Step by step guide to baby first aid: CPR and choking

baby CPR

by Emily Thorpe |

When Sophie and Colin Atkins’ baby son stopped breathing due to undiagnosed pneumonia, they brought him back to life using CPR skills learned just months earlier with St John Ambulance. Ethan thankfully went on to make a full recovery.

Colin, a business consultant from Epsom, Surrey, described how he and Sophie heard their 9-month-year-old unable to clear a cough and dashed upstairs, where he had been put down for a nap. Remembering what he’d been shown at the infant first aid training course, Colin picked his son up, checked his mouth and gave him firm back slaps.

However, the baby’s airway did not clear and they realised he had stopped breathing. Ethan’s lips went blue and his eyes changed. While Sophie called an ambulance, Colin laid him on the floor and began CPR.

Colin said: “I remembered the process from our first aid course, and thought, ‘there’s still hope’ and I did exactly what I’d been told to do. It was crystal clear.”

Picturing what the first aid trainer had shown him, he blew five puffs gently into his nose and mouth before giving 30 chest compressions using two fingers to the tune of Nelly the Elephant. Colin repeated this three times until the airway was cleared and Ethan began breathing, just as paramedics arrived and took over.

Ethan’s parents feel very lucky they had the knowledge needed to save their son – especially Colin, who admitted he hadn’t taken the first aid course very seriously at the time.

Sophie added: “I felt like I was looking over a cliff, I can only imagine the loss of a child, it was just horrific.

“This was the scariest and most upsetting moment of my life. I honestly thought I had lost my son and I know that if we had not taken the course we would not have been prepared to deal with the situation. He and his sister mean the world to us.”

What to do if your baby is choking

If you think the baby is choking then they need your help straight away. If they can breathe, are making noises, or coughing, then they may be able to clear their own throat.

  1. Slap it out. If the baby cannot breathe, cry, or cough, they may be choking and you will need to give five back blows. Lay the baby face down along your forearm and thigh, making sure you support their head and neck. Give five sharp back blows between the shoulder blades with the heel of your hand.

  2. Turn them over on your thigh and check their mouth. Pick out any obvious obstructions you can see with your fingertips.
    • Do not sweep the mouth as this could push the object further down the throat.

  3. Squeeze it out. If back blows fail to clear obstruction, give five chest thrusts with your baby facing upwards, making sure you’re supporting their head and neck. Put two fingers in the centre of their chest just below the nipple line and give five sharp chest thrusts.
    • Check their mouth again, each time.

  4. Call 999 or 112 for emergency help if the obstruction hasn't cleared. Take the baby with you to make the call. Keep repeating five back blows and five chest thrusts until help arrives, checking their mouth each time.
    • If the baby becomes unresponsive at any point, prepare to start baby CPR.

How to do baby CPR (under one year old)

  1. After you have performed a primary survey, if you find that the baby is unresponsive and not breathing, you should ask a helper to call 999 or 112 for emergency help while you start CPR.
    • If you're on your own, you need to give one minute of CPR before calling on a speakerphone.
    • Do not leave the baby to make the call.

  2. Start CPR. Place them on a firm surface and open their airway. To do this, place one hand on their forehead and very gently tilt their head back. With your other hand, use your fingertip and gently lift the chin.

  3. Give five initial puffs*. Take a breath and put your mouth around the baby’s mouth and nose to make a seal, and blow gently and steadily for up to one second. The chest should rise. Remove your mouth and watch the chest fall. That’s one rescue breath, or puff. Do this five times.
    • If their chest doesn't rise, check the airway is open.
    • Doing rescue breaths may increase the risk of transmitting the COVID-19 virus, either to the rescuer or the baby. This may be mitigated by placing a face shield or pocket mask over the baby’s mouth.

    *It is vital that you perform rescue breaths as cardiac arrest in a baby is likely caused by a respiratory problem.

  4. You will then need to give 30 pumps. Put two fingers in the centre of the baby’s chest and push down a third of the depth of the chest. Release the pressure allowing the chest to come back up. Repeat this 30 times at a rate of 100 to 120 pumps per minute. The beat of the song ‘Nellie the Elephant’ can help you keep the right rate.

  5. After 30 pumps, open the airway and give two puffs. Keep alternating 30 pumps with two puffs (30:2) until:
    • emergency help arrives and takes over
    • the baby starts showing signs of life and starts to breathe normally.

  6. If the baby shows signs of becoming responsive, such as, coughing, opening their eyes, making a noise, or starts to breathe normally, put them in the recovery position. Monitor their level of response and prepare to give CPR again if necessary.

For more first aid advice, visit St John Ambulance.

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