Pediatric Defibrillator Paddle Selection
Use infant paddles for children weighing less than 10 kg (approximately under 1 year of age), and switch to adult paddles for children weighing more than 10 kg, regardless of age up to approximately 25 kg or 8 years. 1
Weight-Based Cutoffs
The primary determinant for paddle selection is weight, not age:
- Infant paddles: Use for patients <10 kg 1
- Adult paddles (8-10 cm): Use for patients >10 kg (approximately >1 year of age) 1
The American Heart Association 2010 PALS guidelines explicitly state that adult-sized paddles or self-adhering electrodes should be used for children greater than 10 kg, which corresponds to approximately 1 year of age. 1
Rationale: Transthoracic Impedance
The larger adult paddles are superior once the child's chest can accommodate them because they significantly reduce transthoracic impedance, which is the major determinant of defibrillation success. 2, 3
- Adult paddles reduce transthoracic impedance by approximately 47% compared to pediatric paddles (57 ± 11 ohms vs 108 ± 24 ohms). 3
- Lower impedance results in higher peak current flow (8.7 ± 0.5 amps vs 6.2 ± 0.5 amps), which facilitates successful defibrillation. 2
- The transition point where adult paddles can make full chest contact occurs at approximately 10 kg body weight. 3
Upper Age/Weight Limit for Pediatric Equipment
Pediatric paddles or attenuated AED systems should be used up to approximately 25 kg or 8 years of age. 1
- Beyond 25 kg or 8 years, standard adult defibrillation equipment and energy doses are appropriate. 1
- For automated external defibrillators (AEDs), pediatric dose-attenuating systems are recommended for children 1 to 8 years of age. 1
Critical Pitfalls to Avoid
Do not use pediatric paddles beyond 10 kg simply because the patient is young. The higher transthoracic impedance with smaller paddles reduces defibrillation success rates. 2, 3
Ensure adequate paddle force: Apply at least 3 kgf of force with infant paddles and at least 5 kgf with adult paddles to minimize transthoracic impedance. 4 Studies show that clinicians frequently apply suboptimal force during pediatric defibrillation, with only 47% achieving optimal force in infants and 24% in children. 5
Use the largest paddles that fit on the chest without touching each other. 1 This maximizes the surface area and minimizes impedance while preventing current arcing between paddles.
Special Considerations for Infants <1 Year
For infants under 1 year of age, the evidence regarding AED use remains limited. 1 Manual defibrillators capable of weight-based energy adjustment are preferred in hospital settings for this age group. 1 However, case reports have documented successful AED use in infants when manual defibrillators were unavailable. 6