller children, two hands for larger children. Adults always get two-handed compressions.
- Rescue breaths are essential: Hands-only CPR is not recommended for children. Because pediatric cardiac arrest frequently starts as a breathing emergency, delivering oxygen through rescue breaths significantly improves outcomes.
- Two-rescuer ratio changes: Adults use 30:2 regardless of how many rescuers are present. For children and infants with two rescuers, the ratio shifts to 15:2.
The compression rate of 100 to 120 per minute stays the same across all age groups. That consistency makes it easier to remember in a high-stress moment. What changes is how much force you use and how you position your hands, not how fast you push.