Unconscious Infant Choking

This unconscious infant choking lesson is for situations where you find an infant who is unconscious, and you suspect they became unresponsive due to an airway obstruction.

Ideally, either you or a bystander witnessed the victim choking before they went unconscious. Through further assessment, you find that the infant has a pulse but isn't breathing. You attempt rescue breathing at a rate of one breath every two to three seconds, but your first breath does not produce chest rise. You reposition the airway and try again - still no chest rise.

In this scenario, you would treat this patient as an unconscious infant choking victim. The method of care will closely resemble performing CPR on an infant, however there are subtle differences to pay attention to.

How to Provide Care

As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy.

• Assess the infant to make sure he or she is not breathing normally and is unconscious.
• Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Then go right into chest compressions.
• Draw an imaginary line across the infant's nipples and place your two thumbs on the lower part of the sternum in the center of the infant's chest. Your fingers should be wrapping around the infant’s chest. Alternatively, you may also use the heel of one hand in the center of the chest.
• Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, and count as you perform them.
• Conduct 30 chest compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
• Grab the rescue mask and seal it over the victim's face and nose.

Pro Tip #1: It's important to have a properly sized rescue mask. In other words, one that fits the size of the victim's face. If you have an infant mask, use that..

• If you can, place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position.
• Here’s the difference between CPR and unconscious choking - open the airway and look for the object before giving your two breaths. If you see the object, use your pinky finger to sweep out the object. Never do a finger sweep unless you see the object.
• Breathe into the rescue mask and wait for the chest to rise and fall. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions.
• Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths.

Pro Tip #2: Because infants' mouths are small, it's best to use your pinky finger combined with a hooking motion to sweep out obstructions.

• If the rescue breaths go in this time – causing the chest to rise and fall – check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse.

Pro Tip #3: For infants with a pulse rate lower than 60 beats per minute, you are instructed to override with chest compressions in CPR. But if you're only allowing 10 seconds to check a pulse, how do you know the rate per minute? Multiply the 10-second rate by six, and this will give you the number of beats per minute.

• If you detect a pulse but there are still no signs of normal breathing, continue to perform one rescue breath every two to three seconds for two minutes.
• After two minutes, reassess for a pulse and check again for normal breathing.
• If you still detect a pulse and the patient still isn't breathing normally, continue with one rescue breath every two to three seconds for two minutes. If you do not detect a pulse, go into full CPR – 30 chest compressions followed by two rescue breaths.
• Continue until help arrives, an AED arrives, or the victim is responding positively and breathing normally.
• If you have a second rescuer, rather than 30:2, use a 15:2 compression to ventilation ratio.

A Word About Vital Signs (By Age)

Assessing a patient's vital signs is a crucial first step in providing care. Therefore, it's important to know what range is normal when it comes to pulse rates and respirations.

For Adults (12 years and older)

Pulse rate – 60 to 100 beats per minute
Respirations – 12 to 20 breaths per minute

For Children (1 year to 12 years old)

Pulse rate – 70 to 120 beats per minute
Respirations – 15 to 30 breaths per minute

For Infants (1 month to 12 months old)

Pulse rate – 100 to 140 beats per minute
Respirations – 25 to 50 breaths per minute

For Neonates (full term to 30 days)

Pulse rate – 120 to 160 beats per minute
Respirations – 40 to 60 breaths per minute

Pro Tip #4: Infants in distress – not breathing normally – will likely be tachycardic. It's not unusual for them to range between 120-180 beats per minute on the high end, depending on their exact age. It's also not abnormal to feel a fast, slightly thready (or thin) pulse that's becoming weaker. If we cannot correct the breathing issue, infants will quickly deteriorate and have a slowing heart rate until breathing is corrected.