In infants and young children, what is the most effective vagal maneuver?

• A. Valsalva maneuver
• B. Application of ice to the face
• C. Carotid massage
• D. Head-down tilt

Answer: (B)

Vagal maneuvers in kids aim to boost parasympathetic influence on the heart to slow AV nodal conduction and help terminate SVT. In infants and young children, the most reliable and safe way to trigger this reflex is applying a cold stimulus to the face. Ice or a cold pack on the cheeks and forehead activates the diving reflex, which increases vagal tone to the heart, producing bradycardia and slowed AV conduction that can stop or slow SVT.

This approach is preferred in small children because it is simple, quick, noninvasive, and feasible without patient cooperation. The Valsalva maneuver is hard to perform in infants and often less effective in this age group. Carotid massage poses safety risks, including potential stroke, and is not used in pediatric patients. Head-down tilt is not a recognized or reliably effective vagal maneuver for achieving the desired cardiac response.

So, ice to the face best promotes the reflex that slows the heart in infants and young children.