Correct Chest Compression Depth for Children
For children (age 1 year to puberty), compress the chest at least one-third of the anterior-posterior diameter, which is approximately 2 inches (5 cm). 1
Age-Specific Compression Depth Targets
The most recent international consensus guidelines (2020) maintain clear depth recommendations that differ by age group:
- Infants (under 1 year): Compress at least one-third of the anterior-posterior chest diameter, approximately 1.5 inches (4 cm) 1
- Children (1 year to puberty): Compress at least one-third of the anterior-posterior chest diameter, approximately 2 inches (5 cm) 1
- Adolescents (post-puberty): Use adult compression depth of at least 5 cm, but no more than 6 cm 1
Key Technical Points
Compression technique matters for achieving adequate depth. For children, rescuers may use either a 1-hand or 2-hand technique, depending on the size of both the child and rescuer 1. The 2-hand technique produces higher compression pressures with less rescuer fatigue in manikin studies 1.
Complete chest recoil after each compression is essential. Incomplete recoil is common during pediatric CPR, particularly with rescuer fatigue, and significantly impairs venous return, coronary perfusion, and cerebral blood flow 1.
Perform compressions on a firm surface to maximize effectiveness and ensure accurate depth 1.
Compression Rate
Deliver compressions at a rate of 100-120 per minute for both infants and children, consistent with adult guidelines to simplify training 1.
Common Pitfalls and Caveats
Inadequate compression depth is extremely common, even among healthcare providers 1. Studies show that measured one-third anterior-posterior diameter often does not match the absolute depth targets, particularly in infants where the mean one-third diameter was only 3.2 cm versus the 4 cm target 2.
Rescuer fatigue degrades compression quality within 2 minutes. Rotate the compressor role approximately every 2 minutes to maintain adequate rate, depth, and recoil 1. The switch should occur in less than 5 seconds to minimize interruptions 1.
Avoid compressing over the xiphoid or ribs to reduce injury risk. Position compressions on the lower half of the sternum for children 1.
Evidence Quality Considerations
The 2020 International Consensus found no new evidence to change the 2015 recommendations, acknowledging the evidence remains very low quality 1. The task force noted substantial gaps in pediatric literature, including absence of data on overcompression risks and limitations of single-sensor feedback devices that can overestimate depth on compressible surfaces 1.
Recent research suggests potential concerns with current targets. One study found that compressions greater than 51 mm (>2 inches) were associated with improved survival and neurologic outcomes in children 1, while other data indicate the recommended depths may risk overcompression in younger infants 2, 3. However, an animal study found no difference in injury between 1.5 inches and one-third anterior-posterior diameter strategies 4.
Use CPR feedback devices when available to help optimize compression depth and rate, though their effectiveness specifically in pediatrics requires further study 1.