Oct. 25, 2000 -- Ask a caregiver to check a baby's pulse and the likely question will be "How?" A new study, published in September's Journal of Pediatrics, has found one method superior to others -- placing the ear over the left side of the baby's chest. However, some experts assert that in an emergency, time should not be wasted on any method.
Some situations call for checking a baby's pulse at home, such as when a doctors asks for a pulse reading over the phone or if the child is on certain medications. It's also thought to be crucial to check for a pulse before beginning CPR, and for parents of chronically ill infants, knowing CPR is almost a necessity.
When Australian researchers compared the methods used to check a baby's heartbeat, they found that 86% of 200 caregivers could correctly find an infant's pulse by the ear-to-chest method. Unfortunately, just over half could then report an accurate reading. But compared with the other methods tested, this was a fabulous result.
Researchers found that many caregivers could also detect a pulse along the upper arm, but again, fewer than half could get a proper reading. Accuracy was about as bad for using the fingers to detect a chest beat. And worst of all, testing the pulse by touching the neck produced accurate results only 12% of the time.
The results don't surprise John Roquemore, a paramedic and coordinator for the Emergency Medical Service in Jefferson Parish, La. "For an infant, we tell parents to look for a pulse [along the upper arm]. But we are having more and more problems having people find it -- especially if the parent is new. Putting an ear to the baby's chest will give you a better idea of a heartbeat -- especially in the case of an infant, because [the heartbeat is] rapid."
One problem with the whole concept of having parents -- or any layperson -- check for a pulse is that it takes too long in an emergency.
Robert Berg, MD, director of pediatric critical care at the University of Arizona in Tucson, puts it this way: "The most important seconds of your life are ticking by with somebody saying [to themselves], 'Am I hearing anything?'" It is for that general reason that the American Heart Association (AHA) now recommends lay people not waste time checking for a pulse. Rather, if someone looks dead or doesn't move, it's best to start performing CPR. "The old approach, which seemed reasonable, flopped because people couldn't find pulses well," says Berg. He adds that in some studies, laypeople also found pulses when none existed.
Berg, chair of the AHA's Subcommittee on Pediatric Resuscitation, says the Australian study was an excellent one -- and perhaps could lead to other studies which might prove important to health care workers, routinely taught to check for pulses using the arm method. For example, Janet Crowers, RN, house supervisor at Children's Healthcare of Atlanta, Scottish Rite, says, "Our health care organization uses the American Heart Association guideline, which is checking for the pulse [at the arm]. That's what we do as a standard. That's how we teach it."
Phyllis Hlavik, RNC, MN, clinical nurse specialist with the Family Center Care department at Atlanta's Northside Hospital, says she would wager most hospitals in the U.S. -- just like hers -- teach and endorse the AHA-endorsed method. But she adds, "In the hospital ... you use a stethoscope, which is another way of putting the ear to the chest."
In their study, the Australian researchers suggest the time has come to teach those learning infant CPR the ear-to-chest method -- but their advice could be a bit outdated. Though it may be faster, easier, and more accurate than other methods, U.S. experts warn it still wastes valuable time.