Children, babies and drowning

Most people who learn CPR picture an adult on the floor, and everything in lessons 2 to 5 was written for one. Yet the ERC's guide for the public notes that with children it is very often a primary caregiver who is the rescuer,⁷ and the arrest that parent or grandparent meets starts differently: not with a heart that has suddenly lost its rhythm, but with a child who has stopped breathing. That difference changes what you do first. It's also one of the plainest places where the American and the UK guidelines disagree, and a place where a page that says "two fingers for a baby" may be out of date in both countries. This lesson gives you both sequences, side by side, the numbers for a child and a baby, the AED rules, and what changes when someone has been pulled from the water.

Who counts as a child

Before the sequences, the boundaries, because the two bodies draw them in different places.

AHA 2025 Part 6, section 4;² RCUK 2025 Paediatric basic life support.¹

The AHA draws the line at puberty. RCUK draws it at 18, but then tells you that if you think the person in front of you is an adult, you should use the adult sequence, and that little or no harm comes from resuscitating an adult with the paediatric sequence, because the causes of arrest in children continue into young adulthood.¹ The ERC's 2025 guide for the public says the same in one line: "when in doubt, use directions for adults."⁷ You aren't going to be asked for a birth certificate. Decide, act, and let the call handler adjust you.

Why draw a line at all? Because the depth of a compression is set by the size of the chest, and because, as the next section shows, the reason a child's heart stops is usually not the reason an adult's does.

Why a child's arrest is different

RCUK's 2025 paediatric guideline puts the cause first: cardiac arrest in infants, children and adolescents is most often the end of a breathing or circulation problem that has been getting worse, or of a neurological emergency, and is not often due to a primary problem with the heart itself.¹ The AHA says the same in its 2025 paediatric guideline: breathing problems remain the major cause of cardiac arrest in infants and children, and asphyxial arrest, an arrest from lack of air, is more common in children than an arrest from a primary cardiac event, meaning a problem that starts in the heart itself.²

The same guideline's preamble gives US survival to hospital discharge after a child's arrest outside hospital: 17.3% for adolescents, 14.7% for children and 6.6% for infants.²

Set that beside what lesson 4 taught about adults. Most adult arrests begin with blood that is still full of oxygen, which is why compressions come first for an adult: the pump has stopped, and pushing on the chest moves the oxygen that is already there. On this course's reading of the AHA's word asphyxial, a child whose breathing failed first has used up much of that oxygen before the heart stops. The ERC's public guide, writing about drowning, puts the sequence in one line: "With the lack of oxygen, the heart slows down and finally stops."⁷

The AHA's conclusion is that in children effective ventilation is paramount during resuscitation.² Ventilation is the guideline word for getting air into the lungs, which for a bystander means breaths. Kitamura's study is the first of the large observational studies the AHA cites for breaths in children; RCUK gives the same instruction without citing its evidence on the page this course read. The AHA's 2025 paediatric guideline: conventional CPR, compressions with breaths, should be provided to infants and children in cardiac arrest (AHA 2025, COR 1, LOE B-NR), and if a lay rescuer is unable or unwilling to give breaths, compression-only CPR is reasonable (AHA 2025, COR 2a, LOE B-NR).² RCUK's call handlers are told to encourage bystanders to give both breaths and compressions in children of all ages, and to fall back to compression-only if the caller isn't willing or able (RCUK 2025).¹ Lesson 4 spent a long section on whether adults should get breaths from a bystander. For children, the two countries agree that the answer is yes if you can, and their disagreement is about what comes first.

The sequence, side by side

The whole lesson turns on one row of this table. Assume a child or baby who does not respond and is not breathing normally, and that the emergency number is being called on speaker (lesson 2's order for the call holds: RCUK for any unresponsive person, then breathing; the AHA recognise, then call and start).

AHA 2025 Part 6, sections 7.1 and 7.2, and Part 4;²¹² RCUK 2025 Paediatric basic life support.¹

Read the first row twice. In the US you start pushing on the chest, as for an adult, and add breaths after the first thirty. In the UK you start with five breaths, and only then push. Everything after that first half-minute looks much the same: pushes and breaths in cycles, at the ratio you were trained for, until help takes over.

Each side's reason, in its own words

Each body gives a reason. In what this course read, only the AHA says how thin its evidence is.

The AHA gives two reasons in its supporting text. One paediatric study found that starting with compressions delayed the first breath by only 5.74 seconds compared with starting with the airway and breaths. And keeping compressions first, it says, "allows for a consistent approach to cardiac arrest treatment in adults and children"; its synopsis says the sequence mirrors the adult one "to enhance educational simplicity in training".² The sentence that makes the consistency point opens with the AHA's own caveat: "Although the supporting evidence is minimal".²

RCUK and the ERC reason from the cause. RCUK's guideline says: "The differences in adult and paediatric resuscitation algorithms are primarily based on the distinct causes of cardiac arrest."¹ It gives the cause, as above: a breathing or circulation problem that has run its course. RCUK doesn't spell out the step from there to five breaths; on this course's reading, the breaths answer an arrest that began short of oxygen. RCUK gives its reason without grading it, and the ERC chapter behind RCUK's guideline was read here only for its summary table. The ERC's guide for the public describes what a European dispatcher will do with a caller who has found a child: direct them to start with five rescue breaths, and then coach 30:2.⁷

This course doesn't pick between them. The AHA weighs a delay to the first breath that it measured at under six seconds against one sequence for every age; RCUK weighs the cause of the usual child arrest. RCUK's own answer to the parent who only ever learned adult CPR is blunt: "it is far better to use the adult CPR sequence for the resuscitation of a child than to do nothing".⁹

How hard, how deep, and with what

The numbers for a child are the adult numbers with two changes: the depth is set as a fraction of the chest, and the hands change with the size of the child.

AHA 2025 Part 6, sections 7.2 and 7.3;² RCUK 2025 Paediatric basic life support.¹ Lesson 3 has the adult figures and the reasons the AHA gives for them.

Why a fraction of the chest. Lesson 3 gave you a fixed depth for an adult, 5 to 6 cm. A newborn's chest and a ten-year-old's are not the same size, so the paediatric guidelines set the depth as a third of the way down, and the AHA translates that into round figures: about 1.5 inches for a baby and 2 inches for a child. The AHA's supporting text says three studies of body measurements have shown that a child's chest can be compressed to a third of its depth without damaging the organs inside it.² That's the answer to the fear that you can't do CPR on a baby without hurting it: a third of the chest is the depth the guideline asks for, and the studies the AHA cites found the chest can take it. RCUK adds a ceiling that applies to everyone: never more than 6 cm, whatever the age.¹

Why the AHA dropped two fingers. Until 2025, two fingertips on the breastbone was a technique the AHA taught for a baby. Its 2025 guideline removed it. Its take-home message puts the reason in one clause: the use of two fingers along the sternum was eliminated because it was ineffective at reaching the proper depth.² The supporting text explains what convinced the panel: reviews of simulation studies suggest the two-thumb technique is better than two fingers, particularly for depth, and in a registry of real infants the two-finger technique was used rarely and, when it was, no stretch of compressions met the guideline.² The same registry found the heel of one hand reached greater depth than two thumbs, which is why the AHA now allows either (COR 1, LOE B-NR), and says to use one hand if you can't physically get your hands round the chest.²

RCUK recommends the two-thumb encircling method for infants,¹ and the ERC's 2025 paediatric chapter says: "The two-thumbs encircling technique for chest compressions in infants is recommended for all situations."⁶ The ERC's guide for the public gives its reasons: the technique is effective, straightforward, and easy for a dispatcher to describe over the phone to someone who has never done it.⁷ So the two countries now agree that two thumbs is right, and the US adds the heel of one hand as an equal alternative. What neither teaches any more is two fingers.

A page you may meet still does. The British Red Cross's page for someone unresponsive and not breathing says: "For a baby under a year old, use two fingers to do chest compressions."¹⁴ That is the pre-2025 technique. Lesson 8 comes back to the same point for choking, and names the public pages that still show two fingers for chest thrusts.

The thumbs, described. Both hands go round the baby's chest so the fingers rest on the back and the two thumbs sit side by side, or one on top of the other, on the lower half of the breastbone; RCUK's own 2026 video says "Thumbs can be placed side by side or stacked on top of one another".¹³ You push with the thumbs, a third of the way down, 100 to 120 times a minute, and let the chest come all the way back up. For the AHA's one-hand method, it is the heel of one hand on the breastbone, as for a child.

Breaths for a baby and a child. For a baby, RCUK says to keep the head in the neutral position, meaning not tipped fully back as for an adult, tilting it only slightly with two fingers on the chin bone, and to blow steadily into the mouth and nose together for about a second, enough to make the chest visibly rise; older children need more head tilt, and adolescents the full tilt used for adults.¹ The ERC's public guide gives the same rule in a line: try the mouth-to-mouth-and-nose technique in an infant, and mouth-to-mouth in larger children, watching for the chest to rise.⁷ Lesson 4's rule about volume carries over: just enough to see the chest rise, never a hard blow.

The AED on a child

Lesson 5 left two questions for this one: child pads, and child modes. Some AEDs have a child setting, or a set of smaller pads, or a plug-in key, that reduces the energy of the shock. The AHA calls this a paediatric attenuator; RCUK calls it paediatric mode. The AHA's text explains what it is for: many AEDs can attenuate, meaning reduce, the energy dose to make it more suitable for infants and children, and an AED without one delivers 120 to 360 joules (the unit a shock's energy is measured in), more than the recommended dose for a child under 25 kg.²

AHA 2025 Part 6, sections 8.2 and 8.3 and its take-home messages;² RCUK 2025 Paediatric basic life support.¹

Two things in that table deserve a closer look.

Adult AED, small child. Both countries say to use it. The AHA gives its reasoning in full, and it answers a fear that could stop someone opening the box. There are reports of safe and effective AED use in infants and young children when the dose went above the 2 to 4 joules per kilogram that is recommended, and, in the AHA's words, "Because defibrillation is the only effective therapy for shockable rhythms, an AED without a dose attenuator may be lifesaving."² The AHA adds that previous studies suggest AEDs misclassify a child's shockable rhythm only 2% to 4% of the time.² So a bigger shock than ideal is better than no shock for the child who needs one. Lesson 5 taught that most arrests aren't shockable; the AHA's paediatric text says the same for children, most of whose arrests are breathing-related and end in rhythms an AED won't shock.² The AED still goes on.

Why the order differs. The AHA's message is to attach the AED "as soon as possible".² RCUK, for a rescuer on their own, says calling and starting CPR come before fetching and attaching one, and that a second rescuer should call and then bring the AED.¹ The two aren't really at odds: both want CPR under way and the AED on quickly. RCUK says in so many words that a helper, not the person doing CPR, should fetch it; the AHA's text says only "as soon as possible". Lesson 5's rule for a lone adult rescuer holds here: don't leave a child in arrest to go and look for a machine. Tell the call handler where you are and what you have.

Pad position under 25 kg needs a sentence of its own, because it is the one place the child pads go somewhere the adult pads don't. RCUK puts one pad on the front, mid-chest and just to the left of the breastbone, and the other on the back, centred between the shoulder blades.¹ The AHA allows front-and-back or front-and-side and asks for the largest pads that fit without touching, with at least 1 to 2 cm between them.² On a small chest, front and back is how you keep them apart.

The four-year-old on the landing

Now the whole thing once, in both orders. A four-year-old, in her own home, is found by a parent at the top of the stairs, floppy, eyes half open, not responding when her shoulders are held and her name is called. The same first two minutes follow twice, once in Nottingham under RCUK 2025 and once in Portland, Oregon under the AHA's 2025 guideline. The parent has done an adult CPR course and no more. (The spoken lines are this course's illustration of what the guidelines say a call handler will do, not a transcript of any real call.)

Look at where the columns differ: step 3, and the ratio if two rescuers are present. Everything else is the same set of actions in the same order. The parent in Nottingham gave five breaths and then pushed; the parent in Portland pushed thirty times and then gave two breaths. Within a minute, both children were getting compressions and breaths in cycles, with a call handler counting. RCUK's stopping rule for step 7, in its own words, is "Do not interrupt CPR unless there are clear signs of life, or you are instructed to do so by the AED."¹

Drowning: a hypoxic arrest

Everything above about why a child's arrest is different applies, in adults as well as children, to drowning. Lesson 4 quoted the AHA's contrast: an arrest after drowning is most often hypoxic, from lack of oxygen, where a sudden adult cardiac arrest usually begins with oxygenated blood.³ The AHA's 2025 guideline describes the process: drowning generally progresses from a respiratory arrest, caused by lack of oxygen under the water, to a cardiac arrest, and the two can be hard to tell apart because a pulse is difficult to feel in the ten seconds allowed. So, it says, resuscitation after drowning "must focus on restoring breathing as much as it does circulation."³ It also reports how common drowning is: the third leading cause of death from unintentional injury worldwide, 7% of all injury deaths.³ The ERC's guide for the public adds that in Europe it is the fourth leading cause of death in children aged 5 to 14.⁷

First, don't become the second casualty

Lesson 2 gave you the rule for water as a danger, and it stands. RCUK 2025's paediatric guideline: do not enter the water unless you are trained to rescue someone from it; try to reach the child from land and get a flotation device to them, such as a lifebuoy or other rescue equipment.¹ The ERC's guide for the public says the same for anyone: public rescue equipment, anything that floats thrown to them, or a long object reached out, and only someone trained in water lifesaving should go in.⁷ Call for help as you do it.

Breaths in the water

This is for trained rescuers with something that floats, and this course gives it so you know what a lifeguard is doing, not so you try it. The AHA's 2025 guideline: "It may be reasonable for appropriately trained rescuers to provide in-water breaths to an unresponsive adult or child who has drowned if it does not compromise their own safety." (AHA 2025, COR 2b, LOE C-LD).³ ILCOR suggests it for trained rescuers who judge it feasible and safe with the equipment they have and the distance to land, as a weak recommendation on very low certainty evidence (ILCOR 2025 CoSTR, a 2023 recommendation left unchanged).⁴ RCUK 2025 says to start ventilation in the water if you are trained to do so and have a flotation device, and the child is unconscious and not breathing.¹

The AHA's supporting text gives the figure behind the urgency: when breaths interrupt the drowning process at the stage of respiratory arrest, the death rate is 44%; once it has progressed to cardiac arrest and CPR is needed, it is 93%.³ Those are observational figures, not a trial, and this course did not read the studies behind them, but they say why every body wants air into a drowned person as early as it can safely be done.

Out of the water: who you are decides the order

This is the second place the bodies differ, and it is a difference in emphasis rather than in instruction, because it turns on who the rescuer is.

ILCOR split the answer in 2025: "We recommend a compression-first strategy (CAB) for laypeople providing resuscitation for adults in cardiac arrest caused by drowning (good practice statement). Health care professionals and those trained and with a duty to respond to drowning (eg, lifeguards) should consider providing rescue breaths/ventilation first (ABC) before chest compressions (good practice statement)."⁴ Lesson 4 explained the good practice statement: expert opinion where there is very limited or no direct evidence.

AHA 2025 Part 10, sections 11.5 and 11.6;³ RCUK 2025 Paediatric basic life support and First aid;¹¹⁰ ERC 2025 Special circumstances;⁵ BHF, How to do CPR.¹¹

The BHF's public page puts the trained rescuer's start in plain words: "if you are trained and feel comfortable to do so, administer 5 rescue breaths to the person before starting regular CPR (2 rescue breaths for every 30 compressions)."¹¹

Read the columns for what they share. Once the person is out of the water, everyone wants CPR with breaths; an untrained rescuer who can't manage breaths gives compressions, and that is far better than nothing; a trained rescuer may lead with breaths; and the AED waits until CPR is under way. The difference is which half each side leads with. The US column puts the full CPR first and makes breaths-first a permission for the trained (2b). The UK and European material leads with five breaths for anyone trained, and the ERC's reason is in the rest of its sentence: "since the time to ventilation is critical in restoring cardiac arrest in drowned victims."⁵ The ERC's public guide says the evidence shows a better prognosis when drowned people receive rescue breaths before compressions.⁷ The AHA, for its part, says there is no direct evidence on the sequence in drowning, and reports a manikin study, not specific to drowning, in which a compression-first start finished the first cycle 15 seconds sooner; it adds that trained rescuers starting with the airway and breaths may be appropriate as long as starting breaths doesn't delay compressions, for instance by waiting for equipment.³ So the AHA says plainly that there is no direct evidence on the order; the ERC guide points to evidence of a better prognosis with breaths first, which this course hasn't read. Neither is called wrong here.

Why does ILCOR say compressions first for lay people, when the arrest is hypoxic? It gives its reason directly under the statement: "The compression-first strategy for adults prioritizes simplicity and cohesiveness in training recommendations for laypersons, with the goal of faster initiation of resuscitation."⁴ The ERC's sentence gives the same reason in fewer words, "for simplicity".⁵ ILCOR also says what it doesn't know: "It is unclear if earlier ventilations improve outcomes once cardiac arrest has occurred or if the benefit is in preventing respiratory arrest from deteriorating into cardiac arrest."⁴ Notice the word adults. ILCOR's 2023 wording covered "adults and children"; in 2025 it narrowed the lay statement to adults, so it no longer speaks to a drowned child.⁴ Lesson 4 met the same trade in adults: a simpler instruction that more people will act on, set against the physiology of the particular arrest.

For an untrained bystander with a drowned adult, both sides land on "push, and don't wait", and add breaths if a trained person is there to give them. With a drowned child in the UK, the call handler will coach five breaths first, as for any child (RCUK 2025).¹

The paddling pool

Now the hard case, because two trained people disagree, and a baby is between them.

A family barbecue in a garden near Valencia. A six-month-old has been found face down in an inflatable paddling pool a few inches deep. Her father, an American who did an AHA course, lifts her out. She is limp and not breathing. Her grandmother, who did an adult first aid course with St John in England, is beside him. A cousin is already calling 112 on speaker.

Take it in steps, and stop at the gap.

1. Out of the water, onto something firm. A few inches of water in a garden is no danger to the rescuers; she comes straight out onto the patio. (For deep water, the rule above applies to everyone: reach or throw, don't go in unless trained.)

2. Does she respond? No reaction to voice or touch. No normal breathing. Both adults know from their courses what that means: start.

3. The call. 112 works across the EU, and Spain is in it. The cousin has it on speaker beside her; lesson 2's advice about location holds.

4. Breaths, then compressions. The grandmother gives five breaths into the baby's mouth and nose, small and steady, watching the chest (RCUK 2025).¹ The father encircles the baby's chest with his hands and pushes with two thumbs (RCUK 2025; AHA 2025, COR 1, LOE B-NR), a third of the way down (RCUK 2025; AHA 2025, COR 2a, LOE C-LD), 100 to 120 a minute (RCUK 2025; AHA 2025, COR 2a, LOE C-LD).¹² They fall into a cycle: he pushes, she breathes.

5. The ratio. Two rescuers. The AHA gives 15:2 for two rescuers (COR 2a, LOE C-EO); RCUK gives 15:2 only to those trained in paediatric life support and 30:2 to everyone else.²¹ Neither of them has done a paediatric life support course, so RCUK would have them on 30:2 and the AHA on 15:2. This is the one real disagreement in the garden, and it doesn't deserve a second's argument: the 112 call handler coaches a ratio, and they use it.

6. The AED. Someone runs to the house to ask whether the sports club over the road has one. Under both guidelines it goes on after CPR with breaths is running (RCUK 2025; AHA 2025, COR 1, LOE B-NR). It runs in paediatric mode if it has one and adult mode if not (RCUK 2025; under the AHA an adult AED "may be considered", COR 2b, LOE C-EO). The chest is dried first, and one pad goes on the front and one on the back (RCUK 2025).¹²³

What people get wrong

"Two fingers for a baby." The AHA eliminated it in 2025 because it failed to reach the depth; RCUK and the ERC recommend two thumbs, and the AHA also allows the heel of one hand.²¹⁶ A public page may still say so (above).

"Children get compressions only, like adults." Both countries want breaths for children (AHA 2025, COR 1; RCUK 2025), and fall back to compressions only if the rescuer can't or won't.²¹ The Japanese registry found breaths mattered most in the common, non-cardiac kind of child arrest.⁸

"Never use an adult AED on a child." RCUK: use adult mode if there is nothing for children. The AHA: an adult AED may be considered (COR 2b) and may be lifesaving, because a shock is the only treatment for the rhythms it treats.¹²

"You'll break a baby's ribs, so press gently." Both guidelines ask for a third of the chest's depth, and the AHA cites studies showing the chest can be compressed that far without damaging the organs inside.¹² Too shallow is the common error.

"The UK and US disagree about whether children get breaths." They agree on that. They differ on what comes first, five breaths (RCUK) or thirty compressions (AHA), and each gives its reason.¹²

"If I only know adult CPR I shouldn't touch a child." RCUK: far better to use the adult sequence than do nothing.⁹ The call handler will adjust you.

"Jump in and save them." Reach or throw; go in only if trained in water rescue (RCUK 2025; ERC guide for the public).¹⁷

"After drowning, get the AED on first." CPR with breaths before the AED (AHA 2025, COR 1); a study of 919 arrests found early AED use went with worse outcomes, probably by delaying CPR.³

Practice

Two films, for the UK method

RCUK published two short videos in August 2026, each saying it is aligned to the 2025 UK guidelines. This course opened both, read their on-screen text and captions in still frames taken at intervals, and found them current for the UK sequence; it could not hear their audio, so treat the text of this lesson as the check on anything you hear.¹³

There's no US video in this lesson. The AHA's 30-second infant CPR film from 2024 shows two-finger compressions, which the AHA itself removed in 2025, so this course does not embed it.¹³

Where to learn with your hands

Everything in this lesson is harder to learn from a page than adult CPR, because the depth is a fraction of a chest you can't see into, and a baby's breath has to be judged by eye, just enough to make the chest visibly rise. A class with an infant manikin and a child manikin is where it comes together, and the RCUK videos above are a good rehearsal before one. The BHF's free RevivR course teaches adult CPR on a cushion with camera feedback, and RCUK's Lifesaver is an interactive film; the British Red Cross publishes a free Baby and Child First Aid app.¹⁵ None of them was taken for this course, and none replaces a class. Lesson 16 says where to find one in each country.

Connections

Lesson 3's adult depth of 5 to 6 cm became a third of the chest here, with the AHA's 4 cm and 5 cm as the round figures. Lesson 4 argued about breaths for adults; here the two countries agree that children need them and disagree only about what comes first, and the Japanese registry is the evidence this course has for why. Lesson 5's AED gained a child mode, a 25 kg or 8-year line, and pads on the front and back. Lesson 2's water danger became the first rule of drowning.

Lesson 8 uses these sequences again: when a choking child or baby goes unresponsive, the country's CPR order from this lesson is what follows, including the infant technique. Lesson 7 covers the adult who is breathing but not awake. Relationships and Family, later on the Core, can assume you know how a child's arrest differs and what a household with a baby should have rehearsed.

From earlier on the Core: Mental Fitness taught you to ask what the comparison group got. In Kitamura's registry, the compression-only children were compared with children given conventional CPR by bystanders who chose to give it. On this course's reading, the difference could include who those bystanders were, which is why the finding is an association. The AHA's own list of knowledge gaps says that "pediatric studies are critically needed".²

Go deeper

• RCUK, 2025 Paediatric basic life support guidelines, the sections "Recommendations for untrained rescuers and dispatcher-assisted CPR" and "Recommendations for PBLS in paediatric OHCA". Free; read here in full for those sections. The whole of the UK sequence, the AED rules and the drowning steps for children, on one page.
• AHA and American Academy of Pediatrics, Part 6: Pediatric Basic Life Support, 2025, sections 7 and 8. Read here from an Internet Archive capture. Its supporting text is where the AHA says why it dropped two fingers and why it kept compressions first.
• Kitamura and colleagues, "Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests", The Lancet, 2010. This course read the abstract only. It's the study this course leans on for why children need breaths, and the first of the observational studies the AHA cites for them.
• ERC, The ERC Guidelines 2025 on Resuscitation for Everyone, the pages "How to perform CPR by age of victim" and "Using an Automated External Defibrillator with Children". Free, written for the public, read here in full for those pages, with drawings of the thumb, one-hand and two-hand techniques.

Sources

1. Resuscitation Council UK, 2025 Resuscitation Guidelines: Paediatric basic life support, 27 October 2025 . Read level: full, direct for key points, PBLS, AED and drowning sections, re-read on 2026-09-24 for this lesson. The age definitions, the call handler instructions, the five breaths, ratios, depth, techniques, AED mode and pad positions, the single-rescuer order, and the drowning steps for children.
2. B. L. Joyner, M. Dewan, A. Bavare and colleagues, "Part 6: Pediatric Basic Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for CPR and Emergency Cardiovascular Care", Circulation 152 (suppl 2), 2025 . Read level: full, direct, from the Internet Archive capture 20251026203140; the preamble, the take-home messages and sections 4, 5, 7.1 to 7.3, 8.1 to 8.3 and 9 re-read on 2026-09-24. Every AHA paediatric recommendation here with its COR and LOE, the puberty definition, the two-finger reasoning, the attenuator text, the paediatric survival figures and the knowledge-gap sentence.
3. D. Cao, A. M. Arens, S. L. Chow and colleagues, "Part 10: Adult and Pediatric Special Circumstances of Resuscitation: 2025 American Heart Association Guidelines", Circulation 152 (suppl 2), 2025 . Read level: partial, from the Internet Archive capture 20251027153841: the drowning section (11.1 to 11.7) read again on 2026-09-24 by this lesson's reviewer; the in-water breaths recommendation and its grade confirmed in this course's browser check of the publisher's table on ahajournals.org, because the archived web page carried the wrong text in that box. The drowning recommendations with COR and LOE, the hypoxic mechanism, the 919-arrest study, the 44% and 93%, and the 2% to 12%.
4. J. E. Bray, M. A. Smyth, G. D. Perkins and colleagues for the ILCOR Basic Life Support Task Force, "Basic Life Support: 2025 International Consensus on CPR and ECC Science With Treatment Recommendations", Circulation, 2025 . Read level: the accepted manuscript from ilcor.org, direct: every "Treatment Recommendations" statement and the compression-only section closely, the rest skimmed; the drowning statement quoted here checked word for word against the typeset text. The drowning compression-first and breaths-first statements, their 2023 wording and ILCOR's stated reason, and the in-water breaths suggestion.
5. C. Lott, V. Karageorgos, C. Abelairas-Gomez and colleagues, "European Resuscitation Council Guidelines 2025 Special Circumstances in Resuscitation", Resuscitation 215 (suppl 1), 2025, 110753 . Read level: partial (the drowning, opioid and hypothermia passages), direct, on the publisher's page. The untrained-bystanders sentence and its reason.
6. J. Djakow, N. M. Turner, S. Skellett and colleagues, "European Resuscitation Council Guidelines 2025 Paediatric Life Support", Resuscitation 215 (suppl 1), 2025, 110767 . Read level: partial (the summary of changes table only), direct, on the publisher's page. The two-thumbs sentence. RCUK's paediatric guideline (source 1) is its UK adaptation and is cited for everything else European.
7. European Resuscitation Council, The ERC Guidelines 2025 on Resuscitation for Everyone, 2025 . Read level: full, direct for the adult, paediatric and special circumstances pages; the paediatric and drowning pages re-read on 2026-09-24. "When in doubt, use directions for adults", the dispatcher's five breaths, the reasons for two thumbs, mouth-to-mouth-and-nose, the water rescue advice, and the European drowning figure.
8. T. Kitamura, T. Iwami, T. Kawamura and colleagues, "Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study", The Lancet 375, 2010, pp. 1347 to 1354 . Read level: abstract only, re-read on 2026-09-24. Every figure from it here is in the abstract.
9. Resuscitation Council UK, "FAQs: Basic Life Support (CPR)". **Read level: full, direct.** "Far better to use the adult CPR sequence".
10. Resuscitation Council UK, 2025 Resuscitation Guidelines: First aid and Special circumstances, 27 October 2025 . Read level: partial (recovery position, opioid, drowning and pregnancy sections). Trained first aiders and lifeguards give five rescue breaths, then standard CPR; reach or throw a flotation aid.
11. British Heart Foundation, How to do CPR, undated . Read level: full, direct. Its answer on drowning.
12. C. Dezfulian, J. G. Cabañas, J. R. Buckley and colleagues, "Part 4: Systems of Care: 2025 AHA Guidelines", Circulation 152 (suppl 2), 2025 . Read level: partial, from the Internet Archive capture 20260208194135 (the telephone CPR section). Call-taker instructions for infants and children: conventional CPR with breaths (COR 1, LOE C-LD).
13. Resuscitation Council UK, "How to give CPR to a baby (0-1 year)" and "How to give CPR to a child (1-18 years)", YouTube, ResusCouncilUK, both 4 August 2026; and American Heart Association, "Infant CPR", YouTube, 11 January 2024 . Read level: the watch pages' descriptions, and still frames with their on-screen text and captions, read on 2026-09-24; the audio was not heard. The RCUK films' technique and order, and the AHA film's two-finger compressions.
14. British Red Cross, Unresponsive and not breathing, undated . Read level: full, direct. Its two-fingers sentence.
15. British Heart Foundation, RevivR; Resuscitation Council UK, Lifesaver; British Red Cross, First aid apps. **Read level: all three pages full, direct**; no course was taken and the app was not installed.
16. M. E. Kleinman, J. E. Buick, N. Huber and colleagues, "Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care", Circulation 152 (suppl 2), 2025 . Read level: full, direct, from the Internet Archive capture 20251026225858. The adult depth in the Case 1 answer, as lesson 3 taught it.