Rescue breathing, often called mouth-to-mouth resuscitation, is a life-saving technique used when a child has a pulse but is not breathing adequately on their own. This intervention is designed to supply oxygen to the body and prevent damage to vital organs like the brain, which begins to occur within minutes of oxygen deprivation. Proper technique and maintaining the correct rate are necessary to ensure effective gas exchange without causing harm, providing a bridge until professional medical help arrives. Since pediatric cardiac arrests are often caused by respiratory failure, delivering timely and correct ventilations is a high-priority action in a child emergency.
Defining a Child for Rescue Protocols
In the context of cardiopulmonary resuscitation (CPR) and rescue protocols, a “child” is specifically defined to guide the rescuer in using the appropriate techniques. This category generally includes individuals from one year of age up to the onset of puberty, which is a physical development marker rather than a specific chronological age. Puberty is the point at which an individual transitions to using adult rescue protocols, largely because their physical structure, including chest size and lung capacity, has matured. Using this definition helps rescuers apply the correct force for compressions and the proper volume for breaths, as a child is not simply a small adult. For females, the onset of puberty is typically marked by breast development, while for males, it is often indicated by the presence of armpit hair.
Recommended Ventilation Rate for Standalone Rescue Breathing
When a child has a detectable pulse but is not breathing, the intervention is focused solely on providing oxygen through rescue breaths to support the circulatory system. The recommended standalone ventilation rate for a child is one breath every three to five seconds. This timing translates to approximately 12 to 20 breaths per minute, which is the necessary frequency to maintain oxygenation without causing issues from excessive ventilation. Each breath delivered should last for about one second, which is sufficient time to allow air to enter the lungs without causing air to be forced into the stomach. A practical way to maintain this rhythm is to deliver a breath, then count slowly “one thousand one, one thousand two, one thousand three,” before delivering the next breath.
Technique for Delivering Effective Rescue Breaths
Delivering an effective rescue breath requires careful attention to the child’s airway and the volume of air introduced to the lungs. The first step involves opening the airway using the head-tilt, chin-lift maneuver, which gently moves the tongue away from the back of the throat. The rescuer then pinches the child’s nose shut, uses their mouth to create a tight seal over the child’s mouth, and delivers a gentle breath. A visible rise of the child’s chest is the key indicator of an effective breath, confirming that air has entered the lungs.
The volume of air should be just enough to cause this chest rise, and not a forceful, deep breath, which helps prevent gastric inflation. Excessive force can push air into the stomach, potentially causing vomiting and aspiration, which complicates the rescue effort. After the chest rises, the rescuer should immediately remove their mouth to allow the chest to fall as the air passively exits the lungs. If the chest does not rise, the rescuer must reposition the head and attempt the breath again, as the airway may still be blocked.
Integrating Ventilation with Chest Compressions
When a child is not breathing and has no pulse, rescue breathing must be combined with chest compressions as part of Cardiopulmonary Resuscitation (CPR). The rate of ventilation changes significantly, as it is dictated by a specific compression-to-ventilation ratio rather than the standalone breathing rate. For a single rescuer performing CPR on a child, the standard ratio is 30 compressions followed by two breaths (30:2), matching the ratio used for adults. This ratio is intended to minimize interruptions to chest compressions, which are necessary to maintain blood flow to the brain and other organs.
When two rescuers are present, the guidelines recommend a ratio of 15 compressions to two breaths (15:2). This higher frequency of ventilation is used in pediatric CPR because children often experience cardiac arrest secondary to respiratory problems, meaning they are already significantly oxygen-deprived. The 15:2 ratio effectively delivers twice as many breaths per minute compared to the 30:2 ratio, addressing the child’s greater need for oxygenation during the resuscitation effort. Regardless of the ratio used, the goal remains to deliver two effective breaths, each lasting about one second, during the brief pause in chest compressions.