What to Expect the Toddler Years (249 page)

RESCUE BREATHING
Cover the child’s mouth completely with your mouth and pinch his or her nose shut with your fingers.

If breathing hasn’t resumed or if the child is struggling to breathe and has bluish lips and/or a weak, muffled cry, you must try to get the air into the lungs immediately. Continue with step B-2 below.

Important:
If emergency medical assistance has not yet been summoned and you are alone, continue trying to attract neighbors or passersby as you work.

B-2.
Maintain an open airway by keeping the child’s head in the neutral-plus position (chin pointed slightly upward) with your hand on the forehead.

Important:
If vomiting should occur at any point, turn the child on one side and clear the mouth of vomit with a finger sweep (hook your finger to sweep it out). Reposition the child and resume rescue procedure. If there is a possibility of neck or back injury, be very careful to turn the child as a unit, supporting head, neck, and back as you do; do not allow head to roll, twist, or tilt.

FINDING THE CAROTID PULSE
To locate the carotid pulse, place your index and middle fingers on the child’s Adam’s apple while maintaining a head tilt with the other hand.

B-3.
Pinch the child’s nose shut with the thumb and forefinger of the hand that is maintaining the head tilt. Take a breath through your mouth, and then make a complete seal around the child’s mouth with your mouth (see the illustration on facing page).

B-4.
Blow two slow breaths (lasting 1 second each) into the child’s mouth. Pause between rescue breaths (so you can breathe in again and to let air flow out of the child’s mouth). Observe with each breath whether the child’s chest rises. If it does, allow it to fall again before beginning another breath. After two successfully delivered breaths, move on to Step C.

B-5.
If the chest doesn’t rise and fall with each breath, your breaths may have been too weak or the child’s airway may be blocked. Readjust the child’s head to try to open the airway by tilting the chin upward a bit more (Step B-1) and give two more breaths. If the chest still does not rise with each breath, it is possible the airway is obstructed by food or by a foreign object—in which case, move quickly to dislodge it, using the procedure described in “First Aid for a Choking Toddler” on page 689. If the chest does rise, indicating the airway is open, move on to Step C.

Slide your fingers down into the groove next to the trachea and locate the pulse.

C. Check Circulation

C-1.
As soon as you’ve determined that the airway is clear, as evidenced by the successful delivery of two breaths, check for a pulse at the carotid artery using your index and middle fingers for no more than 10 seconds. (The carotid pulse is located on the side of the neck between the trachea and the neck muscles; see illustrations above).

C-2.
If you can’t locate a pulse, proceed with CPR immediately (see page 688). If you find a pulse, the child’s heart is beating and CPR is not necessary. Perform rescue breathing immediately if breathing has not resumed.

1.
Give one rescue breath into the toddler’s mouth as described in B-4, at the rate of roughly one breath every 3 seconds (or 20 breaths per minute). Watch to be sure the child’s chest rises and falls with each breath.

2.
After about 2 minutes, recheck for signs of life (breathing or movement) and pulse for no longer than 10 seconds to make sure the heart is still beating. If there is no pulse, go to CPR. If the child has begun to breathe independently, continue to maintain an open airway and check breathing and pulse frequently while waiting for help to arrive; keep the child warm and as quiet as possible. If there are signs of life, but no breathing, continue rescue breathing, checking for pulse and signs of life about every 2 minutes.

Activate Emergency Medical System Now.

If you’re alone, give care for about 2 minutes before calling 911. If one is available, bring a cordless or cell phone to the child’s side. If not, and the child is small enough and there is no evidence of head or neck injury, carry the child to the phone, supporting the head, neck, and torso.

Continue rescue breathing as you go. Quickly and clearly report to the EMS dispatcher, “My child isn’t breathing,” and give all pertinent information the dispatcher requests. Don’t hang up until the dispatcher does. If possible, continue rescue breathing while the dispatcher is speaking; if it’s not possible, return to rescue breathing immediately on hanging up.

Important:
Continue rescue breathing until the child begins to breathe on his or her own, the location you are in becomes unsafe, you are too exhausted to continue, or another trained responder takes over for you.

1. Position the child.
Continue with the child face-up on a firm, flat surface. There should be no pillow under the child’s head; the head should be level with the heart or lower and in a neutral-plus position (see illustration, page 686).

2. Position your hands.
Locate the correct hand position by placing the heel of one hand on the child’s sternum (breast-bone), at the center of his chest. Your fingers should be pointing toward the child’s head, and should be raised so that only the heel of your hand is touching the child. Place your other hand directly on top of the first hand, interlacing your fingers if it helps you keep your fingers from resting on the chest. Alternatively, you can use a one-handed technique by placing one hand on the child’s chest and the other hand on the forehead to maintain an open airway. Position your body correctly by kneeling beside the child, placing your hands in the correct position, straightening your arms and locking your elbows so that your shoulders are directly over your hand.

Important:
Do not apply pressure to the tip of the sternum (xiphoid process). To do so could cause severe internal damage.

3. Begin compressions.
Compress the chest smoothly to a depth of about 1
¹
/
₂
inches using the heel of the dominant hand. Lift up your hand, allowing the chest to fully return to its normal position, but keep contact with the chest. Repeat, performing 30 compressions.

HAND POSITION FOR CHEST COMPRESSIONS
Place the heel of one hand on the child’s breastbone at the center of his chest with your fingers pointing toward the child’s head. Be sure only the heel of your hand is touching the child’s chest.

4. Pause and breathe.
After giving 30 compressions, remove your compression hand or hands from the chest, open the airway, and give 2 rescue breaths. After giving the breaths, place your hand or hands in the same position as before and continue compressions. Keep repeating cycles of 30 compressions and 2 rescue breaths.

Activate Emergency Medical System Now.

If you are alone, give care for about 2 minutes before calling 911. If one is available, bring a cordless or cell phone to the child’s side. If not, and the child is small enough and there is no evidence of head or neck injury, carry him or her to the phone supporting head, neck, and torso. Continue rescue breathing as you go. Quickly and clearly report to the EMS dispatcher, “My child isn’t breathing and has no pulse,” and give all pertinent information the dispatcher requests. Don’t hang up until the dispatcher does. If possible, continue compressions while the dispatcher is speaking; if it’s not possible, return to CPR immediately on hanging up.

Important:
Continue CPR until an automated external defibrillator (AED) becomes available or emergency medical assistance arrives.

Coughing is nature’s way of trying to clear the airways (of mucus, dust, smoke) or dislodge an obstruction. A child (or anyone else) who is choking on food or on a foreign object and who can breathe, cry, and cough forcefully should be encouraged to keep coughing. But if the child continues to cough for more than 2 or 3 minutes, call 911 for emergency medical assistance. If the cough becomes ineffective (it’s silent) or the child is struggling for breath, making high-pitched crowing sounds, unable to speak or cry, and/or starting to turn blue (usually starting around the lips and fingernails), begin the following rescue procedure.

ABDOMINAL THRUSTS FOR A CONSCIOUS CHILD
Kneel behind your child to give quick abdominal thrusts. Continue back blows and abdominal thrusts until the object is dislodged.

Start these rescue efforts immediately if the child is conscious and not breathing and if attempts to open the airway have been unsuccessful.

Important:
An airway obstruction may also occur with such infections as croup or epiglottitis. A child who is struggling to breathe and seems ill—has fever and, possibly, congestion, hoarseness, drooling, lethargy, or limpness—needs immediate medical attention at an emergency care facility. Do not waste time in a dangerous and futile attempt to relieve the problem yourself: Call 911.