4. Perform chest compressions:
- Place the heel of one hand on the breastbone -- just below the nipples. Make sure your heel is not at the very end of the breastbone.
- Keep your other hand on the child's forehead, keeping the head tilted back.
- Press down on the child's chest so that it compresses about 1/3 to 1/2 the depth of the chest.
- Give 30 chest compressions. Each time, let the chest rise completely. These compressions should be FAST and hard with no pausing. Count the 30 compressions quickly: "1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30, off."
5. Open the airway. Lift up the chin with one hand. At the same time, push down on the forehead with the other hand.
6. Look, listen, and feel for breathing. Place your ear close to the child's mouth and nose. Watch for chest movement. Feel for breath on your cheek.
7. If the child is not breathing:
- Cover the child's mouth tightly with your mouth.
- Pinch the nose closed.
- Keep the chin lifted and head tilted.
- Give two breaths. Each breath should take about a second and make the chest rise.
8. Continue CPR (30 chest compressions followed by 2 breaths, then repeat) for about 2 minutes.
9. After about 2 minutes of CPR, if the child still does not have normal breathing, coughing, or any movement, leave the child if you are alone and call 911. If an AED for children is available, use it now.
10. Repeat rescue breathing and chest compressions until the child recovers or help arrives.
If the child starts breathing again, place them in the recovery position. Periodically re-check for breathing until help arrives.
Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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