If a child does not show signs of poor perfusion but has a pulse less than 60 bpm, what is the first step?

In the scenario where a child has a pulse rate of less than 60 beats per minute but does not show signs of poor perfusion, the appropriate first action is to begin CPR. This is due to the fact that a pulse below 60 bpm in a child is considered a critical condition, as it can signify inadequate circulation and oxygenation of vital organs, potentially leading to cardiac arrest if not promptly addressed.

Starting CPR in this situation provides immediate support to the child's circulation and can help restore an effective heart rhythm. The emphasis is placed on the child's need for urgent intervention, making CPR the most vital first step in this circumstance.

The other options like continuing to monitor or calling for help without taking immediate action do not provide the necessary urgent intervention that the child requires. Although providing ventilation is important in cases where breathing is absent or inadequate, the presence of a low heart rate necessitates a more immediate response in the form of CPR.