The most appropriate vagal maneuver for an infant involves:

• A. Valsalva maneuver.
• B. Carotid sinus massage.
• C. Holding ice packs firmly to the face.
• D. Gently tapping the chest.

Answer: (C)

The idea being tested is using a non-drug vagal maneuver in an infant to slow the heart rate by triggering the diving reflex. Applying ice to the infant’s face activates facial nerve pathways that stimulate the medulla to increase vagal (parasympathetic) tone, which slows conduction through the AV node. In many cases of SVT in infants, this reflex can terminate the tachycardia or at least slow it enough to allow a normal rhythm to resume.

Holding ice packs firmly to the face is the practical, safe way to provoke that reflex in an infant. It’s quick, noninvasive, and does not require patient cooperation. Other maneuvers aren’t appropriate here: Valsalva is hard to perform in an infant and often ineffective; carotid sinus massage is not only inappropriate for infants but can be dangerous due to potential vascular injury or stroke risk; gently tapping the chest isn’t a recognized or reliable vagal maneuver for managing infant tachyarrhythmias.