Defibrillator on a Child: What You Need to Know
Cardiac arrest in children is uncommon, but when it occurs, immediate action is essential. Using a defibrillator on a child can make the difference between life and death.
Defibrillators analyse the heart's rhythm and, if needed, deliver a controlled electrical shock to help restore a normal rhythm.
In medical guidelines, a "child" typically refers to someone between one and eight years old or weighing less than 25 kg. Children over this threshold are generally treated with adult defibrillator settings. Special precautions apply for infants under one year.
While many people associate defibrillators with adult emergencies, their use in children follows clear, evidence-based procedures that are accessible to the public. Understanding how and when to use an defibrillator on a child increases the chances of survival and supports effective bystander intervention during paediatric cardiac events.
Contents
Why Using a Defibrillator on a Child Matters
Although cardiac arrest is far less common in children than adults, early defibrillation significantly increases survival rates when it does occur. In paediatric cases, cardiac arrest is often caused by respiratory failure or trauma rather than a primary heart condition. However, if a shockable rhythm like ventricular fibrillation is present, a defibrillator can be lifesaving.
According to the Resuscitation Council UK, defibrillators are safe to use on children and should not be withheld due to concerns about age or size. Delays in defibrillation decrease the chances of survival by approximately 7–10% for every minute without intervention.
When used appropriately, defibrillators have a low risk of harm. Their built-in safeguards and voice prompts guide even untrained users through the process, making them suitable for emergency use in schools, sports facilities, and public spaces.
Age, Weight & Pad Considerations
It’s important to match the equipment and technique to the child’s age and weight. The Resuscitation Council UK provides clear guidance for this:
Children Over 8 Years or Over 25 kg
Use adult defibrillator pads and standard settings. Pad placement is the same as for adults — one on the upper right chest and one on the lower left side.
Children Aged 1–8 Years or Under 25 kg
Use paediatric pads if available. These pads reduce the energy delivered (via an in-line attenuator) to a level appropriate for smaller bodies. Pad placement should ideally be anterior-lateral, unless the pads overlap — in which case, use anterior-posterior placement (one on the front of the chest and one on the back).
Infants Under 1 Year
Defibrillator use is not routinely recommended but may be considered if no alternative is available and the rhythm is shockable. Manual defibrillation is preferred by trained professionals, but in a community setting, using an automated defibrillator with paediatric pads is acceptable if no manual device is present.
Pad Placement Summary
Anterior–lateral (chest side): Standard approach when pads fit without touching.
Anterior–posterior (chest and back): Use this if pads are too large or overlap.
Manufacturers provide diagrams on the pad packaging to assist with placement, and defibrillators give step-by-step voice instructions once activated.
Energy Dosing & Attenuation
Children require a lower defibrillation dose than adults. This is achieved using paediatric attenuator pads, which reduce the shock energy to a level considered safe and effective for smaller bodies.
Recommended Energy Levels
Children aged 1–8 years: Paediatric pads typically attenuate the shock to between 50–75 joules depending on the device.
Manual defibrillation (by trained professionals): The standard recommendation is 4 joules per kilogram (J/kg) of body weight.
Children over 8 years or 25 kg: Use the full adult dose and standard pads.
What If Paediatric Pads Are Not Available?
If only adult pads are available:
Use them regardless of the child’s age or size.
Place the pads in the anterior–posterior position if the standard placement causes them to touch.
According to the Resuscitation Council UK, the risk of harm from using a full adult dose is low and is outweighed by the risk of delaying treatment.
Built-In Safety Features
Most defibrillators automatically adjust their prompts and energy delivery based on pad type. When paediatric pads are connected, the device delivers the appropriate lower energy level and changes voice prompts to suit a paediatric emergency.
Practical Use: Step‑by‑Step (CPR + Defibrillator)
When a child is unresponsive and not breathing normally, begin cardiopulmonary resuscitation (CPR) immediately and use a defibrillator as soon as it is available. The sequence for children closely mirrors adult resuscitation, with minor adjustments.
Step-by-Step Procedure
Check for Response and Breathing
Gently tap the child and shout.
If unresponsive and not breathing normally, call 999 or ask someone to do so.
Start CPR
Give 5 initial rescue breaths if trained to do so.
Follow with 30 chest compressions at a depth of about one third of the chest.
Use one hand for compressions in small children; two hands may be needed for older children.
Attach the Defibrillator
Turn the device on and follow the voice prompts.
Attach pads in the correct position (anterior–lateral or anterior–posterior as needed).
Use paediatric pads if available, or adult pads if not.
Allow the Device to Analyse the Rhythm
Ensure no one is touching the child.
The defibrillator will advise whether a shock is needed.
Deliver the Shock if Instructed
Press the shock button when prompted (if the device is not fully automatic).
Resume CPR immediately after the shock or if no shock is advised.
Continue CPR and Follow Prompts
Alternate 30 compressions with 2 breaths.
The defibrillator will reanalyse the heart rhythm every 2 minutes.
Minimising Delays
Begin chest compressions immediately and keep interruptions to an absolute minimum. Even if the defibrillator is not immediately at hand, starting CPR provides essential circulation until defibrillation can occur.
Special Situations & Common Misconceptions
Using a defibrillator this way may raise concerns in certain scenarios. The following clarifies common misunderstandings and outlines special considerations based on UK guidance.
Can Defibrillators Be Used on Infants Under 1 Year?
Yes — but with caveats. For infants under one year:
Manual defibrillation is preferred in clinical settings.
In public settings, using a defibrillator with paediatric pads is acceptable if a shockable rhythm is suspected.
If only adult pads are available, they may be used with anterior–posterior placement to avoid pad overlap.
The Resuscitation Council UK states that defibrillation should not be delayed due to age.
Wet or Metallic Surfaces
Defibrillators can be used safely if the child is on a wet surface, provided:
The chest is dry.
Pads do not come into contact with pooled water or metal beneath the patient.
Remove the child from water if safe to do so, but do not delay treatment unnecessarily.
Pregnant Adolescents
Treat as adults for resuscitation purposes. Use standard defibrillator settings unless under 8 years or 25 kg, in which case paediatric pads should still be used if available.
Use in Schools and Public Places
Defibrillators placed in UK schools are generally equipped for use on children, often including paediatric pads. However:
Not all public defibrillators have paediatric accessories.
All defibrillators can still be used on a child, regardless of pad type.
Some schools may store paediatric pads separately to prevent damage or misuse. This can delay access if not clearly labelled.
Common Misconceptions
“I could hurt the child” — A defibrillator will not deliver a shock unless one is needed.
“Training is required” — While training helps, defibrillators give verbal instructions and can be used by anyone.
“Adult pads must never be used on a child” — It is better to use adult pads than to delay defibrillation.
Did You Know?
Fewer than 10% of out-of-hospital cardiac arrests in children currently receive defibrillation before emergency services arrive — yet survival rates more than double when a defibrillator is used within 3 minutes.
(Source: Resuscitation Council UK)
This highlights the importance of publicly accessible defibrillators in locations such as schools, leisure centres, and parks. Even without paediatric pads, immediate use of a defibrillator can greatly improve a child’s chance of survival.
Real‑World Note
In UK schools, defibrillators are often installed in reception areas or near gymnasiums. However, visibility and accessibility can vary.
During site visits to educational settings, it is common to observe:
Defibrillator cabinets placed behind locked doors or inside staff-only areas.
Paediatric pads stored separately in unlabelled drawers.
Signage that uses only adult figures, which may discourage use on children.
These factors can lead to hesitation or delay in an emergency. Schools and community centres are advised to ensure:
Clear, visible signage using child-appropriate symbols.
Cabinets unlocked or access codes prominently displayed.
Paediatric pads stored directly with the defibrillator or in a clearly marked location.
Small adjustments in visibility and access can remove critical barriers to early use.
FAQs
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No. Defibrillators only deliver a shock if the child’s heart rhythm is one that requires it. The device analyses the rhythm automatically and will not act unless appropriate. The potential benefit of prompt use far outweighs any risk.
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Use adult pads. Place them in an anterior–posterior position to avoid overlap. Never delay treatment due to lack of paediatric pads. Adult pads are safe and effective for use on children in emergencies.
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Training is not required. Defibrillators are designed for use by members of the public and provide voice prompts for every step. However, attending a first aid course can build confidence and improve response time.
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Yes — with caution. Paediatric pads are preferred. If unavailable, use adult pads in anterior–posterior position. Manual defibrillation is ideal, but an automated defibrillator may still be used in emergencies if no alternative is available.
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No. Some models include built-in paediatric modes or pads; others do not. It is good practice for locations serving children (like schools or leisure centres) to ensure their defibrillator includes or supports paediatric use.
Wrapping it Up
Defibrillators can and should be used on children experiencing sudden cardiac arrest. While paediatric pads and age-specific settings are recommended, their absence should not delay action. Current UK guidelines support defibrillator use in children of all ages, including infants under specific circumstances.
Understanding key principles — such as appropriate pad placement, age thresholds, and energy dosing — helps ensure rapid, safe intervention. Whether in a school, public setting, or at home, early defibrillation combined with CPR offers the best chance of survival.
Clear signage, visible placement, and integrated paediatric accessories can remove barriers to effective use. Most importantly, any attempt to help with a defibrillator is better than doing nothing.
Sources
Resuscitation Council UK – “Automated External Defibrillators Guide”
Provided information on energy attenuation, paediatric pad recommendations, and the importance of prompt defibrillation in paediatric patients.UK Department for Education – “Defibrillators Guidance for Schools”
Offered data on survival rates when CPR and defibrillation are delivered promptly and the importance of defibrillator accessibility in schools.European Resuscitation Council Guidelines 2021
Supplied comprehensive guidance on paediatric life support, including dosing (4 J/kg) and use of paediatric pads.PMC – “Current recommendations for paediatric resuscitation”
Provided survival outcome statistics (e.g., return of spontaneous circulation and survival to discharge).Wikipedia – “Automated external defibrillator”
Confirmed survival reduction (≈7–10% per minute) with delayed defibrillation.
