Infant cardiopulmonary resuscitation (CPR) and first aid techniques are essential skills for childcare workers and parents in Australia, providing critical knowledge to respond effectively during emergencies involving babies under 12 months of age.
Understanding the proper procedures for infant resuscitation, choking management, and breathing assessment can make the difference between life and death in critical situations.
This comprehensive guide covers Australian-standard baby CPR techniques, choking protocols, and emergency response procedures specifically designed for childcare settings, helping providers meet their duty of care while ensuring the safety of the youngest and most vulnerable children in their care.
What Makes Infant CPR Different from Adult CPR?
Baby CPR techniques differ significantly from adult procedures due to the unique anatomical and physiological characteristics of infants. Understanding these differences is crucial for providing effective emergency care.
Infants have proportionally larger heads and shorter, narrower airways than adults. Their tongues are also relatively larger in proportion to their mouths, making airway management more challenging. The cartilage in an infant’s trachea is softer and more pliable, requiring gentler handling during resuscitation efforts.
According to Australian Resuscitation Council guidelines, the primary differences in infant CPR include:
- Hand positioning: Two fingers or two thumbs with hands encircling the chest are used for compressions rather than interlocked hands
- Compression depth: Approximately one-third of chest depth (about 4cm) versus 5-6cm for adults
- Compression-to-ventilation ratio: 30:2 for single rescuers, 15:2 for healthcare professionals with two rescuers
- Breathing technique: Mouth-to-mouth-and-nose for infants rather than mouth-to-mouth only
The Australian paediatric emergency response protocol also emphasises the importance of early ventilation for infants, as respiratory issues are the most common cause of cardiac arrest in babies, unlike adults where cardiac problems typically precede breathing difficulties.
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How to Check If A Baby Is Breathing
Before initiating CPR, it’s essential to properly assess whether an infant is breathing effectively. Australian first aid protocols recommend the “look, listen, feel” approach:
Look for chest movements. An infant’s chest and abdomen should rise and fall regularly. Irregular, gasping, or see-saw breathing (where the chest draws in while the abdomen pushes out) indicates respiratory distress.
Listen for breathing sounds. Normal infant breathing is relatively quiet. Wheezing, grunting, stridor (high-pitched noise during inhalation), or silence when there should be breath sounds are concerning signs.
Feel for breath. Place your cheek near the baby’s mouth and nose to feel for exhaled air. Simultaneously, you can gently place a hand on the baby’s chest to feel for movement.
Normal breathing in infants is characterised by:
- Rate of 30-60 breaths per minute (significantly faster than adults)
- Regular rhythm without extended pauses
- No excessive effort or chest retractions
- Normal colour (not blue or extremely pale)
According to Australian emergency response standards, if you’re unsure whether breathing is normal, proceed as if it’s not. Take no more than 10 seconds to make this assessment. If the infant is unresponsive and not breathing normally, begin CPR immediately after calling triple zero (000).
Step-by-Step Infant CPR Guide for Childcare Providers
When an infant in your care requires CPR, following the correct sequence of actions is critical. This step-by-step guide aligns with the latest Australian Resuscitation Council guidelines for childcare settings.
Proper Hand Position for Infant CPR
Correct hand positioning is crucial for effective compressions without causing injury:
- Place the infant on a firm, flat surface.
- Locate the centre of the chest, just below the nipple line.
- For single rescuer technique: Place two fingers (index and middle) perpendicular to the chest.
- For two-rescuer technique (preferred method for trained providers): Use the two-thumb encircling hands technique—place both thumbs side by side over the lower half of the sternum, with fingers encircling the chest and supporting the back.
Avoid pressing on the very bottom of the sternum (xiphoid process) or on the ribs themselves. Maintaining the correct position throughout resuscitation efforts reduces the risk of injury while ensuring effective compressions.
How Many Compressions for Infant CPR?
According to current Australian guidelines, infant CPR requires:
- Compression rate: 100-120 compressions per minute
- Compression depth: Approximately one-third the depth of the chest (about 4cm)
- Compression-to-ventilation ratio:
- 30 compressions followed by 2 breaths for single rescuer
- 15 compressions followed by 2 breaths for healthcare providers in two-rescuer scenarios
Maintain a steady rhythm, allowing complete chest recoil between compressions. Count out loud to maintain pace: “One and two and three and…” continuing to thirty (or fifteen in two-rescuer scenarios).
Research shows that many rescuers compress too slowly, so aim for a pace similar to the beat of the song “Stayin’ Alive” by the Bee Gees, which coincidentally has the appropriate rhythm for effective CPR..
How to Perform Rescue Breathing on an Infant
Effective rescue breathing for infants requires special technique:
- After completing a cycle of chest compressions, open the airway using the head-tilt/chin-lift method—but be gentle and avoid overextension. Tilt the head to a neutral or slightly sniffing position.
- Cover both the infant’s mouth and nose with your mouth, creating a complete seal.
- Deliver two gentle breaths, each lasting about 1 second, with just enough volume to make the chest visibly rise.
- Watch for the chest to rise with each breath; if it doesn’t, reposition the head and try again.
In childcare settings, it’s recommended to use barrier devices such as face shields when available. However, the absence of such devices should not deter rescue breathing if needed, as the risk of disease transmission is extremely low, especially compared to the certain consequences of withholding ventilation from a non-breathing infant..
What to Do if a Baby Stops Breathing
When you discover an infant who has stopped breathing, immediate action is crucial:
- Check responsiveness: Gently tap the soles of the feet and call the infant’s name. Never shake a baby.
- Call for help: If alone in a childcare setting, shout for assistance. Have a colleague call triple zero (000) immediately while you begin assessment and care.
- Position the infant: Place the baby on a firm, flat surface with the head in a neutral position.
- Check breathing: Using the look, listen, feel technique described earlier, take no more than 10 seconds to determine if breathing is normal.
- Begin CPR if needed: If the infant is not breathing or only gasping, begin CPR starting with 30 compressions followed by 2 gentle breaths.
If the infant regains normal breathing and responsiveness, place them in the recovery position by:
- Gently turning the infant onto their side
- Ensuring the head is slightly extended to maintain an open airway
- Supporting the position with a small rolled towel behind the back if needed
- Continuously monitoring breathing and responsiveness
Australian emergency response protocols emphasise that for infants who have experienced respiratory arrest, close monitoring should continue even after normal breathing resumes, as they remain at high risk for recurring arrest.
Infant First Aid for Choking at Day-care
Choking is one of the most common emergencies in childcare settings, as infants frequently explore objects with their mouths. Recognising and responding to choking is a critical skill for all childcare providers.
How to Clear Infant Airway Blockage
If an infant shows signs of severe airway obstruction (inability to cry, cough, or breathe; blue lips; or silent struggling), act immediately:
- Position the infant: Hold the baby face-down along your forearm, supporting the head and jaw with your hand. Keep the head slightly lower than the body.
- Deliver back blows: Using the heel of your free hand, deliver up to five sharp back blows between the shoulder blades.
- Check for object clearance: After each blow, check if the object has been dislodged.
- If back blows fail, perform chest thrusts:
- Turn the infant face-up along your forearm
- Place two fingers on the breastbone, just below the nipple line
- Give up to five sharp chest thrusts (similar to chest compressions but sharper and slower)
- Alternate techniques: Continue alternating five back blows and five chest thrusts until the object is expelled or the infant becomes unconscious.
If the infant becomes unconscious, begin CPR, calling triple zero (000) immediately. During CPR, check the mouth for visible objects before giving breaths, but only remove objects you can see—never perform blind finger sweeps, which can push obstructions deeper.
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When Not to Intervene in Choking
Not all choking situations require intervention, and sometimes well-intentioned actions can make matters worse. According to Australian first aid guidelines:
- If the infant is coughing effectively (strong, forceful coughs), allow them to clear the obstruction themselves. Stay close and monitor carefully.
- If the infant is crying or making vocal sounds, the airway is at least partially open. Maintain watchful waiting unless the situation deteriorates.
- Do not “check” the mouth by inserting fingers unless you can clearly see the object—blind finger sweeps can push objects deeper into the airway.
- Avoid picking up or carrying an infant who is managing to cough effectively, as this may interfere with their natural clearance efforts.
The most appropriate response to partial airway obstruction with good air exchange is to encourage continued coughing while monitoring for deterioration or resolution.
Can You Use an AED on an Infant?
Automated External Defibrillators (AEDs) can be used on infants, but with important modifications. Australian guidelines recommend:
- Use paediatric pads/settings if available. These deliver a lower energy dose appropriate for infants.
- If paediatric pads are unavailable, adult pads may be used with specific placement: one pad on the centre of the chest and one on the back.
- Ensure the pads don’t touch each other (trim if necessary, but avoid cutting across the conductive portion).
Many modern AEDs in Australian childcare centres have a key or switch that converts to paediatric mode. Current regulations recommend that all childcare facilities have immediate access to an AED with paediatric capability.
While sudden cardiac arrest is relatively rare in infants compared to respiratory issues, having AED access and knowledge is still essential, particularly for infants with known cardiac conditions..
When Should You Not Perform CPR on an Infant?
While CPR is a life-saving intervention, there are specific situations where it should not be performed:
- When the infant is breathing normally and has a pulse
- When there are obvious signs of life
- When there is a known Do Not Resuscitate (DNR) order (rare but possible in infants with terminal conditions)
- When performing CPR would place the rescuer in danger
In Australian childcare settings, providers have a duty of care requiring them to respond appropriately to emergencies. Documentation of all incidents is legally required under the Education and Care Services National Regulations, including:
- The circumstances leading to the emergency
- Actions taken by staff
- Time of events and notifications
- Medical interventions provided
It’s important to note that in Australia, the Good Samaritan legislation provides legal protection for those who provide assistance in good faith during emergencies, including childcare workers performing CPR according to their training.
Infant Emergency Response Plan for Childcare
Every Australian childcare service must have a comprehensive emergency response plan that addresses infant medical emergencies:
- Develop clear protocols: Create step-by-step procedures for various emergencies, including infant respiratory distress, choking, and cardiac arrest.
- Assign specific roles: Designate primary first aid providers, those responsible for calling emergency services, staff who will manage other children, and someone to retrieve emergency equipment.
- Create contact lists: Maintain updated emergency contact information for all children, with specific medical information prominently noted.
- Establish communication procedures: Develop clear guidelines for notifying parents, regulatory authorities, and documenting incidents.
Under Australian regulations, emergency response drills must be practised every three months, with records kept of each drill. These should occasionally include scenarios involving infant emergencies to ensure staff readiness.
Regular reviews of emergency plans should occur after any incident or at least annually to incorporate updated best practices and staff feedback.
Baby First Aid Kit Essentials for Day-care
Australian childcare regulations require facilities to maintain properly stocked first aid kits accessible to staff but not children. For infant care areas, essential items include:
- Basic supplies: Adhesive dressings, sterile gauze, bandages, scissors, tweezers, disposable gloves
- Infant-specific items:
- Paediatric pocket mask with one-way valve
- Digital thermometer with axillary (armpit) capability
- Small cold packs (for bumps and bruises)
- Age-appropriate bandages
- Emergency information:
- First aid manual with infant-specific protocols
- Emergency contact information
- List of children with medical conditions or allergies
First aid kits should be inspected monthly, with a documented check system to ensure all items are within expiry dates and in sufficient supply. Australian standards recommend storing the kit in a clearly marked, easily accessible location known to all staff but out of children’s reach.
Infant CPR Certification Requirements For Day-Care In Australia
Australian childcare regulations mandate specific first aid training requirements for staff:
- At least one staff member with current approved first aid qualification must be present at all times
- The required qualifications include HLTAID012 (Provide First Aid in an education and care setting), which specifically covers infant and child CPR
- Certification must be renewed every three years, with CPR components requiring annual refresher training
First Aid Workplace Training offers nationally recognised courses that meet these requirements, with flexible options including on-site training at childcare centres throughout Australia.
For compliance purposes, childcare services must maintain documentation of:
- Staff certification levels and renewal dates
- Training completion records
- Any additional specialised training relevant to children with specific medical needs
The Australian Children’s Education & Care Quality Authority (ACECQA) provides regulatory oversight of these requirements, with penalties for non-compliance that can impact service approvals and ratings.
Essential Skills For Childcare Workers
Infant CPR and first aid skills are not just regulatory requirements for Australian childcare providers—they are essential competencies that can save lives during critical emergencies. By understanding the unique aspects of infant resuscitation, regularly practising emergency response techniques, and maintaining current certification, childcare workers create safer environments for the children in their care.
Remember that confidence in emergency response comes from proper training and regular practice. Even experienced providers benefit from refresher courses to stay current with the latest techniques and guidelines.
Don’t wait for an emergency to test your readiness
Enrol with First Aid Workplace Training today to ensure you have the skills and confidence to respond effectively to infant emergencies. Our nationally certified courses are designed specifically for childcare settings, with expert instructors who understand the unique challenges of infant first aid. Contact us now to schedule training for your team.
Additional Resources
- Australian Resuscitation Council guidelines: www.resus.org.au
- Kidsafe Australia (child accident prevention): www.kidsafe.com.au
- ACECQA First Aid Qualifications Information Sheet: www.acecqa.gov.au/resources
