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 cardiopulmonary arrest in children include: drowning, choking, head trauma or serious injury, excessive bleeding, electrical shock, poisoning, and respiratory or lung disease.

• Unconsciousness
• No breathing
• No pulse

1. Check for consciousness. Shake or tap the child gently. Shout, "Are you OK?" See if the child moves or makes a noise. Do not move the child excessively if a spinal cord injury is suspected.
   
   
2. If there is no response, shout for help.
   
   
3. Roll the child onto his back on a hard, flat surface, keeping the back in a straight line, and firmly supporting the head and neck. Expose the chest.
   
   
4. Kneel next to the child with your knees against the child's side. Lift the child's chin while tilting the head back to move the tongue away from the windpipe. 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. Do not let the child's mouth close.
   
   
5. Place your ear close to the child's mouth, and watch for chest movement. Look, listen, and feel for breathing for up to 10 seconds.
   
   
6. If the child is breathing, place him or her in the recovery position (see unconsciousness).
   
   
7. If the child is not breathing, begin rescue breaths. Maintain the head position, close the child's nostrils by pinching them with your thumb and index finger, and cover the child's mouth tightly with your mouth. Give 2 slow, thorough breaths, with a pause in between. (Note: An adult's lungs are much larger than a child's, so use small breaths and blow just enough to make the child's chest rise.)
   
   
8. If the chest does not rise, reposition the head or jaw, and give 2 more breaths. If the chest still doesn't rise, the child's airway may be blocked. Follow instructions for choking (for unconscious adult or child over 1 year).
   
   
9. If the chest rises, non-medical rescuers should reassess the victim 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 child 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 victim's head position with one hand, and place the heel of your other hand 1 or 2 finger-widths above the lowest notch of the child's breastbone (where the lower edge of the ribcage meets in the middle). Your fingers should be pointing parallel to the child's nipple line. Lean your shoulder over your hand and quickly press about one to one and one-half inches into the child's chest 5 times. Give the compressions in a smooth, rhythmic manner, keeping your hand in the same place on the child's chest. Don't rock back and forth -- push straight down. Don't pause between compressions. Avoid pushing on the lowest notch of the breastbone (the xiphoid process).
    
    
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 child 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 about one and one-half times per second (100 times per minute).
    
    
14. Recheck the child for signs of circulation.
    
    
15. Repeat Steps 13 and 14 until signs of circulation resume or help arrives. If signs of circulation resume, go to Step 10.
    
    
16. If the child starts breathing again spontaneously, 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 there is a pulse -- doing so may cause the heart to stop beating.
• DO NOT move the child'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 child with you as you go to the nearest phone.

The most common situations in which young children need CPR are car accidents, drowning, fires and burns, suffocation, and unintentional firearm accidents. With this in mind, remember that simple measures can help prevent accidents.

• Teach your child the meaning of "No!"
• Teach your children the basic principles of fire safety.
• Teach your child to swim.
• Teach your child pedestrian safety and bicycle safety.
• Never let a child ride in a car without a car seat or safety belt firmly in place.
• 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.

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

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. Inspect toys for fragility, small or loose parts, sharp edges, projectiles, and other hazards.

Choose non-toxic toys, paints, markers, and crayons.