Assessment of Infant Cardiopulmonary Resuscitation Rescue Breathing Technique: Relationship of Infant and Caregiver Facial Measurements
Authors: Dembofsky Cynthia A. , Gibson Eric , Nadkarni Vinay , Rubin Sara , Greenspan Jay S. 
Published: August 2004

Objective.
Although a few infants ever require resuscitation, pediatric cardiopulmonary resuscitation (CPR) is performed most commonly under 1 year of age. American Heart Association guidelines for pediatric basic life support recommend that the caregiver place his/her mouth over the infant's mouth and nose to create a seal. The way CPR is currently taught encourages parents to attempt to seal the nose and open the mouth of the infant for rescue breathing. Recent studies suggest some parents may have trouble sealing an infant's nose and open mouth, but their study participant numbers were small. The aim of this report is to estimate, among a large cohort, the ability of caregivers to create a seal to their infants for the provision of rescue breathing according to current guidelines.

Methods.
Infants up to 1 year of age (n = 281) and their caregivers were enrolled from Philadelphia pediatric offices. Facial measurements of the infants were obtained to estimate the length needed to seal the nose and open mouth, and the nose and closed mouth. Mouth widths of the caregivers were compared with their infant's nose and mouth lengths. One-way analysis of variance with Tukey's postmortem analysis and ordinary least squares means regression were used for univariate analysis with analysis of covariance used to control for the effects of multiple variables when necessary. Infant measurements were stratified into 3-month age quadrants to compare against matched adult caregiver measurements.

Results.
Most caregivers (n = 270) were female. Females had smaller mouth widths than males (4.9 ± 0.5 cm vs 5.2 ± 0.5 cm). Infant nose and mouth length increased during the first year of life, with the largest increase between 0 to 3 months and 3 to 6 months (4.2 ± 0.4 cm to 4.7 ± 0.4 cm). As infant age and face length increased, a progressively higher rate of adult females were estimated not to be able to cover their infant's nose and open mouth, with the greatest increase again between 0 to 3 months (9%) and 3 to 6 months (40%). All female caregivers except 1 were predicted to be able to seal their infant's nose and closed mouth by our measurements.

Conclusions.
Infant face length grows rapidly during the first year of life with the most rapid growth occurring during the first 6 months. As early as 3 to 6 months of infant age, many adult caregivers' facial measurements, especially female, predict that they may not be able to form a seal for mouth-to-nose and open-mouth infant rescue breathing. By related measurements, nearly 100% of caregivers should be able to seal their infant's nose and closed mouth. If facial measurement predictions correlate with functional inability to seal an infant's nose and open mouth, infant CPR rescue breathing instruction will need to emphasize head position and creation of a seal over the mouth and nose without teaching that the mouth be open. pediatric basic life support, infant CPR, rescue breathing, sudden infant death syndrome, acute life-threatening episode.