For Children over 8 years, one can generally apply the adult CPR guidelines.

Cardiac arrest in the pediatric age group is rarely of cardiac origin, and more commonly results from a low oxygen level secondary to respiratory difficulty in the arrest.

CPR in children has had poor outcome according to statistics as it is basically due to long periods of hypoxemia. The outcome of resuscitation from respiratory arrest before the development of a cardiac arrest is however better and hence educational programs should emphasize on prevention, early recognition of child in distress and rapid intervention before a cardiac arrest occurs.

Most common indications for CPR in children are:

• injuries
• suffocation caused by foreign bodies
• smoke inhalation
• sudden infant death syndrome
• Respiratory tract infections.

Airway: The head is not tilted too far back, only straightened out, as hyperextension or hypo extension could still obstruct the airway. Steps include a head tilt neck lift by using two fingers placed under the neck.
The mandible should be at the level of the tip of the nose to ensure the neck is not over extended.
Breathing: Look, listen and feel as in the case of adult CPR.
In infants seal the infant’s mouth and nose with your mouth. Children over 1 year of age cover the child’s nose or mouth with your mouth.
Exhale into the child’s mouth and/or nose watching for movement of chest and abdomen.
For an infant fill only the mouth with air and exhale only from the mouth. For other children use the rise and fall of the chest as a guide.
The rate of delivered breaths in case of neonates is around 20 to 30 breaths per minute, for children 15 to 20 breaths per minute and for adolescents 10 to 15 per minute.
After two breaths establish circulation.

Circulation:For children over one year feel for the carotid pulse as in the case of Adult CPR. In infants the brachial or femoral arteries (refer above picture) are preferred. The artery can be felt in the cubital fossa medial to the tendon of the biceps or in the arm. Femoral artery is felt in the mid inguinal point. If pulses are not felt or pulse less than 60 per minute proceed to external chest compressions.

External chest compressions:

Position the child: place index finger in the chest in a line joining the child’s nipples.
Place the index finger and middle finger of the other hand below this finger perpendicular to the chest. For infants use two fingers and depress the sternum by about 2cm using the tips of the fingers. For children less than 8 years use the heel of one hand and depress the sternum by about 3cm. rate of compression is about 100 per minute
RATIO of ventilation to compression
In children less than 8 years: 1 is to 5

Conscious children should be encouraged to cough if possible. Check the open mouth for foreign bodies and remove it. Blind finger sweeps and finger probing should be avoided.
 Position the child for back blows: place the child along your thigh, face down and head lower than the body. In case of older children place him/her across your lap. Deliver 5 firm back blows. If this is unsuccessful deliver 5 abdominal thrusts or chest thrust s for children over 1 year of age. This is done using the heel of one hand only ensuring excessive force is not used. Abdominal thrusts are also not advisable in infants. Only chest thrusts are used.
Encircle the infants or child chest with your hands as shown in the picture and squeeze vigorously so as to suddenly raise the intrathoracic pressure. If not possible to encircle the chest apply pressure on the chest one finger breath below the nipple line. Check the open mouth for foreign bodies again.
Open the airway and administer rescue breaths. If there is no improvement repeat the cycle with greater force.