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.

A rapid response is very important when dealing with an unconscious person 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.

Cardio-pulmonary arrest is a combination of two life-threatening conditions: absence of breathing and lack of an effective heartbeat.

Major causes of cardio-pulmonary arrest in infants include: respiratory or lung disease, SIDS, choking, seizures, poisoning, electrical shock, hypothermia (too cold), head trauma or serious injury, excessive bleeding, infection, and septic shock.

• Unconsciousness
• No breathing
• No pulse

1. Check for consciousness. Rub the infant's back, nudge, or rub the sternum to check for responsiveness. See if the infant moves or makes a noise. Do not move the infant excessively if a spinal cord injury is suspected, and never shake a infant.
   
   
2. If there is no response, shout for help.
   
   
3. Place the infant on its back on a hard, flat surface, keeping the back in a straight line, and firmly supporting the head and neck. Expose the chest.
   
   
4. Lift the infant's chin while tilting the head back slightly to move the tongue away from the windpipe. Do not overextend the head. If a spinal injury is suspected, do not tilt the head back, but instead open the airway by putting 2 or 3 fingers under each side of the lower jaw and lifting upward. Don't let the infant's mouth close.
   
   
5. Place your ear close to the infant's mouth, and watch for chest movement. Look, listen, and feel for breathing for up to 10 seconds.
   
   
6. If the infant is breathing, place him or her in the recovery position (see unconsciousness).
   
   
7. If the infant is not breathing, begin rescue breaths. Maintain the head position and cover the mouth and nose tightly with your mouth. Give 2 slow, gentle puffs -- each lasting 1 second -- with a pause in between. Puff in just enough air to make the chest rise.
   
   
8. If the chest does not rise, reposition the head or jaw, and give 2 more puffs. If the chest still doesn't rise, the infant's airway may be blocked. Follow instructions for choking (for unconscious infant under one year).
   
   
9. If the chest rises, non-medical rescuers should reassess the infant for signs of circulation (spontaneous breathing, coughing, or movement) and if still absent, should begin chest compressions. (Trained health care providers should assess for the presence of a pulse before beginning chest compressions.)
   
   
10. If the infant has evidence of circulation, but is not breathing effectively on his or her own, continue to give 1 rescue breath every 3 seconds (about 20 breaths per minute) for as long as needed.
    
    
11. If chest compressions are necessary, maintain the head position with one hand and place 2 fingers on the middle of the infant's breastbone, one fingerbreadth below the nipple line. Quickly press your fingers one-half to 1 inch into the infant's chest 5 times in rapid succession. Give the compression in a smooth, rhythmic manner, keeping your fingers in the same location on the infant's chest. Provide firm compressions, but avoid pushing on the lowest part of the breastbone (the xiphoid process) which can injure the abdominal organs if accidentally compressed.
    
    
12. Call the local emergency number after you have administered CPR for 1 minute (20 cycles) or, if possible, have someone else make the call as you continue CPR.
    
    
13. Give the infant 1 breath, followed by 5 chest compressions. Repeat this sequence 10 times. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of AT LEASTone and one-half times per second (at least 100 times per minute).
    
    
14. Recheck the infant for signs of circulation.
    
    
15. Repeat Steps 13 and 14 until signs of circulation resume or help arrives. If the signs of circulation resume, go to Step 10.
    
    
16. If the infant starts breathing again on its own, place him or her in the recovery position, and periodically re-check for breathing and signs of circulation until help arrives.
    

• DO NOT give chest compressions if you can feel a pulse -- doing so may cause the heart to stop beating.
• DO NOT move the infant's head or neck to check for breathing if a spinal injury is suspected.

• If you are not alone, have one person call the local emergency number 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 other help has arrived, call the local emergency number. If there is no evidence of spinal injury, consider carrying the infant with you as you go to the nearest phone.

Create a safe environment and supervise children carefully, particularly around water and near furniture. Know where your children are and what they are doing at all times.

Never underestimate what a infant can do. Play it safe and assume the child is more mobile and more dexterous than you thought possible. Never leave an infant unattended on a bed, table, or other surface from which the infant could roll. Never leave a infant in a mesh playpen with one side down.

Recognize what is age-appropriate for children, especially when choosing toys. Don't give infants toys that are heavy or fragile, or that have batteries or small parts.

To reduce the risk of choking accidents, make sure small children do not come into contact with buttons, watch batteries, popcorn, coins, grapes, or nuts. It is also important to sit with an infant while he or she eats. Do not prop up a baby bottle so the infant can drink without you. Do not allow an infant to crawl around while eating or drinking from a bottle.

Never tie pacifiers (or anything else) around an infant's neck.

Start teaching your child the meaning of "Don't touch." The earliest safety lesson is "No!"