Paediatric CPR starts with five rescue breaths, then 30 chest compressions and two breaths in cycles until help arrives. On babies you press with two fingers, on bigger children with one or two hands, about a third of the depth of the chest. Call 112 straight away. And the most important thing of all: it cannot be learnt on a screen. Take a course and practise on a manikin.
It is Saturday morning in a kitchen in Bromma. A one year old is sitting in the high chair with a grape in her hand, dad turns round to get the coffee, and when he turns back the child is no longer coughing. Those seconds are what this article is about. What happens next depends entirely on whether the adult in the room knows what to do, or has to guess.
Why children differ from adults
Adults usually suffer cardiac arrest because of the heart. In children it is almost always because breathing stopped working first: a blocked airway, drowning, suffocation, a severe infection. That is why paediatric CPR starts with air, not with compressions. Five rescue breaths before anything else. It is the single biggest difference, and the one many people who have only done adult CPR miss.
How to do CPR on a child, step by step
- Check. Call the child's name, touch them. No response? Open the airway by gently tilting the head back and lifting the chin. On a baby only slightly, head in a neutral position. Look, listen and feel for breathing for no more than ten seconds.
- Call 112. If you are alone: put the phone on speaker and start CPR at the same time. If there are two of you: one calls, one starts.
- Five rescue breaths. On a baby: cover the nose and mouth with your mouth. On a bigger child: pinch the nose, blow into the mouth. Just enough air for the chest to rise, about one second per breath.
- 30 compressions. In the middle of the breastbone, lower half. Baby: two fingers. Child: the heel of one hand, or both hands if the child is big. Press down about a third of the depth of the chest, at a rate of 100 to 120 per minute.
- Two breaths. Then 30 compressions again. Continue 30:2 without pausing until the ambulance takes over or the child breathes on their own.
- Defibrillator. If there is one nearby, use it. Most have a child mode or child pads. The device tells you what to do.
| Baby under 1 year | Child from 1 year to puberty | |
|---|---|---|
| Airway | Head in a neutral position | Tilt the head slightly back, lift the chin |
| Rescue breaths | Mouth over nose and mouth | Pinch the nose, mouth to mouth |
| Compressions | Two fingers in the middle of the breastbone | The heel of the hand, one or two hands |
| Depth | About a third of the chest | About a third of the chest |
| Rate | 100 to 120 per minute | 100 to 120 per minute |
| Order | 5 rescue breaths, then 30:2 | 5 rescue breaths, then 30:2 |
Choking: the part you are most likely to need
Cardiac arrest in children is rare. A child choking on something is not. Grapes, pieces of sausage, carrot sticks, small toy parts, nuts. One year olds put everything in their mouths and three year olds talk with their mouths full. This is the part of the course our nannies have actually used.
The first question is whether the child can cough. If they can cough, scream or cry, the airway is not completely blocked. Encourage coughing and do nothing else. Do not slap the back of a child who is coughing, it can shift the object to a worse position.
- A baby who cannot cough: lay the baby face down along your forearm or across your knee, head lower than the body, supporting the head with your hand. Up to five firm blows between the shoulder blades with the heel of your hand. If that does not help, turn the baby onto their back and give up to five chest thrusts with two fingers, as in CPR but slower and sharper. Alternate until it comes loose.
- A child over one who cannot cough: lean the child forward, up to five blows between the shoulder blades. If that does not help: stand behind the child, a clenched fist just above the navel, the other hand over it, push inwards and upwards, up to five times. Alternate between back blows and abdominal thrusts.
- If the child goes limp and unconscious: lay them on the floor, call 112 and start CPR. Look in the mouth before each rescue breath and remove what you can see, but do not fish blindly with a finger.
- After abdominal thrusts: the child should always be examined by a doctor, even if everything seems fine. The pressure can injure internal organs.
What no course can give you, but you can do at home
Most of this can be prevented. Cut grapes and cherry tomatoes lengthways into four. Cut sausage lengthways, not into round pieces. No whole nuts before the age of four or five. Children should sit down when they eat, not run around with a piece of biscuit in their mouth. Keep small toy parts belonging to older siblings out of reach. It sounds like nagging, but choking is the accident we hear about most often, and the one that almost always could have been avoided. Childproofing your home covers the rest.
Take a course, and take it again
We will say it plainly: reading this article is not enough. Compressions on a child require you to have felt how deep a third actually is, and you only feel that on a manikin. Röda Korset (the Swedish Red Cross), Svenska Livräddningssällskapet (the Swedish Life Saving Society) and many BVC clinics (BVC is the child health clinic every family in Sweden is enrolled in) run paediatric CPR courses in Stockholm. A course usually takes two to three hours. Check current times and prices with each provider. Then you need to refresh: the knowledge does not stay in the body after a year if it has never been used, and that is exactly how it is for everyone, not just you.
How we do it with our families
All our nannies must know paediatric CPR before they start with a family. Anyone with a certificate from a course shows it. Anyone without one gets test questions from Aleksandra at the interview: what do you do if the baby stops breathing, what do you do if the five year old chokes on a peanut? If she answers wrongly, we book a course before she is given an assignment. Before every new family she also watches a refresher video, because it is in the first week with new children that you are most nervous and least able to hesitate. Sanna, who has been with us since June 2024, says she refreshes the evening before a new shift, so she does not have to think about it during the shift.
This text is general information and does not replace advice from BVC, your vårdcentral (local health centre) or 1177 (the national healthcare helpline). If you are worried about your child, call 1177. In an emergency, call 112.
Would you like a nanny who knows your child, knows how things usually are and notices when something is different? Book a free first meeting with the nanny in your home.
Read more: Criminal record checks for nannies in Sweden · Child swallowed something dangerous · Childproofing your home · FAQ
Frequently asked questions
What is the difference between CPR on children and on adults?
On children you start with five rescue breaths before the chest compressions, because children usually suffer cardiac arrest from lack of oxygen, not heart problems. The compressions are shallower, about a third of the depth of the chest, and on babies two fingers are used instead of the heel of the hand.
What do I do if my baby chokes?
Lay the baby head down along your forearm or across your knee and give up to five firm blows between the shoulder blades. If that does not help: turn the baby onto their back and press with two fingers in the middle of the breastbone, up to five times. Alternate until the object comes out or the baby goes limp. Call 112.
What do I do if an older child chokes?
If the child can cough, let them cough. If they cannot: lean the child forward and give up to five blows between the shoulder blades. If that does not help, stand behind the child and give up to five abdominal thrusts, upwards and inwards just above the navel. Alternate. Call 112 as soon as you can.
How often do you need to refresh?
The knowledge fades quickly if it is not used. Count on refreshing at least once a year, ideally with a manikin. Many courses take two to three hours. Our nannies show a certificate or answer test questions, and watch a refresher video before every new family.
Where can you take a course in Stockholm?
Röda Korset, Svenska Livräddningssällskapet, many BVC clinics and several private trainers run paediatric CPR courses in Stockholm. Some employers pay for them. Check current times and prices on each website, and choose a course where you get to practise on a manikin, not just watch.