Pediatric First Aid: Emergency Care for Infants and Children
Children are not small adults. Their anatomical and physiological differences dramatically change how first aid should be delivered in emergencies. An infant’s airway is narrower and more easily obstructed, their head is proportionally larger making falls more dangerous, their metabolic rate is higher leading to faster dehydration and temperature changes, and their immune and organ systems are still developing. According to the American Academy of Pediatrics, unintentional injury is the leading cause of death among children aged one to 19 in the United States, and appropriate first aid can significantly improve outcomes.
This guide provides age-specific pediatric first aid protocols for the most common childhood emergencies, drawing on guidelines from the American Red Cross, the American Heart Association, the CDC, and the American Academy of Pediatrics.
Pediatric CPR and Rescue Breathing
Cardiac arrest in children is most often caused by respiratory failure, not primary cardiac events as in adults. This means the CPR sequence differs. The American Heart Association Pediatric BLS guidelines emphasize that a child’s chance of survival depends on timely rescue breaths combined with chest compressions.
For infants under one year, the rescuer places two fingers on the center of the chest just below the nipple line and compresses to a depth of approximately 1.5 inches at a rate of 100–120 compressions per minute. After 30 compressions, open the airway using the neutral head-tilt chin-lift (do not hyperextend an infant’s neck), seal your mouth over the infant’s nose and mouth, and give two gentle breaths — each lasting one second and producing visible chest rise. For a lone rescuer, the compression-to-ventilation ratio is 30:2. For two rescuers, it is 15:2. The AHA recommends using the “push hard, push fast” approach for children over one year with the same 100–120 compression rate but compressing to a depth of approximately two inches.
For children over one year, use the heel of one or two hands depending on the child’s size. The landmark is the center of the chest at the nipple line. Compression depth should be at least one-third the anterior-posterior diameter of the chest, or approximately two inches for most school-age children. Rescue breaths are given by pinching the nose, sealing your mouth over the child’s mouth, and delivering one-second breaths with visible chest rise.
Choking Emergencies by Age
Choking is one of the most common pediatric emergencies. The American Red Cross teaches different techniques based on the child’s age.
For infants under one year who cannot cough, cry, or breathe, perform back blows and chest thrusts. Hold the infant face-down along your forearm, supporting the head and neck with your hand. Deliver five firm back blows between the shoulder blades using the heel of your hand. Turn the infant face-up on your other forearm and deliver five chest thrusts using two fingers on the center of the chest just below the nipple line, similar to CPR compressions but sharper and slower. Alternate back blows and chest thrusts until the object is expelled or the infant becomes unresponsive.
For children over one year, perform abdominal thrusts (the Heimlich maneuver) from behind. Place your fist just above the navel, grasp it with your other hand, and deliver upward, inward thrusts. Do not use abdominal thrusts on infants under one year — their internal organs are vulnerable and the maneuver can cause liver laceration.
If the child becomes unresponsive, lower them to the ground and begin CPR, starting with chest compressions. Each time you open the airway, look for the foreign object in the mouth. If visible and within reach, remove it with a finger sweep — but do not perform blind finger sweeps, which can push the object deeper.
Fever Management and Febrile Seizures
Fever is one of the most common reasons parents seek medical attention. The American Academy of Pediatrics defines fever as a rectal temperature of 100.4 °F (38 °C) or higher. For infants under three months with any fever, the AAP advises immediate medical evaluation because their immature immune systems mask serious bacterial infections. For older children, fever management focuses on comfort rather than reaching a normal temperature. Acetaminophen (10–15 mg/kg every four to six hours) or ibuprofen (5–10 mg/kg every six to eight hours, for children over six months) can reduce fever. Do not alternate medications without a clear schedule to avoid dosing errors. Never give aspirin to children due to the risk of Reye syndrome.
Febrile seizures affect 2 to 5 percent of children aged six months to five years. The CDC emphasizes that these seizures are typically harmless, do not cause brain damage, and do not indicate epilepsy. During a febrile seizure, protect the child from injury by clearing the area, time the seizure to inform medical providers, do not restrain the child, and do not put anything in the child’s mouth. Call 911 if the seizure lasts longer than five minutes, is the child’s first seizure, involves difficulty breathing, or follows a head injury.
Falls and Head Injuries
Falls are the leading cause of emergency room visits for children. The CDC reports that more than 2.8 million children are treated in emergency departments for fall-related injuries each year. After a fall, assess the mechanism: a fall from a height greater than twice the child’s height, from a moving object, or onto a hard surface increases the risk of serious injury.
Signs of a serious head injury requiring immediate emergency care include loss of consciousness for any duration, vomiting more than once, severe or worsening headache, confusion or unusual behavior, unequal pupil size, difficulty walking or speaking, clear fluid or blood draining from the nose or ears, and seizure activity. For minor bumps, apply a cold pack wrapped in a cloth for 20 minutes and observe the child for the next 24 hours. Wake the child every two to three hours during sleep to check responsiveness. The American Academy of Pediatrics advises against the routine use of CT scans for minor head injuries and provides the PECARN criteria to guide imaging decisions in the emergency department.
Burns and Scalds
Scalds from hot liquids are the most common burn injury in children, accounting for more than 70 percent of pediatric burns. The American Red Cross protocols for pediatric burns follow the same principles as adult care but require special sensitivity to the child’s body size — a burn affecting a small percentage of body area on a child can be proportionally much larger than it would be on an adult. First aid for pediatric burns includes immediately cooling the burn under cool running water for 10 to 20 minutes, covering the burn with a clean, non-stick dressing or plastic wrap, and not applying ice, butter, or toothpaste. For pediatric burns covering more than 10 percent of body surface area, burns on the face, hands, feet, or genitals, or any full-thickness burn, seek emergency medical care.
Poisoning in Children
The CDC reports that more than 60,000 children under five are seen in emergency departments each year for poisoning from medications or household chemicals. Prevention is the most effective strategy: store all medications, cleaning supplies, and chemicals in locked cabinets out of sight. Use child-resistant packaging correctly. Do not refer to medicine as candy. Keep the Poison Control number visible: 1-800-222-1222. If you suspect your child has ingested something dangerous, call Poison Control immediately. Do not induce vomiting. Do not give syrup of ipecac. Bring the container to the phone so you can describe the substance to the poison specialist.
When to Call 911 for Pediatric Emergencies
The American Red Cross advises calling 911 for any of the following: the child is unresponsive or not breathing, the child has a seizure lasting more than five minutes, the child has difficulty breathing or is turning blue, there is severe bleeding that does not stop with direct pressure, the child has a suspected head injury with loss of consciousness or vomiting, the child has ingested a known poison and is showing symptoms, the child has a temperature above 104 °F (40 °C) with altered mental status, or the child is burned over a significant body surface area.
FAQ
How is infant CPR different from adult CPR?
Infant CPR uses two fingers for compressions (instead of two hands) to a depth of 1.5 inches, with a compression-to-ventilation ratio of 30:2 for a lone rescuer. Rescue breaths cover both the infant’s nose and mouth simultaneously with gentler puffs.
When should I take my child to the ER for a fever?
For infants under three months with a fever of 100.4 °F or higher, go to the ER immediately. For older children, seek care if the fever persists beyond three days, is accompanied by a stiff neck, severe headache, rash, difficulty breathing, or if the child is unusually lethargic or irritable.
What is the correct choking rescue for a baby under one year?
Use back blows and chest thrusts. Do not use abdominal thrusts (Heimlich maneuver) on infants. Hold the baby face-down along your forearm and give five back blows, then turn face-up and give five chest thrusts on the center of the chest.
How do I treat a child’s minor burn?
Cool the burn under cool running water for 10 to 20 minutes. Cover with a clean, non-stick dressing. Do not apply ice, butter, toothpaste, or home remedies. Give acetaminophen or ibuprofen for comfort and watch for signs of infection.
Are child-proof locks enough to prevent poisoning?
No. Child-resistant locks reduce the risk but are not infallible. Many children can bypass them. The most effective approach combines locked storage, keeping products in original containers, never calling medicine “candy,” and supervising children around any area where medications or chemicals are present.
Additional Resources
For detailed poisoning response protocols, see our poisoning first aid guide and choking emergency article. Every family should maintain a pediatric-specific first aid kit adapted for children’s medical needs.
Sources: American Heart Association Pediatric BLS Guidelines, American Red Cross Pediatric First Aid, American Academy of Pediatrics Injury Prevention, CDC Child Injury Prevention, Mayo Clinic Pediatric Fever Management.