Severe respiratory distress and failure are what typically lead to cardiac arrest in a child. Early recognition of and intervention for respiratory distress can prevent deterioration. 

During the assessment, if the patient has a strong pulse but ineffective breathing, rescuers open the airway using the head tilt-chin lift technique and begin rescue breathing. Rescue breathing for the adult should be at the rate of 1 breath every 6 seconds. For children and infants, the rate for rescue breathing is 1 breath every 2 to 3 seconds.

Mouth-to-Mouth in Adult and Older Children

It is important not to give breaths too rapidly or forcefully, as this may force air into the stomach, resulting in enlargement and less room for lung expansion. 

The instructions for mouth-to-mouth rescue breathing include the following:

• The airway should be kept open.
• The nose is pinched closed.
• The rescuer takes a regular breath and creates a seal around the patient’s mouth using their mouth or a barrier device.
• Each breath is given over 1 second while watching for the chest to rise.
• If there is no chest rise, the patient’s head should be repositioned using the head tilt-chin lift maneuver.
• Another breath is delivered while watching for chest rise.
• The rescuer readjusts the airway again if unable to see the chest rise.  If the rescuer is unable to provide adequate ventilation after 2 attempts to reposition the airway, they return to giving high-quality chest compressions.

Mouth-to-Mouth in Infants

Ventilation techniques for an infant resemble those for children and adults with the following exceptions: 

• If the infant is small enough and the rescuer’s mouth can cover the infant’s nose and mouth and create a good seal, they do not have to pinch the infant’s nose. 
• An infant’s lungs are tiny, so a smaller volume of air will be enough to inflate the infant’s lungs. Each breath should be given over 1 second but with less volume than that used for adults.