Two Fingers Out, Two Thumbs In

If there's one change from the new resuscitation guidelines that deserves the widest possible audience, it's this one. It affects how CPR is performed on babies under one year old, and it's a genuine, evidence-driven improvement — not just a tweak for the sake of it.

What's changed

Under the old guidance, if you weren't trained or couldn't manage the two-thumb technique, a two-finger method was often taught as an acceptable way to deliver chest compressions to an infant: pressing down on the centre of the chest with two fingertips.

That method has now been dropped. The two-thumb encircling technique is the only recommended method for infant chest compressions. In this technique, you wrap both hands around the infant's chest with your thumbs meeting over the lower half of the breastbone, and use your thumbs to compress while your fingers support the back.

Why the change

The research behind this shift is fairly straightforward: two-finger compressions consistently don't generate enough depth or force to circulate blood effectively in a baby. The two-thumb technique produces deeper, more consistent compressions, which means better blood flow to vital organs during a resuscitation attempt — and ultimately, a better chance of a good outcome.

For babies and children more broadly, the compression-to-ventilation ratio guidance has been reinforced too: 5 initial rescue breaths, then compressions and breaths at a ratio of 15:2 for trained responders. This hasn't changed dramatically from previous guidance, but the emphasis on accurate hand positioning and full compression depth has been strengthened.

What this means in practice

If you did your paediatric first aid training more than a year or so ago, there's a good chance you were taught the two-finger method as an option. It's worth deliberately unlearning it and practising the two-thumb technique until it feels natural — muscle memory matters enormously in a real emergency, when there's no time to stop and think through the steps.

This is a particularly important update for:

• Parents and carers of infants, who are often the first — and sometimes only — person present in an emergency involving a baby.

• Childcare and early years staff, who are required to hold current paediatric first aid qualifications and should make sure their next refresher reflects this change.

• First aid instructors, who need updated manikins and teaching aids that support and assess the two-thumb technique properly, rather than continuing to present the two-finger method as an equal alternative.

A quick way to check yourself

If you're not sure whether your current knowledge is up to date, ask yourself: when I picture infant CPR, do I picture two fingers or two thumbs? If it's fingers, it's time for a refresher. The good news is that the technique itself isn't complicated to learn or teach — it just needs a slight change in how you position your hands, and a bit of deliberate practice to make it stick.

Babies are resilient, but chest compressions that are too shallow or inconsistent can mean the difference between a good outcome and a tragic one. This update exists because the evidence showed a better way — and it's a change well worth making.

Want hands-on practice with the updated technique?

Reading about the two-thumb technique is one thing — building the muscle memory to use it confidently in an emergency is another. Basecamp First Aid runs paediatric and infant first aid courses that include plenty of hands-on manikin practice, fully updated to the latest guidance.

Book a course at basecampfirstaid.com or email info@basecampfirstaid.com to find a session near you.

Disclaimer: This article is for general information and educational purposes only and does not constitute medical advice. It reflects a summary of the Resuscitation Council UK 2025 Guidelines as understood at the time of writing; guidance may be updated, and implementation timelines can vary between awarding bodies and training providers. Always follow the specific instructions of your first aid course provider and the current guidance of the Resuscitation Council UK (resus.org.uk). In a real emergency, always call 999 (or your local emergency number) immediately.

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