What is the correct hand placement when giving chest compression during CPR on an unconscious child?

If you see a teen or adult suddenly collapse, hands-only CPR is the recommended form of cardiopulmonary resuscitation (CPR). It not only increases the likelihood of surviving breathing and cardiac emergencies that occur outside of medical settings, but it's simple to learn and easy to remember. For a refresher any time, you can print up this page and keep it with the rest of your first-aid supplies.
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Before Giving CPR

1

Check the scene and the person. Check to make sure the scene is safe, tap the person on the shoulder to see if they're OK, and look for signs of rhythmic, normal breathing.

2

Call 911 for assistance. If there's no response from the victim when asked if he or she is OK, call 911, or ask a bystander to call for help.

3

Begin compressions. If the person is unresponsive, perform hands-only CPR.

How to Perform Hands-Only CPR

1

Ensure the person is on their back on a firm, flat surface

2

Kneel beside the person
- Your knees should be near the person’s body and spread about shoulder width apart
3

Use correct hand placement
- Place the heel of one hand in the center of their chest, with your other hand on top
- Interlace your fingers and make sure they are up off the chest
4

Use correct body position
- Position your body so that your shoulders are directly over your hands
- Lock your elbows to keep your arms straight
5

Give continuous compressions
- Push hard and fast (at least 2 inches; 100 to 120 compressions per minute)
6

Allow chest to return to its normal position after each compression

Be prepared for moments that matter by taking a CPR class today.

Although you hope you'll never use cardiopulmonary resuscitation (CPR) for a child or infant, it's important to know the steps so that you can help in the event of a cardiac or breathing emergency. And although you may have taken a class in child CPR, it's a good idea to keep the steps handy so that the information stays fresh in your memory. With our printable step-by-step guide, you can access the child and baby CPR steps anytime, anywhere. Simply print them up and place them in your car, your desk, your kitchen or with your other first aid supplies, then read over them from time to time to help maintain your skills.

Before Giving Child or Baby CPR

Check the scene for safety, form an initial impression, obtain consent from the parent or guardian, and use personal protective equipment (PPE)

If the child or baby appears unresponsive, check the child or baby for responsiveness (shout-tap-shout)

For a child, shout to get the child’s attention, using the child’s name if you know it. If the child does not respond, tap the child’s shoulder and shout again while checking for breathing, life-threatening bleeding or another obvious life-threatening condition
For a baby, shout to get the baby’s attention, using the baby’s name if you know it. If the baby does not respond, tap the bottom of the baby’s foot and shout again while checking for breathing, life-threatening bleeding or another obvious life-threatening condition
Check for no more than 10 seconds

If the child or baby does not respond and is not breathing or only gasping, CALL 9-1-1 and get equipment, or tell someone to do so

Performing Child & Baby CPR

Place the child or baby on their back on a firm, flat surface

For a child, kneel beside the child
For a baby, stand or kneel to the side of the baby, with your hips at a slight angle

Give 30 compressions

For a child, place the heel of one hand in the center of the child’s chest, with your other hand on top and your fingers interlaced and off the child’s chest
- Position your shoulders directly over your hands and lock your elbows
- Keep your arms straight
- Push down hard and fast about 2 inches at a rate of 100 to 120 per minute
- Allow the chest to return to normal position after each compression
For a small child, use a one-handed CPR technique
- Place the heel of one hand in the center of the child’s chest
- Push down hard and fast about 2 inches at a rate of 100 to 120 per minute
For a baby, place both thumbs (side-by-side) on the center of the baby’s chest, just below the nipple line
- Use the other fingers to encircle the baby’s chest toward the back, providing support
- Using both thumbs at the same time, push hard down and fast about 1 ½ inches at a rate of 100 to 120 per minute
- Allow the chest to return to its normal position after each compression
Alternatively, for a baby, use the two-finger technique
- Use two fingers placed parallel to the chest in the center of the chest
For a baby, if you can’t reach the depth of 1 ½ inches, consider using the one-hand technique

Give 2 breaths

For a child, open the airway to a slightly past-neutral position using the head-tilt/chin-lift technique
For a baby, open the airway to a neutral position using the head-tilt/chin-lift technique
Blow into the child or baby’s mouth for about 1 second
- Ensure each breath makes the chest rise
- Allow the air to exit before giving the next breath
If the first breath does not cause the chest to rise, retilt the head and ensure a proper seal before giving the second breath. If the second breath does not make the chest rise, an object may be blocking the airway

Continue giving sets of 30 chest compressions and 2 breaths until:

You notice an obvious sign of life
An AED is ready to use
Another trained responder is available to take over compressions
EMS personnel arrive and begin their care
You are alone and too tired to continue
The scene becomes unsafe
You have performed approximately 2 minutes of CPR (5 sets of 30:2), you are alone and caring for baby, and you need to call 9-1-1

Be prepared for moments that matter by taking a CPR class and you could help save a life.

We're working to put more life savers in your community. We need your help. Together, we can save more lives with first aid.

Rescue breathing and chest compressions - child; Resuscitation - cardiopulmonary - child; Cardiopulmonary resuscitation - child

CPR stands for cardiopulmonary resuscitation. It is a lifesaving procedure that is done when a child's breathing or heartbeat has stopped. This may happen after drowning, suffocation, choking, or an injury. CPR involves:

Rescue breathing, which provides oxygen to a child's lungs
Chest compressions, which keep the child's blood circulating

Permanent brain damage or death can occur within minutes if a child's blood flow stops. Therefore, you must continue CPR until the child's heartbeat and breathing return, or trained medical help arrives.

For the purposes of CPR, puberty is defined as breast development in females and the presence of axillary (armpit) hair in males.

1. Check for responsiveness. Shake or tap the child gently. See if the child moves or makes a noise. Shout, Are you OK? 2. If there is no response, shout for help. Send someone to call 911 and retrieve an automated external defibrillator (AED) if one is available. Do not leave the child alone to call 911 and retrieve an AED until you have performed CPR for about 2 minutes. 3. Carefully place the child on their back. If there is a chance the child has a spinal injury, two people should move the child to prevent the head and neck from twisting. 4. Open the airway. Lift up the chin with one hand. At the same time, push down on the forehead with the other hand. 5. Look, listen, and feel for breathing. Place your ear close to the childs mouth and nose. Watch for chest movement. Feel for breath on your cheek.

CPR is best done by someone trained in an accredited CPR course. The newest techniques emphasize compression over rescue breathing and airway management, reversing a long-standing practice.

All parents and those who take care of children should learn infant and child CPR if they have not already. See cpr.heart.org/en/course-catalog-search for classes near you.

Time is very important when dealing with an unconscious child who is not breathing. Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 to 6 minutes later.

Machines called automated external defibrillators (AEDs) can be found in many public places, and are available for home use. These machines have pads or paddles to place on the chest during a life-threatening emergency. They use computers to automatically check the heart rhythm and give a sudden shock if, and only if, that shock is needed to get the heart back into the right rhythm. When using an AED, follow the instructions exactly.

The procedures described in this article are NOT a substitute for CPR training.

There are many things that cause a child's heartbeat and breathing to stop. Some reasons you may need to do CPR on a child include:

Head trauma or other serious injury

CPR should be done if the child has any of the following symptoms:

No breathing
No pulse
Unconsciousness

1. Check for alertness. Tap the child gently. See if the child moves or makes a noise. Shout, "Are you OK?"

2. If there is no response, shout for help. Tell someone to call 911 or the local emergency number and get an AED if available. Do not leave the child alone until you have done CPR for about 2 minutes.

3. Carefully place the child on its back. If there is a chance the child has a spinal injury, two people should move the child to prevent the head and neck from twisting.

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. You may need to use both hands depending on your size and the size of the child.
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 one third to one half 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''.
Rescuers, especially those who are trained in CPR, may also perform chest compressions by the 'two-thumb encircling hands technique.' To do this, encircle the infant's chest with both hands, and compress the chest with both thumbs about one third to one half the depth of the chest.

5. Open the airway. Lift up the chin with one hand. At the same time, tilt the head by pushing 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 rescue breaths. Each breath should take about a second and make the chest rise.

8. 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 or the local emergency number. If an AED for children is available, use it now.

9. Repeat rescue breathing and chest compressions until the child recovers or help arrives. Children undergoing CPR should receive two breaths after every 30 chest compressions if there is a single rescuer. They should receive the two breaths after every 15 chest compressions if there are two rescuers.

If the child starts breathing again, place them in the recovery position. Keep checking for breathing until help arrives.

If you think the child has a spinal injury, pull the jaw forward without moving the head or neck. DO NOT let the mouth close.
If the child has signs of normal breathing, coughing, or movement, DO NOT begin chest compressions. Doing so may cause the heart to stop beating.
Unless you are a health professional, DO NOT check for a pulse. Only a health care professional is properly trained to check for a pulse.

If you have help, tell one person to call 911 or the local emergency number while another person begins CPR.
If you are alone, shout loudly for help and begin CPR. After doing CPR for about 2 minutes, if no help has arrived, call 911 or the local emergency number. You may carry the child with you to the nearest phone (unless you suspect a spinal injury).

Most children need CPR because of a preventable accident. The following tips may help prevent an accident:

Teach your children the basic principles of family safety.
Teach your child to swim.
Teach your child to watch for cars and how to ride a bike safely.
Make sure you follow the guidelines for using children's car seats.
Teach your child firearm safety. If you have guns in your home, keep them locked in an isolated cabinet.
Teach your child the meaning of "don't touch."

Never underestimate what a child can do. Assume the child can move and pick up things more than you think they can. Think about what the child may get into next, and be ready. Climbing and squirming are to be expected. Always use safety straps on high chairs and strollers.

Choose age-appropriate toys. Do not give small children toys that are heavy or fragile. Inspect toys for small or loose parts, sharp edges, points, loose batteries, and other hazards. Keep toxic chemicals and cleaning solutions safely stored in childproof cabinets.

Create a safe environment and supervise children carefully, particularly around water and near furniture. Electrical outlets, stove tops, and medicine cabinets can be dangerous for small children.

American Heart Association. Highlights of the 2020 American Heart Association Guidelines for CPR and ECC. cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf. Accessed April 20, 2021.

Duff JP, Topjian A, Berg MD, et al. 2018 American Heart Association focused update on pediatric advanced life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2018;138(23):e731-e739. PMID: 30571264 pubmed.ncbi.nlm.nih.gov/30571264/.

Easter JS, Scott HF. Pediatric resuscitation. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 163.

Rose E. Pediatric respiratory emergencies: upper airway obstruction and infections. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 167.

Topjian AA, Raymond TT, Atkins D, et al; Pediatric Basic and Advanced Life Support Collaborators. Part 4: Pediatric basic and advanced life support: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2):S469-S523. PMID: 33081526 pubmed.ncbi.nlm.nih.gov/33081526/.

Last reviewed on: 2/12/2021

Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 05/23/2022.