If a baby under 1 is unresponsive and not breathing normally, call 120 on speakerphone and perform infant CPR: 30 compressions, then 2 breaths

44. If a baby under 1 is unresponsive and not breathing normally, call 120 on speakerphone and perform infant CPR: 30 compressions, then 2 breaths

Cost: No cost. Infant CPR takes one hands-on class, half a day to a full day. The hard parts are sealing your mouth over the infant’s mouth and nose for breaths and pressing firmly enough.

In plain terms: No response to foot stimulation and no normal breathing — call 120 on speakerphone and do not stop. Encircle the chest with both hands and compress with two thumbs; if you cannot encircle, use the heel of one hand, about 4 cm (1.5 inches) deep, about 2 compressions per second. After every 30 compressions, give 2 breaths covering mouth and nose. Most infant cardiac arrests start with breathing failure; CPR that includes breaths improves survival.

Benefit: The American Heart Association and American Academy of Pediatrics 2025 pediatric basic life support guideline states that respiratory problems remain the main cause of cardiac arrest in infants and children. Among infants with out-of-hospital cardiac arrest, only 6.6% survive to hospital discharge. For an unresponsive infant or child with abnormal breathing and no signs of life, “CPR should be started immediately” without checking a pulse. Compression depth is at least one-third of the anteroposterior chest diameter; for infants, “about 1.5 inches (4 cm).” Rate 100 to 120 per minute. One rescuer: 30 compressions then 2 breaths. Two rescuers: 15 compressions then 2 breaths. Use one-hand heel or two-thumb encircling compressions; if encircling is not possible, use heel of one hand. Two-finger compression has been removed because depth was inadequate. The guideline also states that for out-of-hospital pediatric cardiac arrest, adding ventilations to compressions improves survival. A U.S. registry of 3,900 children under 18 with out-of-hospital cardiac arrest found 59.4% were infants. Bystander CPR was associated with an adjusted hospital discharge survival of 13.2% versus 9.5% without CPR; adjusted OR 1.57 (about 57% higher odds of survival), 95% CI 1.25–1.96. Among infants, CPR with breaths was linked to higher survival and better neurological recovery; compression-only outcomes were similar to no CPR. IFRC 2025 guidance: check responsiveness by picking up the infant or flicking the foot. If alone, call emergency services on speakerphone. If no phone allows simultaneous calling, perform 1 minute of CPR before calling. A popular-science article from the Capital Institute of Pediatrics, republished by the Beijing Municipal Health Commission, states: “If only 1 person is present, perform 2 minutes of CPR before calling 120.” Compression depth “4 cm for infants.” Mouth-to-mouth-nose for breaths under 1 year.

Evidence grade: B

Sources: Joyner BL et al. (2025). Part 6: Pediatric Basic Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 152(suppl 2):S424–S447. <https://doi.org/10.1161/CIR.0000000000001370>, full text at <https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/pediatric-basic-life-support>; Naim MY et al. (2017). Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry. JAMA Pediatrics 171(2):133–141. <https://doi.org/10.1001/jamapediatrics.2016.3643>; International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025, pp. 186–188. <https://www.ifrc.org/sites/default/files/2026-03/IFRC%20International%20First%20Aid,%20Resuscitation%20and%20Education%20Guidelines%202025.pdf>; Capital Institute of Pediatrics (2022). [Pediatrics from the Institute of Pediatrics] Cardiopulmonary resuscitation: essential first aid knowledge for parents (reprinted by Beijing Municipal Health Commission). <https://wjw.beijing.gov.cn/bmfw_20143/jkzs/jksh/202210/t20221017_2837684.html>; European Resuscitation Council (2025). ERC Guidelines 2025 for the lay public (Chapter Paediatric Basic Life Support). <https://www.erc.edu/media/p5ymaeej/gl2025_layperson_book_ipdf-v11-e.pdf>

Notes: Rated B because survival figures come from registry studies with recording bias, pooled across all children; infant-only discharge numbers were not given in the summary. Benefit is rated large from the pooled figures: discharge survival 9.5% to 13.2%, a relative increase of about 40%. Main beneficiaries are your own children. Three differences from item 1 in this section (hard chest compressions for adults): infants need breaths — compression-only works poorly; use two thumbs or one heel at about 4 cm, not stacked adult hands; if you cannot call while compressing, start CPR before calling. How long to compress before calling varies: Capital Institute of Pediatrics and the U.S. single-rescuer flow say 2 minutes; IFRC says 1 minute. Speakerphone removes the trade-off. The European Resuscitation Council teaches 5 breaths first then compressions; the U.S. guideline compressions first — both beat doing nothing. Older Chinese courses taught two-finger compression; the 2025 U.S. guideline removed it. For choking, look in the mouth before breaths and remove only visible objects; see item 43 (infant choking).