Addendum - Paediatric First Aid

Introduction

First aid and resuscitation guidance is regularly reviewed and updated by expert panels to ensure it reflects the latest evidence, research, and best practice.

The guidance contained in earlier editions of this Paediatric First Aid book was correct and appropriate at the time of publication. Ongoing assessment of outcomes and real-world experience has since identified opportunities to refine and improve the early response to life-threatening emergencies.

The 2025 Resuscitation Council (UK) Guidelines introduce updates that:

• Encourage earlier activation of emergency services
• Emphasise the early control of catastrophic bleeding
• Reinforce rapid recognition and escalation in critical situations

These updates do not indicate that previous guidance was wrong or unsafe. Instead, they build upon existing good practice to help first aiders act more quickly and effectively.

This addendum has been produced to align earlier publications with current guidance.

Paediatric CPR

Some of the most significant updates in the 2025 Resuscitation Council guidelines concern paediatric CPR.

Paediatric casualties are defined as ages 0–18 years, with CPR techniques adjusted by age:

• Infant: under 1 year
• Child: 1–12 years
• Adolescent: 13–18 years

The UK Resuscitation Council (RCUK) clarifies that:

• If the rescuer is trained and competent in paediatric basic life support, the recommended compression-to-breath ratio: 15:2
• If the rescuer is not trained in paediatric CPR, they should perform: 30:2

This approach prioritises simplicity, early action, and consistency, reducing hesitation in an emergency.

Where paediatric CPR training is provided in addition to FAW, this may also include:

• 5 initial rescue breaths
• The two finger chest compression has now been replaced with the two-thumb encircling chest compression technique for infants

Infant Choking – Updated Chest Thrust Technique

In line with updates to paediatric resuscitation practice, the technique used for chest thrusts in infants during choking management has been updated.

Chest thrusts for an infant (under 1 year) should now be performed using the two-thumb encircling technique, rather than the two-finger technique previously taught.

This approach aligns with current CPR guidance and provides more effective and controlled compressions.

If the infant becomes unresponsive, begin CPR immediately.

Update to the Primary Survey: DR C ABCDE

Earlier editions of this book refer to the primary survey using DR ABC.

In line with the 2025 Resuscitation Council (UK) Guidelines, the primary survey is now conducted using:

A key change is that emergency services should be contacted as soon as a casualty is found to be unresponsive, before checking for normal breathing.

Early 999 Call

Emergency services should now be contacted as soon as a casualty is found unresponsive, before breathing is assessed.

Breathing checks should be carried out while on the phone.

Use of 999 Call Handler Support

First aiders are encouraged to:

• Place phones on speaker
• Follow call handler instructions while care begins

Life-Threatening Bleeding – Priority Update

Life-threatening bleeding is now prioritised before airway and breathing on arrival at a scene, in line with updated UK Resuscitation Council guidance.

For Paediatric First Aid, first aiders are trained to:

• Recognise life-threatening bleeding
• Apply direct pressure to control bleeding
• Call 999 at the earliest opportunity
• Follow 999 call handler guidance while care is ongoing

Agonal Breathing

Greater emphasis that:

• Gasping or agonal breathing is not normal breathing
• CPR must not be delayed

Updated Chain of Survival

The 2025 European Resuscitation Council (ERC) Guidelines place increased emphasis on the Chain of Survival, which describes the sequence of actions that give a casualty the best chance of survival following cardiac arrest.

The Chain of Survival

Early recognition and call for help
Prompt recognition of collapse, unresponsiveness, or abnormal breathing, and immediate activation of emergency services (999/112).

Early CPR and defibrillation
Immediate CPR if the casualty is unresponsive and not breathing normally, and early use of an AED if available.

Advanced life support and post-resuscitation care
Advanced care provided by emergency services and hospital teams.

Survival and recovery
Ongoing treatment, rehabilitation, and recovery following the emergency.

CPR on Soft Surfaces

First aiders are no longer expected to move casualties from beds or soft surfaces.

Increase compression depth where possible

AED Pad Placement & Clothing

• Correct pad placement
• Removing or repositioning bras where required
• Life-saving actions taking priority over modesty

Amputations

• Wrap amputated part in a clean, damp cloth (water or saline)
• Place in a waterproof bag
• Then place the bag in ice

Jaw Thrust (Spinal Injury)

• The jaw thrust technique is recommended for opening the airway when a spinal injury is suspected
• This helps maintain airway management while minimising movement of the head and neck

Drowning & Rescuer Safety

Drowning recognition, rescue, and in-water response are not normally covered within the standard Paediatric First Aid syllabus.

Where drowning awareness or rescue content is delivered in addition to Paediatric First Aid, updated guidance places increased emphasis on:

• Rescuer safety as the absolute priority
• Avoiding unnecessary personal risk
• Using flotation or buoyancy aids wherever possible
• Avoiding entering the water unless it is safe and unavoidable

First aiders should be reminded that:

• Entering the water to attempt a rescue can place them at serious risk
• Emergency services should be contacted at the earliest opportunity
• Shout for help and use reach / throw principles rather than go, where possible

Post-Incident Self-Care

Guidance on supporting first aider wellbeing after an incident.

Recognising emotional and psychological responses.

Encouragement to access support where needed.

This addendum updates earlier editions of the Paediatric First Aid book to align with current Resuscitation Council (UK). All other guidance within the original publication remains valid when read alongside this update.