The brachial pulse is an essential indicator of an infant’s circulatory health, making it a critical skill for healthcare providers, first responders, and caregivers. As the preferred method of pulse check in infants, the brachial artery is the most reliable location due to the smaller and more delicate anatomy of infants. This assessment is particularly important in emergencies such as cardiac arrest, difficulty breathing, or when an infant is unresponsive.
This blog will guide you through how to assess the brachial pulse in an infant, highlight common mistakes to avoid, and offer tips to enhance your accuracy and confidence in these situations.
Why Brachial Pulse Assessment Is Important in Infants?
Unlike adults and older children, infants have smaller and more delicate anatomy, making certain pulse points harder to detect. The brachial artery, located in the upper arm, is the most reliable site for checking a pulse in infants under one year old. This pulse check is essential to determine whether the heart is pumping effectively, especially in emergencies like cardiac arrest or respiratory distress.
In emergency situations, the brachial pulse plays a critical role. During infant CPR, checking the brachial pulse helps decide if chest compressions are needed. If the pulse is absent or below 60 beats per minute with signs of poor perfusion (such as pale or mottled skin), chest compressions should begin immediately. Quick and accurate pulse assessment can improve survival rates by ensuring the right interventions are taken at the right time.
Beyond emergencies, the brachial pulse is important during routine health checks, allowing healthcare providers to assess the infant’s circulatory health.
When to Check an Infant’s Brachial Pulse
You should assess the brachial pulse:
- During CPR to determine if chest compressions are needed
- When evaluating for cardiac arrest or respiratory failure
- In medical assessments as part of a full set of vitals
- After a sudden collapse or when the infant is unresponsive
How to Find and Assess the Brachial Pulse in an Infant
Finding and assessing the brachial pulse in an infant is an important skill that requires careful technique and attention to detail. Here’s how to do it:
1. Position the Infant
Lay the infant on a firm, flat surface, such as a changing table or a sturdy bed. Ensure the infant is on their back with their arm slightly extended to expose the inside of the upper arm. This position helps you access the brachial artery easily and ensures that the pulse check is accurate.
2. Locate the Brachial Artery
The brachial artery runs along the inside of the upper arm, between the shoulder and the elbow. To find it, extend the infant’s arm slightly and feel along the inner part of the upper arm, just above the elbow crease. You should be able to feel a soft, pulsing sensation when you reach the correct spot.
3. Use Your Fingers
Place two or three fingers (never your thumb) gently on the inner side of the upper arm. The thumb has its own pulse, which can confuse the assessment. By using your fingers, you can avoid this issue and ensure that you’re detecting the pulse in the right location.
4. Apply Light Pressure
When feeling for the pulse, apply just enough pressure to detect it, but avoid pressing too hard. Applying too much pressure could obstruct the pulse and make it harder to feel. A light, gentle touch is ideal for finding a pulse in infants.
5. Count the Beats
Once you’ve located the pulse, count the beats for at least 6 seconds and multiply by 10 for a quick estimate of the heart rate. For a more accurate reading, count the beats for a full 60 seconds. This is particularly important if the pulse feels weak or irregular, as it will provide a more precise assessment of the infant’s heart rate.
Tips for Accurate Pulse Assessment
Accurate assessment of an infant’s brachial pulse requires attention to detail and a careful, sensitive approach. These key tips will help you perform the pulse check more effectively, ensuring that you can make the right decisions in any situation:
- Warm your hands before touching the infant to avoid startling them or causing discomfort.
- Avoid using your thumb, as it has its own pulse and can lead to false readings.
- Stay calm and focused—infants are sensitive to your touch, tone, and overall energy.
- Try both arms if you’re having difficulty locating the pulse, as slight variations in anatomy or position can make a difference.
- Support the infant’s arm properly so the muscles stay relaxed and the artery is easier to palpate.
- Use two to three fingers to gently press—too much pressure can occlude the artery, while too little may not detect the pulse.
- Assess in a quiet environment whenever possible to better concentrate and feel subtle pulses.
- Count for a full 60 seconds if the pulse seems weak or irregular, to get the most accurate rate.
Common Mistakes to Avoid
Here are some common mistakes you should avoid while assessing the brachial pulse of an infant:
- Using too much pressure, which can block the pulse
- Checking the wrong location (e.g., too close to the wrist)
- Relying on visual cues alone instead of feeling the artery
- Not supporting the infant’s arm properly while assessing.
Conclusion
The ability to assess the brachial pulse in an infant plays a crucial role in both emergency care and everyday pediatric assessments. As a reliable indicator of circulation in infants, this skill supports timely and informed decisions during life-threatening situations. Confidence in this technique comes through proper training and repeated practice, which is why regular certification is so important.
For those looking to deepen their knowledge and hands-on skills in pediatric emergency care, enrolling in a PALS (Pediatric Advanced Life Support) course is a valuable next step. At Heart Start CPR, our PALS classes are designed to provide in-depth instruction, real-world scenarios, and the confidence you need to respond in pediatric emergencies. Join us and take the next step in becoming fully prepared to save young lives when it matters most.
