CPR Techniques: Adult, Child and Infant Resuscitation Steps
Cardiopulmonary resuscitation (CPR) is one of the most critical life-saving skills a person can learn. When the heart stops pumping — a condition called cardiac arrest — every second counts. The AHA reports that more than 350,000 out-of-hospital cardiac arrests occur annually in the United States, and only about 10 percent of victims survive. Bystander CPR doubles or triples the chances of survival. The key barrier is that nearly 70 percent of Americans feel helpless to act during a cardiac emergency because they either do not know CPR or their training has lapsed. This guide provides clear, step-by-step CPR techniques for adults, children, and infants, along with instructions for using an automated external defibrillator (AED). All protocols follow the most recent AHA guidelines.
How to Recognize Cardiac Arrest
The first and most critical step is recognizing that cardiac arrest has occurred. The AHA uses the “check, call, care” framework. Check for responsiveness: tap the person’s shoulder and shout, “Are you okay?” If there is no response, simultaneously check for normal breathing and a pulse. Agonal breathing — irregular, gasping, noisy breathing — is not normal breathing and indicates cardiac arrest. Agonal breathing occurs in up to 50 percent of cardiac arrest victims and is frequently misinterpreted by bystanders as a sign of life, delaying CPR.
Check for a pulse at the carotid artery (neck) for adults and children, or the brachial artery (upper arm) for infants. The AHA advises that lay rescuers need not spend more than 10 seconds checking for a pulse — if you are unsure, begin CPR. The risk of performing chest compressions on someone with a beating heart is minimal compared with the risk of withholding compressions from someone in cardiac arrest.
If the person is unresponsive, not breathing normally, and has no definite pulse — or you are unsure — call 911 and begin CPR. If there are other bystanders, direct someone to call 911 and retrieve the nearest AED while you start chest compressions.
Adult CPR: The 30:2 Sequence
The AHA continues to recommend the C-A-B sequence (Chest compressions, Airway, Breathing) for adult CPR. Place the person flat on their back on a firm, level surface. Kneel beside the person’s chest.
Compressions: Place the heel of one hand on the center of the chest (the lower half of the sternum, between the nipples). Place the other hand on top and interlace your fingers. Keep your elbows straight and position your shoulders directly over your hands. Compress the chest at least 2 inches (5 cm) deep but no more than 2.4 inches (6 cm). Allow the chest to recoil fully after each compression — do not lean on the chest, as leaning prevents the heart from refilling. Compress at a rate of 100 to 120 compressions per minute. A helpful mnemonic is to push to the beat of “Stayin’ Alive” by the Bee Gees or “Another One Bites the Dust” by Queen.
Airway: After 30 compressions, open the airway using the head-tilt, chin-lift maneuver. Place one palm on the forehead and two fingers under the chin, then tilt the head back while lifting the chin. Do not tilt if a spinal injury is suspected — use the jaw-thrust maneuver instead.
Breathing: Pinch the nose closed, seal your mouth over the person’s mouth, and deliver 2 breaths, each over 1 second, watching for chest rise. If the chest does not rise, re-tilt the head and attempt again. After 2 breaths, immediately resume chest compressions. Continue the 30:2 cycle without interruption until the person shows signs of life, an AED arrives and is ready to analyze, or EMS takes over.
The AHA emphasizes that “high-quality CPR” means compressions that are adequate depth (2 to 2.4 inches), full recoil, rate of 100 to 120 per minute, and minimizing interruptions in chest compressions to fewer than 10 seconds.
Hands-Only CPR: When to Use It
The AHA recommends hands-only CPR — chest compressions without rescue breaths — for untrained bystanders or those unwilling to give rescue breaths during adult out-of-hospital cardiac arrest. Hands-only CPR doubles survival compared with no CPR at all. The rationale is that most adult cardiac arrests are of cardiac origin (heart attack, arrhythmia), and the blood still contains oxygen that needs to be circulated by compressions.
However, hands-only CPR is not appropriate for children and infants, whose cardiac arrests are typically caused by respiratory failure and require ventilation. Hands-only CPR is also not appropriate for drowning victims, drug overdose, or any scenario where the arrest may have a respiratory cause. In these cases, conventional CPR with rescue breaths is essential.
Child CPR (Age 1 to Puberty)
Child CPR follows the same general C-A-B sequence but with modified compression depth and technique. The AHA guidelines specify that for children, compression depth should be at least one-third of the chest depth, approximately 2 inches (5 cm). You may use one or two hands to achieve adequate depth, depending on the child’s size. The compression-to-ventilation ratio remains 30:2 for single rescuers.
The technique for rescue breathing in a child is similar to the adult: head-tilt, chin-lift, pinch the nose, and give 2 breaths watching for chest rise. Use a gentler breath volume appropriate for the child’s size — just enough to cause visible chest rise.
If you are a trained two-rescuer healthcare provider, the pediatric ratio changes to 15:2. For single lay rescuers, the 30:2 ratio applies to all ages except infants.
Infant CPR (Under 1 Year)
Infant CPR requires the most significant modifications. The AHA recommends the following technique for infants under 1 year old.
To check responsiveness, tap the infant’s foot and shout. Do not shake an infant. Check for breathing and a pulse at the brachial artery (inside of the upper arm). If the infant is unresponsive and not breathing normally with no definite pulse, begin CPR.
For chest compressions, use two fingers — the middle and ring fingers — placed just below the nipple line in the center of the chest. Compress to a depth of approximately 1.5 inches (4 cm), which is about one-third of the chest depth. Compress at a rate of 100 to 120 per minute.
For the airway, use a neutral head position — infants have large occiputs (the back of the head) that naturally flex the neck. A slight head tilt, not a full head-tilt, is appropriate. For rescue breathing, cover both the infant’s mouth and nose with your mouth and deliver gentle breaths — just enough to produce visible chest rise. Each breath should last 1 second.
The compression-to-ventilation ratio is 30:2 for single rescuers. For two-rescuer healthcare providers, the ratio is 15:2.
Using an AED
AEDs are designed for use by untrained bystanders. The devices provide step-by-step voice prompts and will not deliver a shock unless one is needed. The AHA guidelines for AED use are straightforward.
Turn on the AED and follow the voice prompts. Expose the person’s chest — remove clothing, jewelry, and any medication patches. Ensure the chest is dry and free of excessive hair (shave if necessary using the razor included with some AED kits). Apply the pads to the bare chest: one pad on the upper right chest (above the nipple) and one pad on the lower left chest (below the armpit). Do not place pads over a pacemaker or an implanted defibrillator — you may need to reposition the pad away from the device.
Ensure no one is touching the person. The AED will analyze the heart rhythm. If a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia) is detected, the AED will instruct you to press the shock button. After the shock, immediately resume chest compressions — do not check for a pulse or rhythm after the shock. The AED will re-analyze after 2 minutes of CPR.
For children, use pediatric AED pads if available, which reduce the energy dose. If pediatric pads are not available, use adult pads, ensuring they do not overlap on a small child’s chest. The AHA recommends using the anterior and posterior pad placement for small children if the pads are too close together on the front of the chest.
For infants, AED use is recommended with pediatric pads when available. Without pediatric pads, a manual defibrillator is preferred in the hospital setting, but if only an AED with adult pads is available, use it — it is better than no defibrillation.
When to Stop CPR
Once you begin CPR, continue without interruption until one of the following occurs: the person shows signs of life (starts breathing, moving, coughing), an AED arrives and is ready to analyze, trained EMS responders arrive and take over, you are too exhausted to continue — this is rare; bystander CPR is typically only needed for 5 to 15 minutes before EMS arrives, or the scene becomes unsafe.
The American Red Cross emphasizes that you cannot cause additional harm to a person in cardiac arrest — they are already clinically dead. Any CPR is better than no CPR. The only way to do CPR “wrong” is to do nothing.
FAQ
How hard should I push during chest compressions?
For adults, compress at least 2 inches (5 cm) but no more than 2.4 inches (6 cm). This requires significant force — you may hear ribs cracking, which is common and acceptable. For children, compress about 2 inches. For infants, about 1.5 inches.
Do I have to give rescue breaths, or are compressions enough?
For adult cardiac arrests of presumed cardiac origin, hands-only CPR (compressions only) is effective. For children, infants, drowning victims, and overdose victims, rescue breaths are critically important because the arrest is likely caused by respiratory failure.
Can I hurt someone by performing CPR?
You can cause injury — rib fractures, bruising, and soreness are common. However, the alternative for a person in cardiac arrest is death. The AHA states clearly that fear of causing harm should never prevent performing CPR on a person who needs it.
What is agonal breathing, and why is it important?
Agonal breathing is irregular, gasping, noisy breathing that occurs in up to 50 percent of cardiac arrest victims. It is not normal breathing and should not be mistaken for a sign of life. If a person is unresponsive and making gasping sounds, begin CPR immediately.
How long does CPR certification last?
Most CPR certifications from the AHA and American Red Cross are valid for 2 years. Skills deteriorate over time — the National Safety Council recommends practicing on a manikin every 3 to 6 months to maintain proficiency.
Internal links: For information on getting trained and certified, see our CPR certification guide. For the Heimlich maneuver and choking interventions, see choking emergency.