When assisting a victim with breathing, you provide rescue breaths to someone whose breathing has stopped or become dangerously inadequate. The core technique involves tilting the head back, sealing your mouth over theirs, and delivering slow, steady breaths that make the chest visibly rise. The exact rate, method, and approach depend on whether the person has a pulse, their age, and the cause of the emergency.
When Rescue Breathing Is Needed
Rescue breathing is specifically indicated when a person is unresponsive and not breathing normally but still has a detectable pulse. This is different from full cardiac arrest, where the heart has stopped and chest compressions become the priority. A person who gasps occasionally or breathes in an irregular, labored pattern is not breathing normally and needs help.
Several situations commonly require rescue breathing. Drowning victims almost always need ventilation because their emergency begins with oxygen deprivation, not a heart problem. The same is true for children in cardiac arrest, where the cause is usually respiratory (choking, suffocation, or illness that shuts down breathing) rather than a sudden heart rhythm failure. Opioid overdoses also suppress breathing first, making ventilation critical while waiting for naloxone to take effect. For adults who collapse from a sudden cardiac event with no obvious respiratory cause, hands-only CPR (compressions without breaths) is the current recommendation for untrained bystanders.
How to Open the Airway
Before giving any breaths, you need a clear path for air to reach the lungs. When someone is unconscious, the tongue can fall backward and block the throat. The standard technique to fix this is called the head-tilt, chin-lift:
- Place one palm on the person’s forehead and gently tilt the head backward.
- With your other hand, lift the chin forward by pressing under the bony part of the jaw. This pulls the tongue away from the back of the throat.
- Keep the mouth open using your thumb on the chin hand.
If you suspect a neck or spinal injury (from a fall, car accident, or diving incident), minimize head movement. In that case, use a jaw-thrust maneuver instead: place your fingers behind the angles of the jaw on both sides and push the jaw forward without tilting the head.
Giving Mouth-to-Mouth Breaths
Once the airway is open, pinch the person’s nose shut between your index finger and thumb (using the hand already on the forehead). Take a normal breath, not an exaggerated deep one. Cover and seal the person’s mouth completely with yours and blow steadily for about one second. Watch their chest as you do this. It should rise visibly, like a normal breath filling the lungs.
After that first breath, pull your mouth away and let the chest fall as air escapes. If the chest rose, give the second breath the same way. If it did not rise, reposition the head with another head-tilt, chin-lift before trying the second breath. A chest that won’t rise usually means the airway isn’t open enough or there’s an obstruction.
Each breath should last about one second. Blowing too hard or too fast is one of the most common mistakes, and it leads to a real problem: air gets forced into the stomach instead of the lungs. This stomach inflation can trigger vomiting, which then risks aspiration into the lungs. It can also push up on the diaphragm, making it harder for air to reach the lungs on subsequent breaths. Gentle, steady, one-second breaths are far more effective than forceful ones.
Breathing Rates for Adults vs. Children
The correct rate of breathing depends on the person’s age and whether they have a pulse.
For an adult with a pulse but inadequate breathing, the current guideline is one breath every 6 seconds, which works out to about 10 breaths per minute. You deliver each breath over one second, then count to five before the next one.
Children and infants need a faster rate. The recommendation for infants and children who have a pulse but aren’t breathing adequately is one breath every 2 to 3 seconds, producing 20 to 30 breaths per minute. Their smaller lungs cycle oxygen faster, so they need more frequent ventilation. Once a child shows signs of puberty, you switch to the adult guidelines.
During full CPR with compressions, the ratio changes. You alternate 30 chest compressions with 2 rescue breaths, keeping each breath to one second to minimize the pause in compressions.
Breathing for a Person With a Stoma
Some people breathe through a permanent opening in the front of their neck called a stoma, typically from a prior surgery on their airway. For these individuals, mouth-to-mouth won’t work because air won’t reach the lungs through the usual route. Instead, you seal the person’s mouth and nose shut with one hand, place your mouth directly over the stoma, form a tight seal, and breathe slowly into it. Watch for the chest to rise, then pull away and let the air escape. The rate is the same: one breath every 6 seconds for adults, every 2 to 3 seconds for children.
Rescue Breathing During an Opioid Overdose
Opioid overdoses suppress the brain’s drive to breathe, so a person may be taking only a few shallow breaths per minute or none at all. Their lips and fingertips often turn blue. If you have naloxone available (the medication that reverses opioid effects), give it, but don’t wait for it to work before starting rescue breaths. Naloxone can take several minutes to restore normal breathing, and the brain suffers damage quickly without oxygen.
Open the airway, reposition the head if needed, and begin providing rescue breaths while someone else administers naloxone. Continue reassessing responsiveness and breathing between breaths. If the person stops having a pulse or you can’t detect one, transition to full CPR with compressions.
Common Mistakes That Reduce Effectiveness
The biggest errors during rescue breathing are blowing too hard, blowing too fast, and failing to maintain a proper seal. Any of these reduces the amount of air that actually reaches the lungs.
Blowing too forcefully is especially problematic. Excess air pressure overcomes the natural barrier between the airway and the esophagus, sending air into the stomach. Research shows this gastric inflation can reduce blood return to the heart, shrink the lungs’ capacity, and trigger regurgitation. If the person vomits, you need to turn them on their side, clear the mouth, and reposition before continuing.
Another common mistake is not tilting the head back far enough. An inadequate head-tilt leaves the tongue partially blocking the airway, so your breaths meet resistance and the chest doesn’t rise. If your first breath doesn’t produce visible chest rise, re-do the head-tilt before the second attempt rather than blowing harder.
Finally, people sometimes forget to let the chest fully deflate between breaths. Pulling your mouth away and pausing gives the lungs time to passively empty. Stacking breaths on top of each other traps air and raises pressure in the chest, which impairs circulation.