BLS Certification Manual: Ventilations for Infants & Children

Ventilations for Infants & Children

Ventilation is particularly important in pediatric emergencies because many infant and child cardiac arrests begin with respiratory failure. Each breath should be given over approximately 1 second and should produce visible chest rise.

Infant Head Position: The Sniffing Position

Position an infant's head in a neutral position, sometimes called the "sniffing position" — neither tilted far back nor allowed to flex forward. Over-extending an infant's neck can narrow rather than open the airway, due to differences in infant airway anatomy.

Infant Ventilations

For an infant younger than 1 year:

1. Position the infant's head in a neutral or slightly extended position
2. Avoid excessive neck extension
3. Create an effective seal using an appropriately sized mask or, when providing direct rescue breathing, seal over the infant's mouth and nose
4. Give each breath over approximately 1 second
5. Deliver only enough air to produce visible chest rise
6. Avoid excessive pressure, volume, or ventilation rate

Infants require much smaller ventilation volumes than adults.

Infant With a Pulse but Inadequate Breathing

If an infant has a definite pulse but is not breathing adequately:

• Give 1 breath every 2-3 seconds
• This equals approximately 20-30 breaths per minute
• Reassess the pulse and condition approximately every 2 minutes

If the heart rate is less than 60 beats per minute with signs of poor perfusion despite adequate oxygenation and ventilation, begin chest compressions.

Infant Cardiac Arrest Without an Advanced Airway

For one rescuer:

30 compressions : 2 breaths

For two trained rescuers:

15 compressions : 2 breaths

Infant With an Advanced Airway Already in Place

If an advanced airway has already been placed by an appropriately trained provider:

• Continue chest compressions at 100-120 per minute
• Do not pause compressions for breaths
• Give 1 breath every 2-3 seconds

Advanced airway placement itself is outside the scope of this course.

Child Ventilations

For a child approximately 1 year of age until signs of puberty:

1. Open the airway using a head-tilt/chin-lift when trauma is not suspected
2. Use an appropriately sized barrier device or mask when available
3. Create an effective seal
4. Give each breath over approximately 1 second
5. Deliver only enough air to produce visible chest rise
6. Avoid excessive pressure, volume, or ventilation rate

Child With a Pulse but Inadequate Breathing

If a child has a definite pulse but is not breathing adequately:

• Give 1 breath every 2-3 seconds
• This equals approximately 20-30 breaths per minute
• Reassess the pulse and condition approximately every 2 minutes

If the heart rate is less than 60 beats per minute with signs of poor perfusion despite adequate oxygenation and ventilation, begin chest compressions.

Child Cardiac Arrest Without an Advanced Airway

For one rescuer:

30 compressions : 2 breaths

For two trained rescuers:

15 compressions : 2 breaths

Child With an Advanced Airway Already in Place

If an advanced airway has already been placed by an appropriately trained provider:

• Continue chest compressions at 100-120 per minute
• Do not pause compressions for breaths
• Give 1 breath every 2-3 seconds

Advanced airway placement itself is outside the scope of this course.

Avoid Excessive Ventilation

For both infants and children, give only enough air to produce visible chest rise. Excessive ventilation rate, pressure, or volume can reduce the effectiveness of resuscitation.