When a child stops breathing, every single second counts. The first two minutes are vital; without oxygen, severe brain damage can begin in moments, and the situation can quickly turn fatal.

Rescue breathing (artificial respiration) is performed when a child still has a detectable pulse but is unable to breathe on their own. Here is a clear, step-by-step emergency guide for administering rescue breaths and basic life support to children between the ages of 1 and 12.

How to Perform Rescue Breathing on a Child

1. Check the scene for safety. Before rushing in, ensure the immediate environment is safe for both you and the child. Look out for traffic, fire, electrical hazards, or unstable structures.

2. Call emergency services immediately. Point directly to a specific bystander and say, “Call 911 (or your local emergency number) right now.” Assigning the task directly prevents the bystander effect.

3. Check for responsiveness. Trap the child gently on the shoulder and speak loudly: “Are you okay? Can you hear me?” Avoid vigorous shaking, especially if there is any suspicion of a neck or spinal injury.

4. Position the child carefully. If the child is lying face down, gently roll them onto their back onto a firm, flat surface. Support the head and neck in a straight line while turning them to minimize the risk of aggravating internal or spinal injuries.

5. Check for normal breathing. Open the airway by gently tilting the head back and lifting the chin (the head-tilt, chin-lift maneuver). Place your ear close to their mouth and nose while watching their chest. Look, listen, and feel for breath sounds for no more than 10 seconds. Irregular gasping is not normal breathing.

6. Check the pulse. Place two fingers gently in the groove beside the windpipe to locate the carotid pulse in the neck. Feel for a pulse for no more than 10 seconds:

• If there is a pulse but no breathing: Start rescue breathing immediately.
• If there is no pulse: You must begin full CPR with chest compressions immediately.

7. Deliver gentle rescue breaths. Pinch the child’s nose shut, form a complete seal over their mouth with yours, and deliver one gentle breath every 3 seconds (about 12 to 20 breaths per minute). Each breath should last about one second.

8. Watch for chest rise. With each breath, observe the child’s chest. You want to see the chest rise gently with the breath and fall as the air escapes. If the chest does not rise, re-tilt the head, reseal your mouth, and try once more.

9. Recheck the pulse after one minute. After delivering rescue breaths for approximately one minute (around 20 breaths), pause briefly to re-evaluate the carotid pulse.

10. Assess and adjust your care.

• If the pulse is still present but the child still isn’t breathing on their own, continue giving one rescue breath every 3 seconds.
• If the pulse has disappeared, switch to pediatric chest compressions right away.

11. Continue until emergency personnel arrive. Do not stop until the child begins breathing normally on their own, an AED becomes available, or paramedics take over the scene. If you become physically exhausted, instruct another bystander to step in and take over without breaking the rhythm.

Important Guidelines for Pediatric Chest Compressions

Children have smaller, more fragile skeletal structures than adults, requiring a controlled and measured touch:

• Hand Placement: Place the heel of one hand (or two hands for an older, larger child) on the center of the chest, along the lower half of the breastbone (just below the nipple line).
• Compression Depth: Press down firmly and smoothly, compressing the chest about 2 inches (roughly one third the depth of the chest). Allow the chest to fully recoil between each pump.
• Rhythm: Maintain a steady pace of 100 to 120 beats per minute (the tempo of the song “Stayin’ Alive”).
• Recheck Periodically: Check for spontaneous signs of life and pulse every two minutes.
• When to Stop: Cease compressions immediately if the child begins coughing, moving, or breathing naturally. Otherwise, continue without interruption until professional medical responders arrive.