When performing chest compressions for an infant you can use two thumbs or put two fingers in the center of the chest just below the?

Between children and infants, BLS procedures are nearly the same. Below are the primary differences of BLS for infants and children:

• The infant’s pulse can be found using the brachial artery on the inside of the infant’s upper arm, located between the elbow and shoulder (Figure 11a).
• Instead of an entire hand, compressions can be done with just two fingers for infants if there is only one person (Figure 11b), or with two thumb-encircling hands if a second person is present and the rescuer’s hands can fit the infant’s chest (Figure 11c).
• The prescribed compression depth should be one-third of the infant’s chest depth, which is about 1.5 inches (4cm) in most cases.
• As a sole rescuer with an unresponsive infant, execute CPR for two minutes before calling 911/EMS or using an AED.
• Know that heart attacks are not common for infants and are usually started by respiratory problems. Quick action prevents the problem from turning into something bigger, as prevention is the primary step in the Pediatric Chain of Survival.
• When an infant experiences cardiac arrest, phone 911/EMS or secure an AED the same way you would with children and adults.

As the sole rescuer at the scene of an emergency, make sure to take the following actions:

1. Tap the heel of their foot and talk loudly at the infant to determine if they are responsive.
2. Assess if they are breathing (Figure 11d) while simultaneously checking for the infant’s brachial pulse for 5 but no more than 10 seconds (Figure 11e). If the infant does not respond and is not breathing (only gasping), yell for help.
3. If someone responds, send the second rescuer to call 911/EMS and get an AED. (The ILCOR emphasizes that cell phones are available everywhere now and most have a built-in speakerphone, so rescuers do not have to leave the scene.)
4. If you cannot feel a pulse (or if you are unsure), begin CPR by doing 30 compressions followed by two breaths. If you can feel a pulse but the rate is less than 60 beats per minute, begin CPR. This rate is too slow for an infant. To perform CPR on an infant, do the following:
   • Be sure the infant is face-up on a hard surface.
   • Using two fingers, perform compressions in the center of the infant’s chest (Figure 11f); do not press on the end of the sternum as this can cause injury to the infant.
   • Compression depth should be about 1.5 inches (4 cm) and 100-120 compressions.
5. Perform CPR for about two minutes (using cycles of 30 compressions and two breaths). If help has not arrived, call 911/EMS and get an AED.
6. Use and follow AED prompts when available while continuing CPR until EMS arrives or until the infant’s condition normalizes.

Two-Rescuer BLS for Infants

If you are with a second rescuer with the infant at the scene, do the following:

1. Tap the bottom of their foot and talk loudly at the infant to determine if they are responsive.
2. If the infant does not respond, have the second rescuer call 911/EMS, and get an AED. (The ILCOR emphasizes that cell phones are available everywhere now and most have a built-in speakerphone, so you can call while at the scene.)
3. Assess if they are breathing. Feel for the infant’s brachial pulse for 5 but no more than 10 seconds.
4. If you cannot feel a pulse (or if you are unsure), begin CPR by doing 15 compressions followed by two breaths. If you can feel a pulse but the rate is less than 60 beats per minute, begin CPR. This rate is too slow for an infant.
5. When the second rescuer returns, begin CPR by performing 15 compressions by one rescuer and two breaths by the second rescuer. If the second rescuer can fit their hands around the infant’s chest, perform CPR using the two thumb-encircling hands method (Figure 11g). Do not press on the bottom end of the sternum as this can cause injury to the infant.
6. Compressions should be approximately 1.5 inches (4 cm) deep and at a rate of at least 100-120 per minute.
7. Use and follow AED prompts when available while continuing CPR until EMS arrives or until the infant’s condition normalizes.

Below is the full detailed cardiopulmonary resuscitation (CPR) sequence for infants (babies under 1 year old) and children.

It's highly recommended that every parent goes on a first aid course, as it makes this process much easier to understand and remember.

In a life-threatening emergency, dial 999. If your child is coughing or wheezy, call NHS 111 or your GP for advice.

Child and baby CPR steps

1. Ensure the area is safe

• Check for hazards, such as electrical equipment or traffic.

2. Check your child's responsiveness

• Gently stimulate your child and ask loudly: "Are you all right?" 

3a. If your child responds by answering or moving

• Leave them in the position they were found in (provided they're not in danger).
• Check their condition and get help if needed.
• Reassess the situation regularly.

3b. If your child does not respond

• Shout for help.
• Carefully turn the child on their back. 

If the child is under 1 year old:

• Ensure the head is in a neutral position, with the head and neck in line.
• At the same time, with your fingertips under the point of your child's chin, lift the chin. Do not push on the soft tissues under the chin as this may block the airway.

If the child is over 1 year old:

• Open your child's airway by tilting the head and lifting the chin.
• To do this, place your hand on their forehead and gently tilt their head back.
• At the same time, with your fingertips under the point of your child's chin, lift the chin. Do not push on the soft tissues under the chin as this may block the airway.

If you think there may have been an injury to the neck, tilt the head carefully, a small amount at a time, until the airway is open. Opening the airway takes priority over a possible neck injury, however.

4. Check their breathing

Keeping the airway open, look, listen and feel for normal breathing by putting your face close to your child's face and looking along their chest.

• Look for chest movements.
• Listen at the child's nose and mouth for breathing sounds.
• Feel for air movement on your cheek.

Look, listen and feel for no more than 10 seconds before deciding that they're not breathing. Gasping breaths should not be considered to be normal breathing.

5a. If your child is breathing normally

• Turn them on their side.
• Check for continued breathing.
• Send or go for help – do not leave your child unless absolutely necessary.

5b. If your child is not breathing or is breathing infrequently and irregularly

• Carefully remove any obvious obstruction in the mouth.
• Give 5 initial rescue breaths (mouth-to-mouth resuscitation) – see below.
• While doing this, note any gag or cough response – this is a sign of life.

Rescue breaths for a baby under 1 year

• Ensure the head is in a neutral position and lift the chin.
• Take a breath, then cover your baby's mouth and nose with your mouth, making sure it's sealed. If you cannot cover both the mouth and nose at the same time, just seal 1 with your mouth. If you choose the nose, close the lips to stop air escaping.
• Blow a breath steadily into the baby's mouth and nose over 1 second. It should be sufficient to make the chest visibly rise.
• Keeping their head tilted and chin lifted, take your mouth away and watch for the chest to fall as air comes out.
• Take another breath and repeat this sequence 4 more times.

Rescue breaths for a child over 1 year

• Tilt the head and lift the chin.
• Close the soft part of their nose using the index finger and thumb of the hand that's on their forehead.
• Open their mouth a little, but keep the chin pointing upwards.
• Take a breath, then place your lips around their mouth, making sure it's sealed.
• Blow a breath steadily into their mouth over about 1 second, watching for the chest to rise.
• Keeping their head tilted and chin lifted, take your mouth away and watch for the chest to fall as air comes out.
• Take another breath and repeat this sequence 4 more times. Check that your child's chest rises and falls in the same way as if they were breathing normally.

5c. Obstructed airway

If you have difficulty achieving effective breathing in your child, the airway may be obstructed.

• Open the child's mouth and remove any visible obstruction. Do not poke your fingers or any object blindly into the mouth.
• Ensure there's adequate head tilt and chin lift, but the neck is not overextended.
• Make up to 5 attempts to achieve effective breaths (enough to make the chest visibly rise). If this is still unsuccessful, move on to chest compressions combined with rescue breaths.

6. Assess the circulation (signs of life)

Look for signs of life. These include any movement, coughing, or normal breathing – not abnormal gasps or infrequent, irregular breaths.

Signs of life present

If there are definite signs of life:

• Continue rescue breathing until your child begins to breathe normally for themselves.
• Turn the child on their side into the recovery position and send for help.
• Continue to check for normal breathing and provide further rescue breaths if necessary.

No signs of life present

If there are no signs of life:

• Start chest compressions immediately.
• Combine chest compressions with rescue breaths, providing 2 breaths after every 30 compressions.

7. Chest compressions: general guidance

• To avoid compressing the stomach, find the point where the lowest ribs join in the middle, and then 1 finger's width above that. Compress the breastbone.
• Push down 4cm (for a baby or infant) or 5cm (a child), which is approximately one-third of the chest diameter.
• Release the pressure, then rapidly repeat at a rate of about 100-120 compressions a minute.
• After 30 compressions, tilt the head, lift the chin, and give 2 effective breaths.
• Continue compressions and breaths in a ratio of 2 breaths for every 30 compressions.

Although the rate of compressions will be 100-120 a minute, the actual number delivered will be fewer because of the pauses to give breaths.

The best method for compression varies slightly between infants and children.

Chest compression in babies less than 1 year

• Do the compressions on the breastbone with the tips 2 fingers, not the whole hand or with 2 hands.
• The quality (depth) of chest compressions is very important. If the depth of 4cm cannot be achieved with the tips of 2 fingers, use the heel of 1 hand – see advice for children, below. 

Chest compression in children over 1 year

• Place the heel of 1 hand over the lower third of the breastbone, as described above.
• Lift the fingers to ensure pressure is not applied over the ribs.
• Position yourself vertically above the chest and, with your arm straight, compress the breastbone so you push it down 5cm, which is approximately one-third of the chest diameter. The quality (depth) of chest compressions is very important.
• In larger children or if you're small, this may be done more easily by using both hands with the fingers interlocked, avoiding pressure on the ribs.

If nobody responded to your shout for help at the beginning and you're alone, continue resuscitation for about 1 minute before trying to get help – for example, by dialling 999 on a mobile phone.

8. Continue resuscitation until

• Your child shows signs of life – normal breathing, coughing, movement of arms or legs.
• Further qualified help arrives.
• You become exhausted.

Further information on first aid

British Red Cross: first aid training courses