For infants and patients who cannot follow verbal commands, what vagal maneuver is used, and where should newborns receive this placement?

• A. Ice packs to the face for 15 seconds
• B. Valsalva maneuver with cold packs to arms
• C. Carotid sinus massage with forehead on pillow
• D. Cold water immersion of entire body

Answer: (A)

The maneuver being tested relies on provoking a vagal response by stimulating the face with cold. In infants who can’t follow commands, this is done to increase parasympathetic input to the heart and slow conduction through the AV node, which can help terminate or help manage SVT.

Place a cold stimulus on the infant’s face for about 15 seconds, typically using an ice pack placed against the cheeks and/or the forehead. This location is chosen because the cold facial stimulus activates the trigeminal nerve and triggers the diving reflex, leading to a vagal-mediated slowing of the heart rate. Newborns receive this placement on the face, not on the body or in other areas.

This approach is preferred here because infants can’t perform a Valsalva maneuver, and carotid sinus massage is inappropriate in neonates due to risk. Cold immersion of the whole body isn’t as targeted or practical. Use small, well-wrapped ice packs to avoid skin injury, and discontinue if the infant does not tolerate it or if there are signs of distress.