Neonatal - Instructions for basic life support in an infant up to one year old

Any baby needing help with breathing, chest compressions or who is choking MUST be taken to hospital by ambulance.

Approach with the 3 S’s in mind:

•    Safety – approach with care and danger in mind
•    Stimulate – gentle stimulation such as holding head and shaking the arm
•    Shout for help

Step 1 - Is the baby OK?

Look at the baby’s colour - is he/she blue/pale…does the baby feel floppy?

Stimulate the baby by calling the baby by name, rubbing their feet, blowing in their face, and looking out for any reaction to you.

If the baby makes no response in 10 seconds then proceed to Step 2.

Step 2 - Take steps to open the airway

Lie the baby on his/her back on a hard surface (e.g. the floor). Place the baby’s head in a neutral position (see figure below) by putting one hand on the head and tilting it back slightly.

Place the other hand under the baby’s chin and lift upwards. Take care not to tilt the head and neck too far. This is called the neutral position.

Check the mouth and nose for secretions/vomit and clear by wiping. If a foreign body is visible follow the procedure for a choking infant.

Step 3 - Check for breathing

Look, listen and feel for 10 seconds.

Do this by placing your face close to the baby’s mouth and nose to listen and feel for the baby breathing.

Place your hand gently on the baby’s tummy, feel for breaths whilst observing the body for movement. As breathing may be shallow, it may be necessary to undress the baby in order to assess breathing.

Step 4 - If the baby is not breathing

Hold the head in a neutral position, make a seal with your mouth over the baby’s mouth and nose and give 5 slow breaths - with just enough pressure to allow the chest to rise, a mouthful of air will be enough.

If the baby begins to breathe on his/her own and becomes responsive, turn him/her on to their side.

Step 5 - Checking for circulation

If the baby is still not breathing, it is more than likely that they will need some help with their heart. It is difficult for parents/ carers to check for a pulse in a baby - just move directly to step 6. This will not harm but help the baby.

Step 6 - Locate the position for chest compression

Place two fingers on the centre of the chest, just below the nipple line. Commence chest compressions, press down about one third of the depth of chest.

Give 30 chest compressions in 15 to 20 seconds in accordance with the UK Resuscitation Council's guideline.

Step 7 - Take the baby with you to the phone and dial 999

Carry on the resuscitation whilst on the telephone using the sequence: 30 compressions: 2 breaths. Explain to the operator that you are giving the baby basic life support. Stay with the baby until emergency help arrives and takes over life support.

Choking

If, when trying to help the baby breathe, resistance is felt, the airway may be obstructed by a foreign body. If a foreign body is visible gently “grasp” and pull it out if possible. DO NOT “finger sweep” as this may push the object further back into the funnel- shaped airway. If it is not possible to “grasp” the object out, move on to back blows.

Back blows

Lay the baby on his/her front over your forearm with the head tilted down. Using the heel of your hand, give the baby up to 5 back blows between the shoulder blades.

The first blow may be sufficient to clear the airway.

However, if after 5 back blows, the airway remains obstructed, move onto chest thrusts.

Chest Thrusts

Turn the baby onto their back with the head in a neutral position but tilted down.

Locate the position for performing “chest thrusts” by placing your fingers as for cardiac compressions but then pushing downwards in the direction of the baby’s head, this will hopefully force the object out.

Give up to 5 chest thrusts

If the airway remains obstructed check the mouth, open the airway, give the baby a breath. If no improvement repeat 5 back blows and then move on to chest thrusts if necessary.

If there is no improvement, start basic life support:

• 30 compressions: 2 breaths
• For one minute
• Repeat back blows and chest thrusts as necessary
• SUMMON EMERGENCY HELP
• Tell them the baby is choking - CALL 999

Parents Training Video available at www.bliss.org.uk – search Resuscitation, alternatively search bliss baby resus on YouTube.
 
This leaflet will help you revise your resuscitation skills and manage choking in an infant up to the age of 1 year.

1. Gently stimulate the baby, talk to him/her to see if there is any response
2. Open the airway
   
   

3.    Check for breathing

4.    If not breathing - give 5 breaths

5.    If not breathing - give 30 chest compressions

Continue to resuscitate by giving: 30 compressions: 2 breaths every minute until help arrives.

TAKE THE BABY WITH YOU TO THE TELEPHONE and call 999. Tell operator you are giving the baby basic life support.