UK Pediatric Basic Life Support Sequence
The UK follows the European Resuscitation Council guidelines for pediatric BLS, which uses a sequential approach: assess responsiveness → shout for help → open airway (head tilt-chin lift or jaw thrust) → check breathing (look, listen, feel) → give 5 rescue breaths → check for signs of life/pulse (brachial in infants) → begin chest compressions at 15:2 ratio (compressions:ventilations) for healthcare providers or 30:2 for lay rescuers → activate emergency services after 1 minute of CPR. 1
The Sequential Algorithm
1. Safety and Initial Assessment
- Ensure the environment is safe for both rescuer and child
- Assess responsiveness by gently shaking or pinching the child 2
- If unresponsive, immediately shout for help
- Move the child only if in a dangerous location 2
2. Airway Management
- Open the airway using head tilt-chin lift as the primary method 2
- Use jaw thrust if cervical spine injury is suspected (jaw thrust is usually most effective in infants) 2
- Remove only visible foreign bodies that can be easily grasped—never perform blind finger sweeps 2
3. Breathing Assessment
Assess for breathing by simultaneously:
- Looking for chest and abdominal movement
- Listening at the mouth and nose for breath sounds
- Feeling for expired air movement with your cheek 2
This should take no more than 10 seconds.
4. Rescue Breathing
If the child is not breathing normally:
- Deliver 5 initial rescue breaths immediately 2
- Each breath should last 1 to 1.5 seconds 2
- For infants (<1 year): cover both mouth and nose with your mouth
- For children (>1 year): seal mouth only, pinch nose closed 2
5. Circulation Check
- Check the brachial pulse in infants (inside of the upper arm) 2
- Check the carotid pulse in children
- Assess for signs of life (movement, coughing, normal breathing)
- Take no more than 10 seconds for this assessment
6. Chest Compressions
If no pulse or signs of life are present:
Compression technique varies by age:
- Infants: Use 2-finger technique OR 2 thumb-encircling hands technique (preferred for healthcare providers). Position fingers one finger's breadth below the nipple line on the lower third of sternum 2
- Children: Use 1-hand or 2-hand technique depending on child size, compressing the lower third of sternum
Compression parameters:
- Depth: approximately 1/3 of chest depth (about 4 cm in infants, 5 cm in children)
- Rate: 100-120 compressions per minute 2
- Ratio:
- Compression phase should occupy half the cycle and be smooth, not jerky 2
7. Emergency Services Activation
After 1 minute of CPR, activate emergency medical services 2
- Carry infants or small children to the telephone if possible
- Older children may need to be left briefly
- Resume CPR immediately after calling and continue without interruption until help arrives 2
Critical Pitfalls to Avoid
- Do not delay rescue breaths: Unlike adult BLS where compressions come first, pediatric arrest is usually respiratory in origin—the 5 initial breaths are crucial 2
- Do not use blind finger sweeps: This can push foreign bodies deeper into the airway 2
- Do not interrupt CPR once started except to activate emergency services after the first minute 2
- Ensure adequate compression depth: Inadequate depth is the most common error—compress at least 1/3 of chest depth 2
Key Differences from Adult BLS
The pediatric sequence prioritizes airway and breathing first because most pediatric arrests result from respiratory failure (croup, bronchiolitis, asthma, foreign body aspiration, drowning) rather than primary cardiac causes 2. This is why 5 rescue breaths precede compressions, and why the compression:ventilation ratio emphasizes more frequent ventilations than adult BLS 1.