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Infant Heimlich Maneuver and CPR

According to the American Heart Association, there are between 1,900 and 14,200 pediatric cardiac arrests that occur each year outside of a hospital. The average ambulance response time is 10 to 12 minutes, but a child whose heart has stopped will have irreversible brain damage within 4 to 6 minutes and will die within 8 to 10 minutes. Learning infant Heimlich maneuver and CPR could save the life of your child or another in your care.

The following are some guidelines for performing the Heimlich maneuver and CPR on an infant younger than one year old. However, these are simply guidelines and you should take an infant/child CPR course to ensure you are fully educated and prepared to react in an emergency. You can find a class in your area on the American Red Cross Website at www.redcross.org.

Infant Heimlich Maneuver

If your baby is suddenly unable to cry or cough or turns bright red or blue she may be choking. If she is coughing or gagging, her airway is only partially blocked and you should let her try to cough the obstruction out. If she cannot cough, check to see if she is breathing by watching her chest for rising and falling and listen for the sound of her breathing. However, do not spend more than 30 seconds determining whether she is breathing.

If there are other people nearby, shout loudly for someone to call 911. If you are alone, take your baby with you to the phone and call 911 while you try to dislodge the object in her throat.

Hold your baby face down lengthwise on your forearm. Support her head with your hand and position her so her head is lower than the rest of her body, bracing your forearm against your thigh. If your baby is too big for your arm, lay her face down on your lap, making sure her head is lower than the rest of her body.

Deliver five firm back blows between your baby's shoulder blades, using the palm of your hand. If she begins coughing or crying, stop and allow her to try to cough up the object. However, if you get no response, lay her face up on the ground or on your arm and locate her sternum (imagine a line between her nipples, and measure one finger-width down from the middle of that line). Position two fingers on her sternum and give five upward chest thrusts, each about 1/2 to one inch deep. Continue to alternate between the back blows and chest thrusts until the object is dislodged, your baby begins to breathe on her own, she loses consciousness, or medical help arrives.

CPR
If you succeed in dislodging the object from your baby's throat, but she is still not breathing, or she has stopped breathing for another reason (such as drowning), begin CPR immediately. If you have not called 911 yet or asked someone else to do so, perform 5 cycles (about 2 minutes) of CPR before stopping to call 911.

Gently place your baby on her back on the floor. Make sure her airway is open by lifting her chin gently, tipping her head back slowly. Locate her sternum again and depress her chest between 1/2 and one inch. Be sure to allow the chest to recoil completely before beginning the next compression. Give 30 rapid chest compressions (at a rate of approximately 100 compressions per minute), then place your mouth over your baby's nose and mouth, making a tight seal with your lips and give two slow, gentle breaths. Be careful not to blow too much air into your baby's airways; this can damage her lungs. Continue to alternate 30 chest compressions with two breaths until help arrives or your baby begins breathing on her own. If your breath does not move her chest up and down, move her head and neck into a slightly different position and give one more breath. If you still don't see her chest move with your breath, her airway may still be blocked and you should continue with back blows.

The American Heart Association recently changed their CPR recommendations, stating that CPR without breaths (compressions or Hands-Only CPR) is as effective as conventional CPR (with breaths). However, Hands-Only CPR (compressions only) is NOT recommended for children. It is for adults only who have suddenly collapsed. CPR with breaths is still needed for children and people who are victims of drowning, electrocution or other respiratory events. (The new guidelines stress the importance of keeping the blood flowing. When a victim is in cardiac arrest, there is no blood flow and chest compressions are the only maneuver that creates a small amount of blood flow to the vital organs, such as the brain and heart. The better the chest compressions performed the more blood flow they produce. When chest compressions are interrupted, blood flow stops; and every time chest compressions begin again, the first few compressions are not as effective. The more interruptions in chest compressions, the worse the victim's chance of survival from cardiac arrest.)

Once your baby does resume breathing, get her to an emergency room as soon as possible. Even if she seems fully recovered, a doctor needs to make sure that her airway is completely clear and that she has not sustained any internal injuries.