Do you know CPR?
Do you know the differences between CPR for adults and children?
What about infants?

CPR is a lifesaving skill. Though it's simple, it takes practice to master. Unfortunately, due to the misconception that CPR is "easy," it's often under-taught and under-practiced.

An NBA basketball player could demonstrate how to shoot a 3-pointer in 30 seconds, but it would still take hours and hours (if not years and years) of practice to shoot a 3-pointer effectively. The same is true with CPR; there's rhythm, coordination, timing; and all of this is made more difficult by the immense stress. To perform CPR well, you must fervently study and practice.

In this article, we'll go over some of the common variations of CPR and attempt to shed light on the nuances involved in this lifesaving skill. We will also take a close look at hands-only CPR.

The Different Ways CPR is Performed 

CPR is not performed the same way for all people. Learning the different needs of different patients can make you a more effective responder. Many people, when they learn CPR, only briefly see how to perform CPR on children. Nonetheless, knowing the variations based on age groups is important. 

Here are the types of CPR we will cover in this article: 

• Hands-only CPR (Adult)
• Traditional CPR (Adult)
• Child CPR
• Infant CPR
• Newborn CPR

Note: this guide is merely meant to be an overview to help broaden the rescuer's understanding. This is not a step-by-step guide on how to perform CPR. You should take the time to perform more research on CPR and sign up for a local class. CPR is a mental and physical skill, so hands-on practice is important. 

Hands-Only CPR for Adults 

Hands-only CPR requires the rescuer to only push on the chest, foregoing any rescue breaths or airway control. Why is hands-only CPR a thing?  

The AHA wanted people not to hesitate to provide CPR if they witnessed someone suddenly collapse. However, many people do hesitate, as they're worried they won't perform the skill correctly, potentially hurting the patient. They also hesitate to perform mouth-to-mouth on strangers and worry about catching a disease.   

So, the AHA decided to emphasize hands-only CPRs for untrained bystanders, feeling this would be more valuable than no CPR at all. Indeed, in the phases just after someone collapses, there isn't a huge difference in effectiveness between hands-only CPR and traditional CPR - however, there are many nuances to this statement. 

How Does Hands-Only CPR Work? 

Bystander hands-only CPR is recommended for adult patients who are victims of a witnessed collapse - that means the rescuer saw them go down. 

The rescuer should call 911, ask for an AED, and begin performing compressions. The hands are placed on the sternum, right in between the nipples. The compression rate is 100-120 beats per minute, and the rescuer should only stop if someone else is ready to take over. 

Here's a video explaining hands-only CPR. This is not recommended for children or infants. See more below on the misconceptions around hands-only CPR. 

Hands-Only CPR: Misconceptions

Not only are there nuances, but there are also some misconceptions about hands-only CPR. A prominent hands-only CPR misconception is that we're "moving away" from rescue breathing. 

I'm unsure how this falsehood started, but it could be that people view implementing hands-only CPR as an inference that traditional CPR is less effective. On the contrary, this has never been stated by the AHA. Indeed, traditional CPR is still recommended in many cases.  

As it happens, traditional CPR with rescue breaths is recommended for children, infants, drowning victims, overdose victims, and unwitnessed collapses. If you're curious, you can read the AHA FAQ on hands-only CPR for more information. 

Traditional CPR: Adults 

For adult patients of unwitnessed collapse, overdose, drowning, or respiratory ailments, traditional CPR is still the recommended practice. Also, if you're a trained rescuer, traditional CPR is still recommended.  

If you're untrained, providing hands-only CPR still may help; however, the preference is to include airway management and rescue breathing. Get trained! 

Traditional CPR involves checking a pulse, opening the airway, and providing 30 chest compressions (100-120 beats per minute) and 2 rescue breaths. This is continued until help arrives. Traditional CPR also involves understanding an AED and applying it correctly. 

There are variations of adult CPR that include asynchronous breathing and compressions, but these usually require advanced airway techniques. 

Mouth-to-mouth and diseases: If you're curious, read this article on the transmission of infectious diseases by mouth-to-mouth. As you'll see, the risk is much lower than you probably think. Still, it's something you'll have to consider. If you can, grab a pocket CPR mask and carry it with you.

Also, take some time to read this article on rescue breathing.

Let's talk about the kids. 

How to Perform CPR on Children 

There are a few ways children vary from adults. When it comes to CPR, these can mean fairly big differences. First, what is the definition of a child? 

In the medical field, a child is usually anyone pre-pubescent. That means most 14-year-olds are treated as adults. However, this is not the case in all circumstances. If someone is irregularly small, they may be treated as a child. For our purposes, a child is anyone who hasn't been through puberty. 

When treating a child, the main difference is the ratio of chest compressions and the airway. Children have reduced oxygen stores, which means that rescue breathing is important. 

Children and infants have relatively larger heads in proportion to their bodies than adults; this makes it more likely that their airways will close during CPR, as their larger head will force their chin down into their chest. This, on top of oxygen stores, is why it's important to manage a child's airway and breathing during CPR. 

CPR Variations for children:  

• CPR rate is 15 chest compressions to 2 rescue breaths (with two rescuers). 
• Push 1/3 the depth of the chest (instead of the standard 2 inches for adults). 
• Traditional CPR is recommended (with rescue breaths)
• You can use just one hand and palm on the center of the chest 
• You can injure the child further with too much force 
• Place padding behind the shoulders 

These are just a few of the variations for children. If you're curious about building a full first aid kit, see my article on first aid supplies for children.  

Let's talk about infants. 

CPR Variations: Infant and Newborn 

Yes, in the medical world, there is a difference between an infant and a newborn. An infant is often categorized as any child 1 year or less, and a newborn is either (you guessed it) a child who was just born or a child under 28 days. 

Both these children have slightly different CPR needs. Since we started with adults, let's chat about infants, and then we'll talk about newborns. 

CPR for Infants 

Infant CPR is similar to children. However, there are a few key differences between child CPR and infant CPR. The first thing to know is that one of the most common reasons for a child and infant to go into cardiac arrest is breathing problems. These problems could result from several problems, including allergic reactions, viruses, and choking. 

Another thing to know about the infant is that their trachea (or windpipe) is a smaller in ratio to their bodies than an adult trachea. For this reason, children are more likely to choke on small objects and are more likely to experience blockages—just something to keep in mind. 

For infants and newborns, the main difference in CPR is the rate of compressions and when to start compressions. 

For the rate, infants receive 15 chest compressions followed by two rescue breaths. However, the way you provide the compressions is different. You don't want to use the weight of your body with two hands like you would for adults - this could injure the child or infant. 

The best technique is the encircling hands and thumbs technique. For this technique, you hold the infant on a surface with your hands wrapped around either side of the chest. Then, you use both thumbs to push 1/3 the depth of the chest. 

However, you can also use the two fingers technique. You hold out your index and middle finger and use them to push on the center of the chest (between the nipples). 

The second major change is that, for infants, you begin CPR if their heart rate drops below 60 beats per minute. 

Providing CPR for Newborns 

On top of receiving regular newborn care, like drying and warming, responders must be extra vigilant against breathing problems. The first 28 days after birth are the most crucial. 

So, what are the differences in CPR? The first is that resuscitation focuses on breathing - much more than the others. 

For newborns, instead of 30:2 or 15:2, you provide chest compressions and rescue breaths at a ratio of 3:1. This means that you give three compressions followed by one breath: push, push, push, breath. push, push, push, breath. 

We should note that this guideline (3:1) is usually reserved for trained responders. If you use the 15:2 for a newborn, this is often acceptable. However, it will be up to the rescuers to decide. 

Finally, know that guidelines for CPR are always changing. Even the ones in this article could change over the years. Also, professionals all have different opinions. It's important to keep your eyes and ears open to changes surrounding these lifesaving skills.