Thank you to Graham for submitting the following question:

When conducting CPR training on an infant manikin we are told we have to have them on a hard surface rather than holding them in our arm, this poses an issue with the angle of the head. It forces the head to lean forward. While administering the breaths it is hard to get the correct head tilt. Is there any other method or technique that we should be doing?

Reply by Sarah Hunstead RN (B Nurs) MN – Paediatric Emergency Department Nurse

Hi Graham, thank you for your question.

Adequate chest compression depth just can’t be achieved in arms, and also you cannot control their airway. Their large heads roll around in your arms when they are unconscious, and their large tongues flop over the airway unless you are lifting their chin. The airway is definitely not stable in arms.

I recommend that the infant be placed on a hard surface to ensure adequate chest compression depth, and importantly you have much more control over their airway. I tell my students that during compressions, let go of the airway. when you go to do breaths, then reposition the airway – hand on forehead and thumb/index finger lifting chin, the mouth over mouth and nose. let go of the airway to recommence compressions. This is if the rescuer need to use both hands for CPR e.g. using thumbs. If using just the 2 fingers on one hand, the other hand can be used to keep the head in the neutral position.

Another really good way of keeping an infant in the right position is to simply roll up a cloth nappy or tea towel and place it under their shoulder blades – this can help keep them in a more neutral position.

I hope this provides some clarification.

If you have any further queries please let me know.