Updated Pediatric and Neonatal CPR Guidelines Emphasize Unique Needs of Children

The American Academy of Pediatrics and the American Heart Association have published updated guidelines for cardiopulmonary resuscitation and emergency cardiovascular care for newborn and pediatric populations. The "2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" mark a comprehensive update to the guidelines for pediatric basic and advanced life support and neonatal resuscitation since 2020. These guidelines are particularly significant given that every year, more than 7,000 out-of-hospital cardiac arrests and approximately 20,000 in-hospital cardiac arrests occur in infants and children in the United States.

"Children are not little adults, and these guidelines offer specific recommendations that reflect the unique needs of children," said Javier Lasa, M.D., FAHA, FAAP, associate professor in critical care and cardiology at Children's Health in Dallas and volunteer co-chair of the 2025 Pediatric Advanced Life Support Writing Group. The Pediatric Basic and Advanced Life Support guidelines are intended to be a resource for lay responders and health care professionals who provide care for infants and children in multiple settings: the community, prehospital and facility-based environment.

Key changes in the pediatric guidelines include the establishment of a single chain of survival intended to apply to adult and pediatric in- and out-of-hospital cardiac arrest. There is continued emphasis on early recognition of cardiac arrest in infants and children, and early activation of emergency medical services and the initiation of high-quality cardiopulmonary resuscitation beginning with chest compressions. For infants with severe foreign body airway obstruction, or choking, repeated cycles of 5 back blows alternating with 5 chest thrusts are recommended, with abdominal thrusts no longer recommended for infants. For children with severe FBAO, repeated cycles of 5 back blows alternating with 5 abdominal thrusts are recommended, whereas earlier guidance called for performing abdominal thrusts only.

For infants, the recommended compression techniques include using either the one-hand technique or the two thumbs-encircling hands technique. If the rescuer cannot physically encircle the chest, it is recommended to compress the chest with the heel of one-hand. The use of two fingers along the sternum was eliminated due to ineffectiveness in achieving proper depth. Henry Lee, M.D., FAAP, professor of pediatrics and neonatologist from the University of California San Diego and American Heart Association volunteer co-chair of the 2025 Neonatal Writing Group stressed the need for properly trained neonatal clinical care: "The guidelines also observe that one out of every 10-20 newborns each year needs help transitioning from the fluid-filled environment of the womb to the air-filled room. It is essential that every newborn infant has a health care professional dedicated to facilitating that transition who is trained and equipped for the role using these recommendations."

While an updated unified chain of survival has been developed for adults and children, a separate new newborn chain of care was created that provides a framework for considering essential elements of the health care system relating to neonatal health. The newborn chain of care starts with prenatal care and extends to recovery and appropriate follow-up in the postnatal period to ensure optimal short- and long-term health for the infant and family. Most newborn infants can be evaluated and monitored during deferred cord clamping for 60 seconds or more and can maintain skin-to-skin contact with a parent after birth, an increase from the previous recommendation of at least 30 seconds. Effective ventilation of the lungs remains the priority in newborn infants who need resuscitation.

It is reasonable to provide ventilation at a rate of 30-60 inflations per minute in newborn infants, which is expanded from the prior recommendation of 40-60 inflations per minute. The updated guidelines and CPR training materials are available in U.S. and international English with many additional translated languages planned so first responders, clinicians and other learners can begin using the most current, science-backed resources immediately. These educational materials can be accessed at Pediatric Advanced Life Support and the Neonatal Resuscitation Program, 9th Edition.