Written by Joshua Belfer
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The 2025 AHA/AAP Pediatric BLS Guidelines introduce major updates: no more 2-finger compressions in infants, immediate AED use with pediatric attenuators, refined foreign-body airway obstruction management, and reaffirmation that breaths matter for pediatric CPR.
Walking through the major updates
The 2025 update to Pediatric BLS—the first full revision since 2020—reinforces that pediatric arrests are fundamentally different from adult arrests and introduces several practice-changing updates. Respiratory failure remains the dominant arrest etiology, so effective ventilation is again prioritized. The guidelines highlight new evidence on compression technique, defibrillation timing, and foreign-body management while acknowledging persistent gaps in pediatric-specific research.
Major Updates:
- Elimination of 2-finger compressions in infants
- This is ineffective in achieving proper depth.
- Recommended compression techniques are 1-hand or 2-thumb encircling hands.
- Immediate AED use encouraged for all pediatric arrests
- Attach an AED as soon as available.
- Use of a pediatric attenuator for children <8 years old is preferred, but if none available, an AED without a pediatric attenuator may be considered.
- Revised foreign-body airway obstruction sequence
- Infants: Alternate cycles of 5 back blows and 5 chest thrusts.
- Abdominal thrusts are not recommended for infants.
- Children: Alternate cycles of 5 back blows and 5 abdominal thrusts.
- Ventilation guidance clarified
- Provide 20-30 breaths per minute for infants and children who are a) receiving CPR with an advanced airway or b) receiving breaths and have a pulse.
How will this change my practice?
BLS is one of those low-frequency, high-stakes events in the pediatric ER, but the rarity doesn’t lessen our responsibility to be ready the moment it happens. Guidelines like these are important not only for providing evidence-based updates, but as an opportunity to refresh your knowledge and mentally prepare for these high-acuity scenarios. The biggest change is abandoning the 2-finger technique for infants; since rescuers rarely achieve adequate depth with this maneuver, the 1-hand or 2-thumb encircling methods are now recommended. There are some valuable updates regarding the foreign-body algorithm, including starting with back blows and avoiding abdominal thrusts in infants. Finally, this update reinforces the emphasis on ventilation in resuscitations, as respiratory conditions remain the major cause of cardiac arrest in children.
Ultimately, these revisions tighten up some of the most essential components of pediatric resuscitation, ensuring that our approach reflects what actually improves outcomes. The goal is simple: rare events should never feel unfamiliar when they arrive.
Source
Part 6: Pediatric Basic Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025 Oct 21;152(16_suppl_2):S424-S447. doi: 10.1161/CIR.0000000000001370. Epub 2025 Oct 22. PMID: 41122891.
