An Automated External Defibrillator (AED) is a portable device used to treat sudden cardiac arrest by delivering an electrical shock to the heart. This intervention is time-sensitive, as the chance of survival decreases significantly for every minute defibrillation is delayed. While the machine provides spoken instructions, understanding proper setup and pad placement is necessary for maximum effectiveness, especially when treating an infant. For an 11-month-old, the correct positioning of the electrode pads differs markedly from adult protocols due to the child’s smaller anatomy. Knowing the precise technique ensures the electrical current reaches the heart muscle without causing harm.
Identifying the Need for Defibrillation
The decision to use an AED on an 11-month-old begins with recognizing the signs of cardiac arrest, which is often caused by respiratory failure in infants. The rescuer must first assess the child for unresponsiveness by gently tapping and speaking to them. If the infant does not respond and is not breathing normally, or is only gasping, immediate action is warranted. Current guidelines recommend beginning cardiopulmonary resuscitation (CPR) before activating the emergency medical system, especially if the child is alone with the rescuer.
Since oxygen deprivation frequently causes collapse in this age group, CPR should be initiated immediately. A second person should be directed to call for emergency help and retrieve an AED if one is nearby. The AED should be applied as soon as it becomes available, interrupting chest compressions only minimally for pad placement and rhythm analysis. The device will then automatically analyze the heart’s rhythm and determine if a shockable electrical pattern is present.
Selecting the Correct Pediatric Equipment
Using an AED on an infant requires specific equipment to safely deliver the correct amount of energy. The most appropriate choice for any child under eight years of age or weighing less than 55 pounds (25 kg) is pediatric electrode pads. These pads are smaller than adult pads, which prevents them from touching each other on the infant’s chest. More importantly, the pediatric pad system includes a dose attenuator that reduces the electrical charge delivered by the AED.
Attenuation is necessary because the adult energy dose, typically between 120 and 200 joules, is too high for an infant’s developing heart. Pediatric pads reduce this energy to a lower, safer level, often around 50 joules. Delivering an attenuated dose minimizes the risk of post-resuscitation myocardial dysfunction, which can occur if an excessive electrical charge damages the heart muscle. If pediatric pads are not immediately available, adult pads must be used, but placement must be adjusted carefully to ensure they do not overlap.
Achieving Optimal Anterior-Posterior Pad Placement
The optimal placement for AED pads on an 11-month-old is the anterior-posterior (AP) configuration, which directs the electrical current through the heart from front to back. This technique is specifically recommended for infants because their small torso size makes the standard adult placement, known as anterior-lateral, ineffective or unsafe. The AP position ensures the heart is situated directly in the path of the electrical current.
To execute this placement, the first pediatric electrode pad should be applied to the front of the infant’s body, typically over the center of the chest on the sternum, just below the collarbone. This location provides a clear pathway for the current to enter the chest cavity. The second pad is then placed on the infant’s back, positioned between the shoulder blades and slightly to the left of the spine. The goal is to sandwich the heart between the two electrodes, maximizing the chance of successful defibrillation.
The anterior-posterior arrangement is necessary to prevent the two pads from touching, which is a significant safety consideration. If the pads overlap, the electrical current will short-circuit across the pads instead of traveling through the heart muscle. This short circuit renders the shock ineffective and could potentially cause skin burns. Therefore, the AP method maintains a safe and functional distance between the pads on a small child.
Once both pads are securely placed on the bare, dry skin, they are connected to the AED, which will begin its analysis. After the AED delivers a shock, the pads should remain in place, and the rescuer must immediately resume CPR. The AP pad configuration, combined with the attenuated energy dose from pediatric pads, is the most effective approach to treating a shockable rhythm in an infant.