When a child becomes unresponsive, the priority is to quickly and correctly assess their condition to initiate life-saving measures. Time is a significant factor in pediatric emergencies, and delayed action can dramatically reduce the chances of a positive outcome. Knowing where to check for a pulse provides the necessary information to determine the next immediate action, such as rescue breaths or chest compressions. Accurate and rapid assessment is the foundation of emergency care for an unresponsive child.
Activating Emergency Services and Ensuring Safety
Before approaching an unresponsive child, the rescuer must confirm the surrounding area is free of immediate hazards. Scene safety ensures the rescuer does not become another casualty, allowing full focus on the patient. After confirming the scene is safe, check for responsiveness by tapping the child and shouting loudly, sometimes referred to as the “Shout-Tap-Shout” protocol.
If the child does not respond, immediately call for help from anyone nearby to assist with the next steps. The protocol for activating emergency medical services (EMS) depends on whether the collapse was witnessed and if the rescuer is alone. If the collapse was sudden and witnessed, or if two or more rescuers are present, the rule is to “Call First” by immediately contacting 911 or the local emergency number. This ensures professional help is dispatched without delay.
However, if a lone rescuer finds a child who collapsed unwitnessed—which often indicates a problem with breathing preceding cardiac arrest—the guidelines recommend providing two minutes of care first. This “Care First” approach involves delivering five cycles of Cardiopulmonary Resuscitation (CPR) before pausing to call EMS. After the call, the rescuer should immediately return to the child and resume providing care until help arrives.
Proper Technique for Locating a Pulse (Infant vs. Child)
The location for checking a pulse varies significantly depending on the child’s age. For any unresponsive child, the pulse check must be performed quickly, taking no less than five seconds and no more than ten seconds. Spending too much time searching for a pulse delays the initiation of chest compressions, which are necessary if the pulse is absent.
For an infant, defined as a child under one year of age, the pulse is best checked at the brachial artery. This artery runs along the inside of the infant’s upper arm, positioned between the elbow and the shoulder. To check for the pulse, the rescuer should use two fingers and press gently in this area. The brachial artery is preferred for infants because it is usually easier to locate and palpate than other sites.
For a child one year of age or older, the recommended location is the carotid artery in the neck or the femoral artery in the groin. To check the carotid pulse, place two or three fingers in the groove between the trachea (windpipe) and the large muscles on the side of the neck closest to the rescuer. Gentle pressure must be applied to avoid compressing the airway.
The femoral artery is another reliable location for older children, situated in the crease where the thigh meets the abdomen. The rescuer should use two or three fingers to press firmly in the middle of this crease to detect a pulse. Checking the pulse at these sites is more reliable than checking the radial pulse at the wrist, which can be difficult to feel in an emergency.
Immediate Actions Following Pulse Assessment
The next immediate action is entirely dependent on the findings of the pulse and breathing assessment. If the child has a detectable pulse but is not breathing or is only exhibiting gasping, rescue breathing must be started immediately. Providing rescue breaths helps to oxygenate the blood.
Rescue breathing involves delivering one breath every three to five seconds, resulting in 12 to 20 breaths per minute. Each breath should be delivered gently, lasting about one second, and should be just enough to cause the child’s chest to visibly rise. The pulse should be rechecked approximately every two minutes to monitor the child’s condition.
If the pulse is completely absent, or if the heart rate is less than 60 beats per minute and the child shows signs of poor perfusion, the rescuer must transition immediately to full CPR. Poor perfusion signs can include pale or mottled skin and a slow capillary refill. A heart rate below this threshold is too slow to effectively circulate blood and indicates starting chest compressions combined with rescue breaths.
While awaiting the arrival of EMS, maintaining an open airway is a continuous priority. The head-tilt/chin-lift maneuver helps to keep the tongue from blocking the airway, especially when providing rescue breaths. Early assessment, rapid activation of EMS, and immediate life support measures significantly improve the chance of survival for an unresponsive child.