CPR is a lifesaving procedure that is performed when a child's breathing or heartbeat has stopped, as in cases of drowning, suffocation, choking, or injuries. CPR is a combination of:

• Rescue breathing, which provides oxygen to a child's lungs
• Chest compressions, which keep the child's blood circulating.

Permanent brain damage or death can occur within minutes if a child's blood flow stops. Therefore, you must continue these procedures until the child's heartbeat and breathing return, or trained medical help arrives.

CPR can be lifesaving, but it is best performed by those who have been trained in an accredited CPR course. The procedures described here are not a substitute for CPR training.

All parents and those who take care of children should learn infant and child CPR if they haven't already. This jewel of knowledge is something no parent should be without. (See www.americanheart.org for classes near you.)

Time is very important when dealing with an unconscious child who is not breathing. Permanent brain damage begins after only 4 minutes without oxygen, and death can occur in as little as 4 to 6 minutes later.

In children, major reasons that heartbeat and breathing stop include drowning, suffocation, choking, head trauma or serious injury, excessive bleeding, electrical shock, poisoning, and lung disease.

• Unconsciousness
• No breathing
• No pulse

The following steps are based on instructions from the American Heart Association.

1. Check for responsiveness. Shake or tap the child gently. See if the child moves or makes a noise. Shout, "Are you OK?"
   
   
2. If there is no response, shout for help. Send someone to call 911. Do not leave the child yourself to call 911 until you have performed CPR for about one minute.
   
   
3. Carefully place the child on his or her back. If there is a chance the child has a spinal injury, two people are needed to move the child without twisting the head and neck.
   
   
4. Open the airway. Lift up the chin with one hand. At the same time, push down on the forehead with the other hand.
   
   
5. Look, listen, and feel for breathing. Place your ear close to the child's mouth and nose. Watch for chest movement. Feel for breath on your cheek.
   
   
6. If the child is not breathing:
   • Cover the child's mouth tightly with your mouth
   • Pinch the nose closed
   • Keep the chin lifted and head tilted
   • Give 2 slow breaths. DO NOT give large, full, forceful breaths.
   
   
7. If the chest does NOT rise, try the chin lift-head tilt again, and give 2 more breaths. If the chest still doesn't rise, check to see if something is blocking the airway and try to remove it.
   
   
8. Look for signs of circulation -- normal breathing, coughing, or movement. If these signs are absent, begin chest compressions.
   
   
9. Perform chest compressions:
   • Place the heel of one hand on the breastbone -- just below the nipples. Make sure your heel is not at the very end of the breastbone.
   • Keep your other hand on the child's forehead, keeping the head tilted back.
   • Press down on the child's chest so that it compresses about 1/3 to 1/2 the depth of the chest.
   • Give 5 chest compressions. Each time, let the chest rise completely. These compressions should be FAST with no pausing. Count the 5 compressions quickly: "a, b, c, d, off."
   
   
10. Give the child 1 slow, full breath. The chest should rise.
    
    
11. Continue cycles of 5 chest compressions followed by 1 slow, full breath.
    
    
12. After about 1 minute, check again for signs of circulation.
    
    
13. At this time, if the child still does not have normal breathing, coughing, or any movement, leave the child to call 911.
    
    
14. Repeat steps 11 and 12 until the child recovers or help arrives.
    
    

If the child starts breathing again, place him or her in the recovery position. Periodically re-check for breathing and signs of circulation until help arrives.

• If a spinal injury is suspected, DO NOT tilt the head back when attempting to open the airway. Instead, place your fingers on the jaw on each side of the head. Lift the jaw forward. This keeps the head and neck from moving.
• If the child has signs of circulation -- normal breathing, coughing, or movement -- DO NOT begin chest compressions. Doing so may cause the heart to stop beating.
• Unless you are a health professional, DO NOT check for a pulse. Only a healthcare professional is properly trained to check for a pulse.

• If you have help, tell one person to call 911 while another person begins CPR.
• If you are alone, shout loudly for help and begin CPR. After doing CPR for about 1 minute, if no help has arrived, call 911. You may carry the child with you to the nearest phone (unless you suspect spinal injury).

Unlike adults, who may suffer a heart attack, most children need CPR because of a preventable accident. With this in mind, remember these simple measures:

• Teach your child the meaning of "No!"
• Teach your children the basic principles of family safety.
• Teach your child to swim.
• Teach your child to watch for cars and ride bikes safely.
• Make sure you follow the guidelines for using children's car seats.
• Teach your child firearm safety.

Never underestimate what a child can do. Play it safe, and assume the child is more mobile and more dexterous than you thought possible. Think ahead to what the child may get into next, and be ready. Climbing and squirming are to be expected. Always use safety straps on high chairs and strollers.

Choose age-appropriate toys. Do not give small children toys that are heavy or fragile. Inspect toys for small or loose parts, sharp edges, points, loose batteries, and other hazards.

Create a safe environment and supervise children carefully, particularly around water and near furniture. Dangers such as electrical outlets, stove tops, and medicine cabinets are attractive to small children.