CPR Hand Placement for Children: A Paramedic's Step-by-Step Guide

Today I want to talk about something every parent should know: child CPR. Knowing how to perform CPR on a young child, with the right hand placement, is not just a skill. It's a superhero power that saves lives.

The Ideal Hand Placement for Child CPR (Age 1 to the Onset of Puberty)

Place your hands on the center of the child's chest, on the lower half of the breastbone, across from the nipple line. Use the heel of your hand to push.

Use one or two hands, whichever lets you push deep enough. Here's the shortcut I teach, because it works when seconds matter: picture lifting the child off the ground. If you could easily pick them up, start with one hand. If there's no way you could lift them, start with two.

Keep your elbows locked and your shoulders directly above your hands.

Why Child CPR Matters

CPR, or cardiopulmonary resuscitation, is what you do when a child's heart stops. That can happen from suffocation, drowning, electrical shock, or a congenital heart problem.

Here's what makes children different from adults: most children go into cardiac arrest because of a breathing problem that stops the heart, not a heart problem that stops the breathing. That's why rescue breaths matter so much in pediatric CPR.

Immediate Actions

1. Try to wake the child. Tap their shoulder and look for any response or obvious signs of life.
2. If there are no signs of life, call 911 immediately.

Do I Check for a Pulse First?

No. If you are not a healthcare provider, do not spend time checking for a pulse. The current guidelines direct lay rescuers to start CPR if the child is unresponsive and not breathing normally. Pulse checks are unreliable even for trained providers, and every second spent searching for one is a second without compressions.

Look for obvious signs of life instead: coughing, normal breathing with the chest rising, or movement like wiggling fingers or opening their eyes. Take at least 5 seconds and no more than 10. If you see nothing, or you aren't sure, start CPR.

Calling 911

If you have never called for emergency help before, it can be frightening. The dispatchers are trained for this and will walk you through CPR. They will ask for:

• Your name, phone number, and the address of the emergency. This matters in case you get disconnected, and it gets help to the right place.
• Information about the problem. The child's age, and any injury or illness.

Stay on the phone. The dispatcher is helping you and also feeding updates to the responding crews so they arrive ready.

If you are alone with no quick access to a phone, perform 2 minutes of CPR before leaving to get help. Because most children arrest from a respiratory cause, two minutes of good compressions and breaths can meaningfully improve their odds.

How to Perform Child CPR

The goal of compressions is to squeeze the heart and push oxygen-rich blood to the brain and vital organs.

1. Position the child

Get them on their back on a hard, flat surface. If an AED is available, you'll need to cut clothing away for proper pad placement. If there's no AED and you can't quickly clear clothing, compress over the thinnest layer you can. Too much fabric makes it hard to judge depth.

2. Kneel beside the child

Before you drop to your knees, glance for broken glass, sharp objects, or fluids.

3. Find the right hand position

Center of the chest, lower half of the sternum, across from the nipple line. One or two hands depending on the child's size. Elbows locked, shoulders stacked directly over your hands.

4. Compress

• Push straight down about 2 inches, roughly one third of the depth of the chest.
• Aim for 100 to 120 compressions per minute. Counting out loud ("1 and 2 and 3") keeps your pace honest.
• Let the chest come all the way back up between compressions.
• Give 30 compressions, then move to breaths.
• You will see the chest move and you may hear sounds. That's normal.

5. Give 2 rescue breaths

Perform a head-tilt, chin-lift so the tongue isn't blocking the airway. Place one hand on the forehead and the other on the bony part of the jaw. Once the head is tilted back, pinch the nose with the hand on the forehead.

Each breath should last about 1 second and make the chest visibly rise. Don't blow forcefully. Too much air goes into the stomach instead of the lungs.

If the chest doesn't rise, reposition the head and try again. If air still won't go in, consider that something may be blocking the airway. See our guide to the 2025 choking guidelines.

Continuing CPR

Keep going at 30 compressions to 2 breaths for 2 minutes, which is 5 full cycles. If someone else is there who can take over, switch. Research shows that after 2 to 3 minutes, compressions get shallower and slower even when you think you're going strong.

Continue until the child wakes or shows obvious signs of life, someone takes over, or you physically cannot continue.

Is Hands-Only CPR Okay for Children?

No. Hands-only CPR is not the recommendation for children, because most pediatric arrests start as breathing problems. Providing breaths along with compressions improves survival, and rescuers are encouraged to give them when able and willing.

That said, if you are ever in a situation where you cannot or will not give rescue breaths, high-quality chest compressions alone are far better than doing nothing. A barrier device in your first aid kit removes that hesitation before it ever comes up.

What If Someone Else Is There to Help?

If you took a parent or caregiver level course, you learned one ratio: 30 compressions to 2 breaths. That doesn't change when a second person shows up. What they can do is take over compressions when you get tired, call 911, or go get the AED, all of which matter enormously.

The 15 compressions to 2 breaths ratio is taught at the BLS level, for rescuers trained to work as a team. It gives the child twice as many breaths, which is significant in pediatric arrest, but it takes practice to coordinate. Childcare centers and schools are generally required to hold the pediatric CPR and First Aid certification rather than BLS, so 30 to 2 is the ratio their staff will use. If you work in one of those settings, the most valuable thing you can practice is switching rescuers cleanly so compressions never stop for long.

What About Infants Under 1?

Infant CPR is different. Compress about 1.5 inches, again roughly one third of the chest depth. The 2025 guidelines eliminated the two-finger technique. Use the two thumbs encircling hands technique, or the heel of one hand if you can't encircle the chest. The ratio is the same 30 to 2 at the lay rescuer level.

Formal CPR Training

Nothing beats hands-on practice. Reading builds understanding, but muscle memory is what shows up when you're panicking at 2 a.m. I strongly recommend a CPR and First Aid course that includes AED training.

I teach pediatric and infant CPR and First Aid in the Pittsburgh area for parents, caregivers, schools, and businesses, plus BLS for those whose employer requires it. Request on-site group training.

Frequently Asked Questions: CPR Hand Placement for Children

Where do you place your hands for CPR on a child?

Place the heel of one or two hands on the lower half of the sternum, at the center of the child's chest across from the nipple line. Keep your elbows locked and your shoulders directly above your hands. Whether you use one or two hands depends on the child's size. If you could easily lift the child off the ground, start with one hand. If not, use two.

During CPR on a child, you should place 1 or 2 hands over what?

The lower half of the sternum, the breastbone, at the center of the chest across from the nipple line. This is the same whether you use one hand or two.

How deep should chest compressions be for a child?

About 2 inches, or roughly one third of the depth of the chest, for children age 1 to the onset of puberty. Compress at 100 to 120 per minute. Counting out loud, "1 and 2 and 3," helps you hold the pace.

What is the compression to breath ratio for a child?

30 compressions to 2 breaths. That's what parents and caregivers are taught, and it applies whether or not someone else is with you. Rescuers trained at the BLS level use 15 compressions to 2 breaths when two rescuers are working together. Infant ratios follow the same pattern.

Should you use one hand or two hands for child CPR?

Whichever gets you to the right depth. The quick test: if you think you could easily lift the child off the ground, start with one hand. If you couldn't, use two. Research in children 1 to 8 found the two-hand technique achieved greater compression depth, so if you're unsure, two hands is a reasonable default.

You are performing CPR on a 5-year-old. How should your hands be positioned?

One or two hands over the lower half of the sternum, center of the chest. For most adults, one hand reaches the needed 2-inch depth on a 5-year-old. Lock your elbow and keep your shoulder directly above your hand.

What is the correct hand placement for CPR on a 7-year-old?

The heel of one hand on the center of the chest, lower half of the sternum. Depending on your strength and the child's size, you may need two hands to reach the proper depth. Elbows locked, shoulders above your hands.

Should a lay rescuer check for a pulse before starting CPR on a child?

No. Lay rescuers should not check for a pulse. Start CPR if the child is unresponsive and not breathing normally. Things you can look for are coughing, normal breathing, or body movement. Healthcare providers may check a pulse while looking for other sighs of life, taking no more than 10 seconds.

What happens if you don't place your hands correctly during CPR?

Poor placement means compressions that are too shallow, too far to the side, or over the wrong part of the chest. Less oxygenated blood reaches the brain and vital organs, and the risk of injury goes up. Center of the chest, heel of the hand, elbows locked, is what makes every compression count.

Does CPR break ribs in children?

It's less common in children than adults, since children's bones are more flexible. If it happens, a broken rib heals. Not doing CPR doesn't give the child a chance. Never let that fear stop you. More on that here.

How do I learn CPR properly?

Reading is a good start, but nothing replaces practice on a manikin with a certified instructor. Muscle memory is what kicks in when you're panicking. Jeremy is an AHA and HSI certified instructor teaching CPR and First Aid classes in Pittsburgh, PA for parents, caregivers, schools, and businesses, including pediatric and infant CPR. Request on-site group training. If you are not in the Pittsburgh Area, search online for courses near you or check with your local emergency services to see if they can offer training. 

This article is for general education and does not replace medical advice. If you think your child is in danger or needs urgent help, call 911 right away.

Jeremy Manke is a PA-certified paramedic and firefighter with more than 20 years of experience, and the creator of the Children's First Aid and CPR Kit.