Paediatric Basic Life Support 2026: What Changed in ANZCOR Guideline 12.1
ANZCOR Guideline 12.1 is written for health professionals trained in paediatric basic life support who may need to begin resuscitation before advanced equipment, medications and additional clinicians arrive. The 2026 update clarifies several early decisions that directly affect how quickly effective CPR begins.
Start compressions while waiting for bag-mask ventilation
The updated guideline says external chest compressions should begin while rescuers wait for a bag-mask ventilation device. When a bag-mask device is immediately available, two initial ventilations should be given before chest compressions start.
This change recognises two competing priorities in paediatric arrest. Ventilation remains essential because many paediatric arrests are asphyxial, but treatment should not be delayed while equipment is being located or assembled.
Do not rely on pulse palpation alone
Pulse palpation, or failure to feel a pulse, is not reliable as the sole test for cardiac arrest. The updated guidance directs healthcare providers to begin CPR when an infant or child is unresponsive and breathing is absent or agonal. This places the emphasis on rapid recognition of an arrest state rather than a prolonged or uncertain pulse check.
Preferred infant compression technique
For infant chest compressions, ANZCOR now suggests the two-thumb encircling technique because it produces more consistent compression depth and less rescuer fatigue. If the rescuer cannot achieve effective depth with this technique, the heel of one hand may be considered.
The update is a useful reminder that technique should be judged by compression quality, not simply by habit. Training should allow clinicians to practise hand position, depth, recoil and role changes on infant manikins.
Manual defibrillator pads and airway obstruction
The guideline adds a recommendation that clinicians using manual defibrillation in infants and children place pads in an anterior-posterior position. It also adds a dedicated section on foreign body airway obstruction in children rather than relying only on a cross-reference to the general first aid guideline.
What teams should update
The wording applies to health professionals trained in PBLS. Lay rescuers and those trained only in general BLS should follow the relevant general ANZCOR basic life support guidance and emergency dispatcher instructions.
- Revise PBLS teaching to include immediate compressions when a bag-mask device is not yet available.
- Use absent or agonal breathing with unresponsiveness as the key trigger to begin CPR.
- Prioritise two-thumb encircling infant compressions during practical training.
- Check local manual defibrillation diagrams and pad-placement teaching.
- Include paediatric foreign body airway obstruction in PBLS scenarios and assessment.
The practical takeaway
The update is designed to reduce hesitation at the start of paediatric resuscitation. Begin effective CPR promptly, add ventilations as soon as the appropriate equipment is available, use the compression technique most likely to deliver adequate depth, and integrate defibrillation and airway-obstruction management into a coordinated response.
Continue your training
PBLS skills deteriorate without practice. Scenario-based PALS training gives clinicians repeated opportunities to recognise arrest, start CPR, ventilate effectively and coordinate the arrival of advanced equipment.
PALS1 – Paediatric Advanced Life Support
Primary clinical source: ANZCOR Guideline 12.1 – Paediatric Basic Life Support (PBLS) for health professionals
Publication disclaimer: Educational summary only. It does not replace the full ANZCOR guideline, local policy, formal training or clinical judgement. Verify the current official guideline before publication or clinical use.
