Updated Pediatric and Neonatal CPR Guidelines Released with Life-Saving Protocol Changes

The American Academy of Pediatrics and American Heart Association have jointly published updated guidelines for cardiopulmonary resuscitation and emergency cardiovascular care for newborn and pediatric populations. The "2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" represent a comprehensive update to pediatric basic and advanced life support and neonatal resuscitation protocols since 2020.

These guidelines carry significant importance as they address a critical health issue affecting thousands of children annually. More than 7,000 out-of-hospital cardiac arrests and approximately 20,000 in-hospital cardiac arrests occur in infants and children in the United States each year, making these updated protocols essential for improving survival rates and outcomes.

"Children are not little adults, and these guidelines offer specific recommendations that reflect the unique needs of children," said Javier Lasa, M.D., FAHA, FAAP, associate professor in critical care and cardiology at Children's Health in Dallas and volunteer co-chair of the 2025 Pediatric Advanced Life Support Writing Group. This distinction is crucial for healthcare providers and lay responders who must adapt their approach based on the patient's age and physical development.

The updated pediatric guidelines introduce several key changes that could impact emergency response effectiveness. For infants with severe foreign body airway obstruction, or choking, the guidelines now recommend repeated cycles of 5 back blows alternating with 5 chest thrusts, eliminating abdominal thrusts entirely for this age group. For children with severe choking, repeated cycles of 5 back blows alternating with 5 abdominal thrusts are now recommended, whereas earlier guidance called for performing abdominal thrusts only.

Infant compression techniques have been refined, with recommendations including either the one-hand technique or the two thumbs-encircling hands technique. The use of two fingers along the sternum was eliminated due to ineffectiveness in achieving proper depth. If the rescuer cannot physically encircle the chest, compressing with the heel of one hand is now recommended.

Henry Lee, M.D., FAAP, professor of pediatrics and neonatologist from the University of California San Diego and American Heart Association volunteer co-chair of the 2025 Neonatal Writing Group emphasized the critical nature of neonatal care: "The guidelines also observe that one out of every 10-20 newborns each year needs help transitioning from the fluid-filled environment of the womb to the air-filled room. It is essential that every newborn infant has a health care professional dedicated to facilitating that transition who is trained and equipped for the role using these recommendations."

The neonatal guidelines introduce a new newborn chain of care framework that starts with prenatal care and extends to recovery and appropriate follow-up in the postnatal period. Most newborn infants can now be evaluated and monitored during deferred cord clamping for 60 seconds or more, increased from the previous recommendation of at least 30 seconds, while maintaining skin-to-skin contact with a parent after birth.

Ventilation protocols have been updated, with the reasonable ventilation rate for newborn infants expanded to 30-60 inflations per minute from the prior recommendation of 40-60 inflations per minute. Effective ventilation of the lungs remains the priority in newborn infants who need resuscitation.

The guidelines were developed through collaboration between both organizations, with writing groups evenly balanced between members of the American Heart Association and American Academy of Pediatrics. The updated educational materials and training resources are available at https://cpr.heart.org/pals for Pediatric Advanced Life Support and https://aap.org/nrp for the Neonatal Resuscitation Program, 9th Edition, allowing first responders, clinicians and other learners to immediately access the most current, science-backed resources.