How to use an AED on a child and an infant: the paediatric defibrillator

By Cristiano Antonino On Apr 19, 2023

If a child is in out-of-hospital cardiac arrest, you should initiate CPR and ask lay rescuers to call the emergency services and obtain an automated external defibrillator to increase the chances of survival

Children and infants who die from sudden cardiac arrest often have ventricular fibrillation, which disrupts the normal electrical function of the heart.

Out-of-hospital external defibrillation within the first 3 minutes results in survival rates.

To help prevent deaths in infants and children, it is essential to understand the use and function of AEDs on an infant and child.

However, because an AED provides an electric shock to the heart, many are concerned about the use of this device on infants and children.

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What is an automatic external defibrillator?

Automated external defibrillators are portable life-saving medical devices that can monitor the heartbeat of a victim of cardiac arrest and deliver a shock to restore a normal heart rhythm.

The chances of survival from sudden cardiac death decrease by 10% for every minute without immediate CPR or external defibrillation.

Some of the most common causes of sudden cardiac death in the young include hypertrophic cardiomyopathy, which causes enlargement of heart muscle cells, which then causes thickening of the chest wall.

Can you use AEDs on an infant?

AED devices are manufactured with adults in mind.

However, rescuers can also use this life-saving device on children and infants with suspected SCA if a manual defibrillator with a trained rescuer is not immediately available.

AEDs have paediatric settings and defibrillator pads that can be adjusted, making them safe for infants and children weighing less than 55 lbs (25 kg).

The American Heart Association recommends the use of paediatric electrodes on children under eight years of age and infants, while adult electrodes can be used on children eight years of age and older.

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Safety of defibrillator use on a child

It is essential to know that AEDs are safe for children aged eight years and under, and even for infants.

Providing adequate CPR and using an AED is the best way to treat a child or infant in sudden cardiac arrest.

Without effective CPR and an AED to restart the heart, the child’s condition can be fatal within minutes.

And because babies and young children have such small and delicate systems, restarting their hearts quickly is even more critical.

This will restore oxygenated blood flow throughout the body, supplying the brain and vital organ systems, limiting damage to these systems.

How to use an AED on a child or infant?

The use of an AED in children and infants is a crucial step.

It requires a lower energy level to defibrillate the heart.

Here are step-by-step instructions on how to use an AED on a child and an infant.

Step 1: Make sure you know where a defibrillator is located

AEDs are available in most offices and public buildings.

Once you have located an AED, retrieve it from its case and switch the device on immediately.

Each AED is programmed to provide audible step-by-step instructions for its use.

The cases or enclosures are designed to be easily accessible in an emergency.

Step 2: Keep the child’s chest exposed

If necessary, dry the chest of the child victim (children may be playing and sweating).

Peel off existing medication patches, if present.

Step 3: Place electrodes on the child or infant

Place one adhesive electrode on the right upper part of the child’s chest, over the breast or on the left upper part of the infant’s chest.

Then place the second electrode on the lower left side of the chest under the armpit or on the baby’s back.

If the electrodes touch the baby’s chest, place one electrode on the front of the chest and another on the baby’s back instead.

Step 4: Maintain distance from the child or infant

After applying the electrodes correctly, stop performing CPR and warn the crowd to keep their distance from the victim and not to touch him or her while the AED monitors the heart rhythm.

Step 5: Allow the AED to analyse the heart rhythm

Follow the AED’s verbal instructions.

If the AED displays the message “Check Electrodes”, make sure the electrodes are in contact with each other.

Stay clear of the cardiac arrest victim while the AED searches for a shockable rhythm.

If “Shock” is displayed on the AED, press and hold the flashing shock button until the defibrillation shock is released.

Step 6: Perform CPR for two minutes

Start chest compressions and perform rescue ventilations again.

You should perform these at a rate of at least 100-120 compressions per minute.

The AED will continue to monitor the child’s heart rhythm.

If the child responds, stay with him.

Keep the child comfortable and warm until help arrives.

Step 7: Repeat the cycle

If the child does not respond, continue CPR following the AED instructions.

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Do this until the child’s heart has a normal rhythm or the ambulance team arrives.

Stay calm: remember that a defibrillator is also programmed for the hypothesis that the child will not respond.

Is it possible to use adult AED electrodes on an infant?

Most AEDs come with adult and paediatric electrodes designed for use on younger children.

Infant electrodes can be used on children under 8 years of age or weighing less than 55 lbs (25 kg).

Paediatric electrodes cause a smaller electric shock than adult electrodes.

Adult electrodes can be used on children older than 8 years of age or weighing more than 55 lbs (25 kg).

Therefore, if paediatric electrodes are not available, a rescuer may use standard adult electrodes.

How common is sudden cardiac arrest in children and infants?

Sudden cardiac arrest is quite rare in children.

However, SCA is responsible for 10-15% of sudden infant deaths.

The 2015 AHA Heart and Stroke statistics published by the American Heart Association found that 6,300 Americans under the age of 18 suffered an out-of-hospital cardiac arrest (OHCA) assessed by EMS.

Sudden death can be prevented when CPR and AEDs are administered within 3-5 minutes of cardiac arrest.

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The defibrillator in paediatric age

Sudden cardiac arrest occurs when an electrical malfunction of the heart causes it to suddenly stop beating properly, cutting off blood flow to the victim’s brain, lungs and other organs.

SCA requires rapid decision-making and action.

Bystanders who respond quickly make a surprising difference in the survival of SCA victims, be they adults or children.

The more knowledge and training one has, the more likely it is that a life will be saved!

It is useful to keep a few facts in mind:

AEDs are life-saving devices that can be used on both adults and children
Defibrillation is recommended for documented ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT)
There are specialised children’s electrodes that give a smaller paediatric shock than adult electrodes.
Some AEDs also have special settings for children, often activated by a switch or by inserting a special ‘key’.
When placing electrodes on children, they go on the front.
On infants, one electrode is placed on the front and the other on the back to ensure that the electrodes do not come into contact with each other.

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