1. Check the state of consciousness
- Address the baby loudly.
- If he/she does not respond, irritate the foot sole by tapping or scratching (fig. 1).
- You can also rub the baby’s back with the palm of your hand.
- If the baby is passive and does not respond, he/she is unconscious.
- Call the ambulance.
2. Free the respiratory ways
- Inspect the baby’s mouth, remove obvious obstacles and foreign bodies with your fingertips.
- Put one hand on the baby’s forehead and just slightly lean the baby’s head backwards and use your other hand’s fingers to slightly lift the chin (fig. 2).
- You must keep the respiratory ways free by supporting the baby under his/her shoulders.
- If you suspect that your baby has breathed in a foreign object (the breathlessness occurred very suddenly – e.g. during eating, playing with a small toy, the baby is coughing, rattling, is breathing noisily and with an effort, has a red and swollen face and neck, later his/her skin colour becoming bluish to greyish), try to remove the obstacle from the airways using the steps below:
Hit the baby on his/her back with 3-5 blows
- Place the baby’s belly on your forearm with the baby’s face down and the head inclined lower. Keep holding the baby’s body and head safety (fig. 3).
- Hit the baby between his/her scapulae (shoulder blades) with 2-3 fingers or the palm of your hand, direct the blows to get the object out of the respiratory ways.
- Or you can grasp the baby’s ankles (never over clothing), turn the baby upside down and perform the same action. If the action is not successful, then:
Compress the baby’s chest 3-5 times
- Place the baby on your forearm with the face up and the head slightly down (fig. 4).
- In the bottom half of the sternum (breastbone) compress the baby’s chest sharply 3-5 times towards his/her head with two fingers with the frequency of approx. once every 3 seconds.
- After the execution of individual actions always check the oral cavity for releasing of the foreign body.
- If suffocation persists, repeat individual steps 1 to 3 times and call in the ambulance.
3. Ensure breathing
- Check whether the baby is breathing (fig. 5) by listening and visually.
- If you find out that the baby is not breathing, immediately start mouth-to-mouth resuscitation and at the same call an ambulance by dialling 155 or 112.
- With one hand on the baby’s forehead maintain a slight backward inclination of the baby’s head and use your other hand to slightly lift the baby’s chin and enclose the baby’s lips and nose with your mouth (fig. 6).
- Start mouth-to-mouth resuscitation with 2-5 breaths in such a way that at least 2 breaths can be sufficiently efficient.
- You can recognize efficiency of breaths by the chest movement – during breathing in the chest should discernibly move upwards, during breathing out it should move downwards.
- Be careful about the supplied volume of air, it must not be too low (the chest does not move) or too high (baby breathing in the mouth’s contents) – it might injure the baby’s lungs and respiratory ways and his/her condition might even get worse. The chest should approximately move as if the baby was breathing spontaneously. Never breathe against stronger resistance!
- In the case of a new-born baby do the artificial breathing at a frequency of 30 breaths a minute (1 breath every 2 seconds), in the case of an infant 20 breaths a minute (1 breath every 3 seconds).
4. Ensure the blood circulation
- If there are no signs of blood circulation (movement, coughing, breathing), start indirect heart massage immediately.
- The baby must always lie on his/her back on a solid support.
- Place the end of your index finger and middle finger on the bottom third of the sternum (breastbone) – approx. 1.5 cm below the connecting line of the nipples (fig. 7). You can also use the method of encompassing the chest with your arms and compressing the sternum with crossed thumbs (fig. 8) or 2 fingers.
- Compress the chest by approx. 2-3 cm (approx. by 1/3 of its sagittal diameter).
- The compression frequency is 120/min in the case of a new-born baby and 100/min in the case of infant.
- Resuscitation of a new-born baby is performed in the ratio of 1 breath: 3 compressions of the chest while for an infant the ratio is 2 breaths: 30 compressions of the chest if there is one rescuing person and in the ratio of 2 breaths: 15 compressions of the chest if there are two rescuing persons.
- Between individual compressions take a short break for a breath.
- After every 3-5 cycles check whether the breathing and blood circulation have been restored.
5. Put the baby in a stabilized position
- If your resuscitation is successful and the baby’s breathing and blood circulation is successful, put the baby in a stabilized position.
- Nurse the baby on your forearm with his/her face towards yourself and the head slightly inclined frontwards.
- This way you will best prevent possible suffocation by the sunken tongue or breathed in vomit (fig. 9).
- Keep watching the baby, especially regarding breathing and signs of permanent blood circulation – caution, if the baby’s skin turns bluish or greyish, it may be the sign of a recurring breathing and blood circulation disorder.
- Maintain the baby’s body temperature sufficiently and especially prevent hypothermia. Call an ambulance or the emergency number. If there are more people present, one of them should call the ambulance immediately after establishing the breathing arrest or blood circulation disorder, the other one starting the resuscitation.
- If you are alone, start resuscitation in accordance with the instructions for babies, keep resuscitating for approx. 1 minute and then quickly call the ambulance. If you do not have a phone at hand and you must run somewhere to get help (even to the next room), you should take the resuscitated baby with you to shorten the time between the resuscitation attempts.
Ending the resuscitation:
Keep resuscitating until the baby starts to show vital signs (spontaneous breathing, pulse, movement), until a qualified person arrives or until you are completely exhausted. Note: a new-born baby means a baby from birth to 1 month of age, an infant means a baby from 1 month to 1 year of age.
– ERC Guidelines for resuscitation 2010,
– První pomoc u dětí – MUDr. Pavel Srnský, ČČK 2007