Infant CPR Basics Every Parent Should Know

I took my infant CPR class when my daughter was three weeks old. I was emotionally exhausted, lactating through a sweater, and almost too tired to drive there. By the end of the ninety minutes I had practised back blows on a baby mannequin twenty times and I went home and sat in the car and sobbed with relief. It is one of the most important hours I have ever spent in any classroom.

Please read this article. Then please, this week or next, sign up for an in-person infant CPR class with the American Heart Association, the Red Cross, or your local hospital. They cost between zero and forty dollars and take about two hours. There is no substitute for the muscle memory of pressing on a real (silicone) baby chest with your real hands.

This article is a refresher and a memory aid — the thing to read before bed, the thing to keep open in a tab. It is not training.

The two emergencies and how to tell them apart

Choking — partial vs full

A choking baby who is coughing forcefully, gagging loudly, crying, or able to make sounds has a partial airway block. Do not interfere. Stay close, stay calm, let her keep coughing. Her cough is more effective than anything you can do.

A choking baby who cannot make a sound, cannot cough, cannot cry, who is turning pale, blue or grey, has a full airway block. This is the moment for back blows and chest thrusts.

Unresponsive

A baby who is limp, unresponsive to your voice or touch, not breathing or only gasping — this is the moment for CPR.

For a choking baby under 1 year

1. Shout for help. Have someone call 911 immediately. If you are alone, do five back blows and five chest thrusts before pausing to call.
2. Position. Sit down. Lay the baby face-down along your forearm, head lower than chest, supporting her jaw and head with your hand. Rest your forearm on your thigh.
3. Five back blows. With the heel of your free hand, deliver five firm, separate blows between her shoulder blades. Firmer than you think — this is dislodging an obstruction.
4. Turn her over. Supporting her head, flip her face-up along your other forearm.
5. Five chest thrusts. Place two fingers on the centre of her chest just below the nipple line. Push down about 1.5 inches (4 cm), five times, firm and quick.
6. Look in her mouth. Only remove an object if you can clearly see it. Never sweep with a finger blindly — it can push the object further in.
7. Repeat back blows and chest thrusts until the object comes out or she becomes unresponsive.
8. If she becomes unresponsive, start CPR (see below).

For a choking child over 1 year

Standing or kneeling abdominal thrusts (the Heimlich manoeuvre). Place a fist just above her belly button, your other hand over it, and give five quick inward and upward thrusts. Continue until the object comes out or she becomes unresponsive.

Infant CPR — for unresponsive babies under 1 year

Step 1: Check responsiveness

Tap her foot firmly and say her name. If there is no response, no breathing, or only gasping breaths — begin CPR.

Step 2: Shout for help and start compressions

If you are not alone, send someone to call 911 and find an AED. If you are alone, do 2 minutes of CPR first, then call 911. For an infant, calling first delays oxygen to a brain that almost always needs it because of an airway, not a heart, problem.

Step 3: 30 compressions

• Place the baby on her back on a firm surface (the floor, a sturdy table).
• Place two fingers (index and middle) on the centre of her chest, just below the nipple line.
• Push down about 1.5 inches (4 cm) — roughly one-third the depth of the chest.
• 30 compressions, at a rate of 100 to 120 per minute (the beat of "Stayin' Alive" or "Baby Shark").
• Let the chest fully recoil between each compression.

Step 4: 2 rescue breaths

• Tilt her head slightly back to open the airway (just a slight tilt — too far closes the airway in an infant).
• Cover her nose AND mouth with your mouth — they are both small enough.
• Give a gentle puff of air, just enough that you see her chest rise. About one second per breath.
• Give two breaths.

Step 5: Repeat — 30 compressions, 2 breaths

Continue cycles of 30 compressions and 2 breaths until emergency services arrive, she begins breathing, or an AED is available.

Using an AED on an infant

If an automatic external defibrillator (AED) is available, use it. Modern AEDs have paediatric pads or a paediatric setting. If only adult pads are available, use them — one on the chest, one on the back — rather than not using the AED at all. The machine will talk you through every step.

What to teach every caregiver in your house

Anyone who looks after your baby alone — your partner, a grandparent, a nanny, a regular sitter — should know:

• Where the phone is and how to call 911 from a locked phone (every phone has an emergency call button on the lock screen)
• Your full home address, written on the fridge, in case panic erases memory
• The location of the first aid kit
• The location of any prescription medications and emergency action plans (for babies with known conditions)
• The poison control number — US: 1-800-222-1222; UK: 111

Prevention is most of the work

The honest truth: the most useful infant CPR is the CPR you never have to perform because the choking never happened. Almost every infant choking event is preventable:

• Cut grapes and cherry tomatoes in quarters lengthwise until age four.
• Never offer whole nuts, popcorn, hot dog rounds, raw apple chunks or hard candy under age four.
• Get on her eye level once a week and remove every small object from reach — coins, button batteries, magnets, beads.
• Always sit with her while she eats — even raisins, even crackers.
• Use only AAP-approved sleep surfaces (see the safe sleep guide).

The thing nobody tells you about CPR

Performing CPR on a real baby is emotionally devastating, even when you do it correctly and even when she recovers. If you ever have to use these skills, please ask for trauma-informed mental health support afterwards, both for you and for any witnesses in the family. The image stays with parents for years. You will not be "fine in a few days." Please get the support.

And please — this week — book the in-person class. The competence and calm those two hours give you outweigh almost any other parenting skill you can learn in your baby's first year. You will not regret it, and you may, on one quiet, ordinary Tuesday, save your child's life.