The first actions for a child who has experienced trauma are the same as for an adult. You should:

a. Establish an airway and stabilize the child’s spine.

b. Make sure the child is breathing and has a heart beat. If he does not, perform cardiopulmonary resuscitation (CPR).

The sequence of steps for CPR for a child is as follows:

(1) Determine the child’s unresponsiveness or respiratory difficulty.

(2) Call for help. If you (the rescuer) are alone and the child is obviously not breathing, perform CPR for 1 minute. Then, call for help.

(3) Position the victim. Carefully place the child lying on his back on a firm, flat surface. Remember to turn the child’s body as a unit. DO NOT allow his head to roll, twist, or tilt backward or forward as you move him.

(4) Open the child’s airway. Use the head-tilt/chin-lift method or the jaw thrust method.

(5) Determine whether the child is breathing. Continue breathing for the child if he is not breathing. If he is breathing, make sure the airway remains open.

(6) Breathe for the victim. Use rescue breathing to fill the child’s lungs with oxygen. An infant’s or child’s lungs are smaller than those of adults. Remember, therefore, that the proper amount of air is the volume that causes the child’s chest to rise and fall.

(7) Circulation. Check the child’s pulse. For a child less than one year, check the brachial pulse. Check the carotid pulse of a child one year or older.

(8) Perform chest compressions. Remember that chest compressions are always accompanied by rescue breathing. Be sure to coordinate the chest compressions and rescue breathing.

NOTE: For complete information about Pediatric CPR, refer to the booklet “Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care,” JAMA, Vol. 255, No. 21, June 6, 1986.

Editor’s Note: A more current set of recommendations can be found in “Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.” Circulation. 2015;132(18 Suppl 2):S519.

This document is freely available online at:

 http://circ.ahajournals.org/content/132/18_suppl_2/S519.long

c. Control bleeding. Use pressure to control bleeding rather than a tourniquet.

d. Treat for shock. Shock is a condition of low blood pressure which prevents the body tissues from receiving enough oxygen. Treat by keeping the child flat. Provide comfort and reassure the child.

e. Immobilize any neurological or musculoskeletal injuries. DO NOT try to straighten out any obvious deformity; for example, an arm at a strange angle. Follow the principle, “Splint them where they lie.” Items which can be used to splint a body part include a rolled-up newspaper, a blanket, or a pillow.

NOTE: Children respond differently in trauma. A child’s blood vessels are capable of extreme vasoconstriction. For that reason, hypotension may not occur until a child has lost a major portion of his entire blood volume.