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Circulation:
If central pulses (femoral in infants and carotid in children) are not palpable, begin chest compression without losing any time. In young infants, encircle the chest with both hands forming a rigid surface in the back and place the thumbs at the level of mid sternum to compress the chest. In toddlers, heel of one hand and in older children heel of both hands (one above the other) can be placed on the mid sternum for compression. Elbows are then straightened with shoulders directly over the hands so that thrust is directly down. In childern over 8 years you may use "adult" two hand method of chest compression. The depth of compression should be 1/2 to 1" in inhnts, 1 to 1.5" in younger and 1.5 to 2" in older children .
Synchronizing Chest Compression and Breathing: The rate of compression should be about 100 in infants and 80 in older children. After every 5 compressions one breath should be delivered during recovery phase of fifth compression. Every few minutas the CPR can be stopped to see if spontaneous pulse has returned.
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