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BLS Infant CPR Algorithm - 2025 Guidelines Coming Soon

Bradycardia acls algorithm

Knowing how to perform CPR on an infant is a skill that can save a life. Cardiac arrest in infants, though less common than in adults, requires immediate and specialized action. The Basic Life Support (BLS) Infant CPR Algorithm provides a clear, step-by-step framework for rescuers to follow during these critical moments. This guide will walk you through the official algorithm, ensuring you understand each step and can act with confidence.

Unlike adult CPR, the infant algorithm accounts for the unique physiology of babies (individuals under one year of age, excluding newborns). The most common causes of cardiac arrest in infants are respiratory issues, making prompt rescue breathing and high-quality chest compressions essential. Following these established guidelines significantly increases the chances of a positive outcome.

Step-by-Step Breakdown of the BLS Infant CPR Algorithm

When faced with an unresponsive infant, it is crucial to act quickly and systematically. The BLS algorithm provides the necessary structure to ensure no critical step is missed.

1. Verify Scene Safety

Before you approach the infant, your first priority is to ensure the environment is safe for both you and the baby. Look for any immediate dangers, such as traffic, fire, or electrical hazards. A rescuer who becomes a victim cannot help anyone. Once you confirm the scene is safe, you can proceed with the assessment.

2. Check for Responsiveness and Breathing

Gently tap the bottom of the infant’s foot and shout their name or ask loudly, “Are you okay?” Never shake an infant, as this can cause serious injury. While checking for a response, simultaneously scan the infant’s chest for movement to assess their breathing. Look for normal, regular breaths. Irregular gasping, known as agonal breathing, is not considered normal breathing and is a sign of cardiac arrest.

If the infant is unresponsive and not breathing (or only gasping), you must act immediately.

3. Activate the Emergency Response System

How you call for help depends on whether you are alone or if another person is present.

  • If You Are With Another Person: Point to a specific person and instruct them to call 911 (or your local emergency number) and get an Automated External Defibrillator (AED). Direct, clear instructions are more effective than a general call for help.
  • If You Are Alone: If you witnessed the infant’s collapse, leave the infant to call 911 and get an AED. If you did not witness the collapse, immediately begin five cycles of CPR (which takes about two minutes) before leaving to call 911 and retrieve an AED. The logic here is that an unwitnessed collapse in an infant is likely due to a respiratory problem, and immediate CPR is the most critical intervention.

4. Check for a Pulse

For an infant, the recommended site to check for a pulse is the brachial artery. This is located on the inside of the upper arm, between the elbow and the shoulder. Place two fingers on the artery and feel for a pulse for at least 5 seconds, but no more than 10 seconds.

  • If you feel a pulse but the infant is not breathing normally: This is respiratory arrest. Provide rescue breaths by delivering one breath every 2-3 seconds. Recheck the pulse every two minutes.
  • If you cannot feel a pulse (or are unsure) within 10 seconds: Assume cardiac arrest and begin high-quality CPR, starting with chest compressions.

5. Perform High-Quality CPR

High-quality CPR is the cornerstone of the BLS Infant CPR algorithm. It involves a cycle of chest compressions and rescue breaths.

Chest Compressions

The technique for compressions depends on whether one or two rescuers are present.

  • Single Rescuer: Use two fingers (the index and middle fingers) and place them in the center of the infant’s chest, just below the nipple line.
  • Two Rescuers: Use the two-thumb-encircling hands technique. Place both thumbs in the center of the chest while your hands encircle the infant’s torso. This method generally provides better compressions.

Regardless of the technique, follow these guidelines:

  • Rate: Compress at a rate of 100 to 120 compressions per minute.
  • Depth: Compress to a depth of about 1.5 inches (4 cm), which is approximately one-third the depth of the infant’s chest.
  • Recoil: Allow the chest to fully recoil (return to its normal position) after each compression. This allows the heart to refill with blood.
  • Minimize Interruptions: Keep interruptions in chest compressions to less than 10 seconds.

Rescue Breaths

After 30 compressions (or 15 if two rescuers are present), it is time to give rescue breaths.

  1. Open the Airway: Use the head-tilt, chin-lift maneuver. Place one hand on the infant’s forehead and gently tilt the head back to a neutral position. Be careful not to hyperextend the neck.
  2. Give Breaths: Cover the infant’s mouth and nose with your mouth and deliver two gentle puffs of air, each lasting about one second. Watch for the chest to rise with each breath. If the chest does not rise, reposition the head and try again.

The correct ratio is 30 compressions to 2 breaths for a single rescuer and 15 compressions to 2 breaths for two rescuers.

6. Use an AED

As soon as an AED is available, use it. For infants, it is best to use an AED with pediatric pads and an attenuator, which reduces the energy of the shock. If pediatric pads are not available, you can use adult pads, but ensure they do not touch each other. Place one pad on the center of the infant’s chest and the other on the center of their back.

  1. Turn on the AED and follow the voice prompts.
  2. Stop CPR when the AED instructs you to.
  3. If a shock is advised, ensure no one is touching the infant and press the shock button.
  4. Immediately resume CPR, starting with chest compressions, as soon as the shock is delivered.

Continue CPR cycles and follow the AED’s prompts until emergency medical services arrive or the infant begins to show signs of life.

Get Certified and Be Prepared

Reading about the BLS Infant CPR algorithm is an important first step, but nothing replaces hands-on training. At Safety Training Seminars, we believe that practical skills and expert guidance are what truly prepare you to act confidently in an emergency. Our courses are taught by experienced instructors who ensure you master these life-saving techniques.

We offer official American Heart Association (AHA) certification classes for BLS, CPR, and First Aid at over 70 locations across California. Our blended learning model combines a flexible online course with a brief, in-person skills session, making it convenient to get certified. You’ll practice on state-of-the-art manikins and receive your certification card the same day. Book a class with us today and gain the skills and confidence to save a life.