If you need to use an AED on a child and pediatric pads aren’t available, use the adult pads. This is the clear guidance from the American Heart Association: an adult shock is far better than no shock at all. A child in cardiac arrest will die without intervention, so never delay defibrillation while searching for child-specific equipment.
Why Adult Pads Work in an Emergency
Pediatric pads (and pediatric keys or switches found on some AED models) reduce the energy delivered by the device. A standard adult AED delivers roughly 150 to 200 joules per shock. Pediatric systems lower that to about 50 joules, which provides an appropriate dose for smaller bodies, typically children under 8 years old weighing between about 5 and 25 kilograms.
When you use adult pads on a child, the shock will be stronger than ideal. But the heart rhythm causing cardiac arrest needs an electrical reset to return to normal, and a higher-energy shock can still accomplish that. The risk of not shocking is death. The risk of a larger-than-ideal shock is far smaller by comparison.
How to Place Adult Pads on a Child
Adult pads are physically larger than pediatric ones, and on a small child’s chest, there’s a real chance they could overlap or touch each other. If the pads touch, the electrical current can arc between them instead of traveling through the heart, making the shock ineffective. To prevent this, place one pad on the center of the chest and the other on the center of the back, between the shoulder blades. This front-and-back placement (sometimes called anterior-posterior) keeps the pads separated and still sends the current through the heart.
If the child is large enough that both pads fit on the chest without touching, you can use the standard placement shown on the pad diagrams: one on the upper right chest below the collarbone, one on the lower left side below the armpit.
The Priority Order for Children Under 8
If you have time to check the AED before applying it, look for a pediatric mode. Different AED models handle this differently. Some use a separate set of smaller pads that come with a built-in energy reducer. Others have a switch or a pediatric key that lowers the shock dose through the same adult-sized pads. Either option brings the energy down to the appropriate range for a child.
Here’s the order of preference:
- AED with pediatric dose capability: Use pediatric pads or activate the pediatric mode if the device has one.
- AED without pediatric dose capability: Use the adult pads and deliver the adult shock dose.
- No AED available: Perform CPR continuously until help arrives or an AED becomes available.
This hierarchy applies to infants as well. The same principle holds: a pediatric dose is preferred, but an adult dose is acceptable when that’s what you have.
What Happens After You Apply the Pads
The AED does the thinking for you. Once the pads are attached, the device analyzes the child’s heart rhythm and determines whether a shock is needed. Not every cardiac arrest involves a rhythm that responds to defibrillation. If the AED says “no shock advised,” that doesn’t mean the child is fine. It means the specific rhythm detected won’t benefit from a shock. Continue CPR immediately and let the AED re-analyze every two minutes.
If the AED does advise a shock, make sure no one is touching the child, press the shock button, and then resume CPR right away. Don’t wait to see if the child responds. High-quality chest compressions between shocks are critical to keeping blood flowing to the brain.
For Children 8 and Older
Children 8 years old and above are treated with adult pads and adult energy levels as standard practice. Pediatric pads are only designed for children under 8. If you’re unsure of the child’s age, using adult pads is the safe default. There’s no scenario where withholding a shock is the better choice because you’re uncertain about pad selection.
Keeping AEDs Ready for Pediatric Use
If you’re responsible for maintaining an AED in a school, daycare, sports facility, or other setting where children are present, stocking pediatric pads or ensuring your device has a pediatric mode is worth the investment. Pediatric-capable AEDs have been available in the United States since 2001, and most current models offer some form of dose reduction for younger patients. Check your AED’s manual to see whether it uses separate pediatric pads, a child key, or a software switch, and make sure that accessory is stored with the device and hasn’t expired. Pads have a shelf life, typically two to five years, and expired pads may not adhere properly or conduct the shock effectively.