What is the preferred method for a pulse check in an infant?

The answer

For an infant (under 1 year of age), the preferred method for a pulse check is to palpate the brachial pulse. Place two or three fingers on the inside of the upper arm, midway between the shoulder and the elbow, and press gently until you feel a pulse. Check for at least 5 seconds but no more than 10 seconds. If you do not definitely feel a pulse within 10 seconds — or if the heart rate is below 60 beats per minute with signs of poor perfusion — begin CPR.

The brachial site is chosen because an infant's neck is short and often chubby, which makes the carotid pulse difficult and unreliable to find. The brachial artery, by contrast, sits in a soft, accessible spot on the upper arm where a rescuer can press it against the bone and feel it clearly.

Why not the carotid or other sites?

• Carotid (neck): This is the preferred site for adults and children over 1 year, but on an infant the short, thick neck hides the landmark and pressing there can also obstruct the airway. That is why guidelines steer rescuers to the arm instead.
• Radial (wrist): The radial pulse is often too faint to feel reliably in a small infant, especially if circulation is already compromised, so it is not recommended for emergency assessment.
• Femoral (groin): The femoral pulse is an acceptable alternative in infants, but it is harder to access quickly through clothing/diapers, so brachial remains the first choice for lay and healthcare rescuers alike.

Why the timing matters

The 5-to-10-second window exists for a reason. Checking for less than 5 seconds risks missing a slow or weak pulse and starting compressions on a beating heart. Checking for more than 10 seconds wastes precious time — if an infant truly has no pulse, every second without compressions reduces the chance of survival. So rescuers are trained to make a decision within 10 seconds and act. When in doubt, if you cannot clearly feel a pulse, treat the infant as pulseless and start CPR; the risk of withholding needed compressions outweighs the small risk of compressions on a faintly beating heart.

What to do next

If there is no pulse (or a pulse under 60 bpm with poor perfusion), begin infant CPR: 30 compressions to 2 breaths for a single rescuer, or 15:2 for two trained rescuers. Compress the center of the chest just below the nipple line, about 1.5 inches (4 cm) deep, using two fingers (single rescuer) or the two-thumb encircling technique (two rescuers), at 100–120 compressions per minute. If a pulse is present but the infant is not breathing normally, give rescue breaths and reassess. Activating emergency services and getting an AED remain priorities throughout.