Pediatric CPR and Choking

2025 AHA Pediatric Basic Life Support

Pediatrics

Who counts as what

Infant: under 1 year (excluding newborns at birth).
Child: 1 year to puberty (breast development in girls, underarm hair in boys).
Adolescents after puberty: use adult BLS.

Check

Pulse: brachial (infant), carotid or femoral (child), up to 10 sec.
Start compressions if no pulse, or HR <60 with poor perfusion despite good ventilation.

Compressions

Rate	100–120/min, full recoil
Depth	At least ⅓ of chest depth: ~1.5 in (4 cm) infant, ~2 in (5 cm) child
Ratio	30:2 one rescuer · 15:2 two rescuers
Infant hands Updated	Two-thumb encircling hands, or the heel of one hand. The two-finger technique is no longer recommended (2025)
Child hands	One or two hands, lower half of sternum

Breathing

Pulse present but not breathing well: 1 breath every 2–3 sec (20–30/min).
With an advanced airway during CPR: 1 breath every 2–3 sec, compressions continuous.
Just enough to make the chest rise. Over-ventilation is harmful.

Calling for help and the AED

Alone, unwitnessed arrest: give 2 min of CPR first, then call and get the AED (likely respiratory cause).
Sudden witnessed collapse: call and get the AED first (likely cardiac).
AED: pediatric pads or dose attenuator for children <8 years if available; otherwise use adult pads (front and back if they would touch).

Choking (foreign-body airway obstruction)

Infant, responsive

5 back blows (face-down along your forearm, head lower than chest) then 5 chest thrusts; repeat.
No abdominal thrusts in infants.

Child, responsive

Back blows and abdominal thrusts: alternate cycles of 5 and 5 (2025 AHA) until the object comes out or the child becomes unresponsive.

If they become unresponsive

Lower to the floor, call for help, start CPR (compressions).
Before each set of breaths, look in the mouth: remove an object only if you can see it.
No blind finger sweeps.

A child who can cough forcefully or cry: let them keep coughing and stay with them.

PALS doses to recognize

Epinephrine	0.01 mg/kg IV/IO (0.1 mL/kg of 0.1 mg/mL) every 3–5 min
Amiodarone	5 mg/kg (VF/pulseless VT)
Defibrillation	2 J/kg, then 4 J/kg (max 10 J/kg or adult dose)
Fluid bolus	10–20 mL/kg isotonic crystalloid; reassess after each

Memory hook "Two hands, two thumbs, 15:2 for two." Infants: two-thumb encircling (or heel of one hand). Two rescuers on a child or infant: 15 compressions to 2 breaths.