For a child under 8 years old or under 55 pounds, place one AED pad on the center of the bare chest and the other on the center of the back. This front-and-back positioning is the recommended approach for pediatric patients, and it works for both infants and older children. If the child is 8 or older, you can use the same pad placement as an adult.
Pediatric vs. Adult Pads
AEDs designed for adults deliver between 120 and 360 joules of energy. That’s far more than a small body needs. Pediatric pads use a built-in dose attenuator that reduces the energy output to roughly one-quarter to one-third of the adult dose, typically between 50 and 86 joules. The pads themselves are also physically smaller, with about half the surface area of adult pads.
Use pediatric pads (and a pediatric attenuator, if your AED has one) for any child under 8 years old or weighing less than 55 pounds. For children 8 and older, use standard adult pads and placement.
If pediatric pads aren’t available, use adult pads. An AED shock at adult energy levels is not ideal for a small child, but defibrillation is the only effective treatment for the cardiac rhythms an AED detects. A shock at the wrong dose is far better than no shock at all. The 2025 American Heart Association guidelines are explicit on this point: an AED without a dose attenuator may still be lifesaving.
Front-and-Back Placement for Children
The preferred method for children is called anterior-posterior placement, meaning one pad goes on the front of the body and one on the back. Here’s where to position them:
- Front pad: Place it on the center of the child’s bare chest, between the midline and the left nipple.
- Back pad: Place it on the center of the child’s back, aligned along the spine between the shoulder blades.
This front-and-back approach works well for children because their chests are small. It sends the electrical current directly through the heart from front to back, and it avoids the problem of pads being too close together on a narrow chest.
An alternative version of this same approach shifts both pads slightly to the left: the front pad sits between the left side of the breastbone and the left nipple, and the back pad goes on the left side of the back next to the spine. Both variations are acceptable.
When Side-by-Side Placement Works
Older children with larger chests can also use the standard adult positioning, called anterolateral placement. In this setup, one pad goes vertically on the upper right chest just below the collarbone, and the other goes horizontally on the left side of the chest, centered along the side of the ribcage. The key rule: the pads must be separated by at least 1 to 2 centimeters. If they’re too close or touching, the electrical current can arc between the pads across the skin instead of traveling through the heart.
A pediatric study referenced in the 2025 AHA guidelines found no difference in survival outcomes between front-and-back and side-by-side placement. So if a child’s chest is large enough to keep the pads well separated, either position is effective.
What to Do If Pads Touch or Overlap
On a very small child or infant, even pediatric pads may be too large to sit side by side without touching. If this happens, switch to front-and-back placement: one pad on the center of the chest, one on the center of the back. This applies whether you’re using pediatric or adult pads. The pads should never touch each other, regardless of which configuration you choose.
Preparing the Skin
Before attaching the pads, make sure the child’s chest is bare and dry. Moisture on the skin reduces how well the pads stick and increases electrical resistance, which can weaken or prevent an effective shock. If the child is wet from swimming, rain, or sweat, quickly wipe the chest and back dry with a towel or clothing before applying the pads. Remove any medication patches on the chest as well, since they can interfere with energy delivery or cause burns.
Pads need firm, direct contact with the skin. Press each pad down smoothly to eliminate air pockets. A pad that’s peeling or poorly adhered won’t conduct the shock properly.
Step-by-Step During an Emergency
When you open an AED, it will give you voice prompts. The device walks you through each step, but knowing the pad placement in advance saves critical seconds. Here’s the sequence:
- Turn on the AED and open the pad packaging.
- Expose the child’s chest. Remove or cut away clothing. Dry the skin if wet.
- Apply the pads. Peel off the backing and press each pad firmly onto the skin in the front-and-back position. Follow any diagrams printed on the pads.
- Let the AED analyze. Make sure no one is touching the child while the device checks the heart rhythm.
- Deliver the shock if prompted. Announce “clear,” confirm no one is in contact with the child, and press the shock button.
- Resume CPR immediately after the shock, starting with chest compressions.
Attaching the AED as soon as it’s available is critical. Every minute without defibrillation during a shockable cardiac arrest reduces the chance of survival. The AED will only deliver a shock if it detects a rhythm that requires one, so there’s no risk of shocking a child who doesn’t need it.
Infants Under 1 Year Old
AEDs can be used on infants. The same front-and-back placement applies: one pad centered on the chest, one centered on the back. Use pediatric pads with a dose attenuator if available. If only adult pads are on hand, use them in the front-and-back position to prevent the pads from touching on the infant’s small torso. The AHA confirms this approach for infants when no other option exists.