For infant CPR, you use two fingers (or two thumbs) placed on the center of the chest, just below the nipple line, on the lower half of the breastbone. This is different from adult CPR, where you use the heel of your hand. An infant’s chest is small and fragile, so finger-based compression gives you the control needed to push to the right depth without injuring internal organs.
Exactly Where to Place Your Fingers
Find the infant’s nipple line and imagine a horizontal line connecting both nipples across the chest. Place your fingers just below that line, on the breastbone (sternum). You want to be on the lower half of the sternum but not at the very bottom tip. That small pointed piece of cartilage at the bottom of the breastbone, called the xiphoid process, can break off or press into the liver if compressed directly. Staying just below the nipple line keeps you in the safe zone.
Which technique you use depends on whether you’re alone or have help:
- One rescuer (two-finger technique): Place two fingertips (usually your index and middle fingers) on the center of the chest, just below the nipple line. Use your other hand to support the infant’s head or hold their airway open. Press straight down.
- Two rescuers (two-thumb technique): Place both thumbs side by side on the center of the chest, just below the nipple line. Wrap your remaining fingers around the infant’s torso toward the back, encircling the chest. This grip supports the infant’s back and lets you generate more even pressure. The American Red Cross and AHA both recommend this as the preferred method when a second rescuer is available.
The two-thumb encircling technique produces more consistent compression depth and better blood pressure during CPR, which is why it’s preferred whenever two people are present. But either method works, and the most important thing is starting compressions quickly.
How Deep and How Fast to Compress
Push the chest down about 1.5 inches (4 centimeters), which is roughly one-third the depth of the infant’s chest. That may feel like a lot on a small baby, but compressions that are too shallow won’t generate enough blood flow to the brain and heart.
The target compression rate is 100 to 120 compressions per minute. Research from pediatric cardiac arrest cases found that rates in this range produced the best blood pressure during CPR. Rates above 120 per minute actually led to lower blood pressures, likely because the chest didn’t have time to fully rebound between compressions. A simple way to keep pace: compress to the beat of “Stayin’ Alive” by the Bee Gees, which runs at about 104 beats per minute.
After each compression, let the chest come all the way back up to its resting position before pushing down again. This full recoil creates a suction effect that draws blood back into the heart, refilling it for the next compression. If you lean on the chest between compressions or don’t let it rise completely, you reduce blood flow significantly. Keep your fingers (or thumbs) in contact with the skin so you don’t lose your placement, but release all downward pressure.
Compressions and Breaths: The Ratios
If you’re alone, perform 30 compressions followed by 2 breaths, then repeat. If two rescuers are present, the ratio changes to 15 compressions followed by 2 breaths. The shorter cycle with two rescuers means the infant receives more frequent ventilation, which matters because most infant cardiac arrests are caused by breathing problems rather than heart rhythm issues.
For the breaths, cover the infant’s mouth and nose with your mouth and give gentle puffs, just enough to see the chest rise. Overinflating the lungs can push air into the stomach and make ventilation less effective.
Positioning the Infant’s Head and Body
Before you begin, place the infant on their back on a firm, flat surface. A table, the floor, or even a countertop works. A soft mattress or couch cushion absorbs your compression force and reduces how much blood flow you generate.
Infant airways are easily blocked by the position of the head. Unlike adults, where you tilt the head well back, an infant’s head should stay in a neutral or very slightly extended position, sometimes called the “sniffing position.” Imagine the baby is sniffing the air: the chin lifts just slightly, and the neck extends gently. Imaging studies of infants under four months old found that a slightly extended head position gave a greater than 95% chance of keeping the airway open, while tilting the head too far back (hyperextension) actually collapsed the airway, dropping that probability below 20%. The infant’s large head relative to their body naturally pushes the chin toward the chest when lying flat, so you may need a thin rolled cloth under the shoulders to achieve that slight extension.
Key Components of High-Quality Infant CPR
The 2025 AHA and AAP guidelines identify four priorities for effective compressions: adequate depth, adequate rate, full chest recoil, and minimizing interruptions. Every pause in compressions, whether to reposition, check for a pulse, or switch rescuers, drops blood pressure rapidly. Keep pauses under 10 seconds whenever possible.
If you’re performing CPR alone and you fatigue, your compression depth will naturally decrease before you realize it. With the two-finger technique especially, the small muscles of the hand tire quickly. Switch hands if needed, or if a second person arrives, switch to the two-thumb encircling method and take turns compressing in two-minute cycles. The goal is to maintain that 1.5-inch depth consistently, which matters more than how many total minutes you can keep going without a break.
For infants, “high-quality” also means not over-ventilating. Breathing too forcefully or too often raises pressure inside the chest, which counteracts the blood-pumping effect of compressions. Gentle puffs at the prescribed intervals are enough.