The correct pulse to check on an infant during CPR is the brachial pulse, located on the inside of the upper arm between the shoulder and the elbow. This is the standard recommended by the American Heart Association for infants under one year old. Unlike adults and older children, where you’d check the neck, infants have short, chubby necks that make a neck pulse unreliable.
Where to Find the Brachial Pulse
To locate the brachial pulse, lay the infant on their back with one arm bent so the hand is up near the ear. Place two fingers (not your thumb, which has its own pulse) on the inside of the upper arm, in the soft area between the shoulder and the elbow. Press gently until you feel a beat.
You have between 5 and 10 seconds to check for a pulse. If you don’t feel one within that window, or if the heart rate is below 60 beats per minute with signs of poor blood flow, begin CPR immediately. Spending longer than 10 seconds delays compressions in a situation where every second matters.
Why Not the Neck?
For adults and children over one year old, rescuers check the carotid pulse on the side of the neck. Infants have proportionally shorter, rounder necks with more soft tissue and fat, which makes the carotid artery extremely difficult to find reliably. The brachial artery sits closer to the skin surface in a baby’s arm and is much easier to access quickly.
Interestingly, even the brachial pulse can be hard to detect under pressure. A study of 102 people found that only 48 could correctly locate the brachial pulse, while 84 were able to detect the heartbeat by placing a bare ear directly against the infant’s chest (called the apical pulse). If you’re struggling to find the arm pulse, listening at the chest is a reasonable backup method. But the key point is: don’t delay. If the infant is unresponsive, not breathing normally, and you can’t confidently detect a pulse within 10 seconds, start compressions.
Signs That CPR Is Needed
A pulse check is just one part of the assessment. Before you get to the pulse, you’re looking at whether the infant is responsive and breathing. Tap the bottom of the foot and call out to the baby. If there’s no response and no normal breathing, call 911 (or have someone else call) and prepare to start CPR.
Warning signs that an infant is in serious trouble include a blue or gray tint to the skin (especially around the lips and face), extreme paleness, limpness, loss of consciousness, abnormal breathing patterns like gasping, and unusual stillness or unresponsiveness to touch or sound. These are signs of poor blood circulation, and they mean the body’s organs aren’t getting enough oxygen.
The threshold for starting compressions in an infant is a heart rate below 60 beats per minute with those signs of poor perfusion, or no detectable pulse at all.
How Infant CPR Differs From Adult CPR
Once you’ve confirmed the infant needs CPR, the technique is different from what you’d use on an adult. Use two fingers (your index and middle finger) placed on the center of the chest, just below the nipple line. Push down about 1½ inches deep, which is roughly one-third the depth of the infant’s chest.
If you’re alone, perform 30 compressions followed by 2 gentle breaths, then repeat. Each breath should be just enough to make the chest visibly rise. If a second rescuer is available, the ratio changes to 15 compressions and 2 breaths. Continue this cycle until emergency medical services arrive or an AED becomes available.
Compress at a rate of 100 to 120 pushes per minute. That’s fast, roughly the tempo of the song “Stayin’ Alive.” Let the chest fully recoil between each compression so blood can refill the heart before the next push.
Quick Reference
- Pulse location: Brachial artery, inside of the upper arm
- How to feel it: Two fingers pressed gently between the shoulder and elbow
- Time limit: 5 to 10 seconds maximum
- Start CPR if: No pulse detected, or heart rate below 60 bpm with signs of poor circulation
- Compression depth: 1½ inches with two fingers
- Ratio (single rescuer): 30 compressions to 2 breaths
- Ratio (two rescuers): 15 compressions to 2 breaths