What should you do for a responsive infant who is choking and cannot cough, cry or breathe?

How to Help a Choking Child

One minute you and your child are laughing at the dinner table. The next minute the child is choking. What should you do?

1. Be sure the child really is choking. If she is coughing forcefully or talking, leave her alone; she's not choking. A choking child will gag or make a high-pitched sound.

2. Ask your child, "Are you choking?" If she nods yes or cannot speak, let her know you can help. Most important: Don't panic! Your child needs you to stay calm.

Treating children (ages 1 to 8 years old)

Have someone call 911 while you try the steps listed below. This person can keep 911 informed of progress and have an ambulance on the way if you are not successful at dislodging the obstruction.

• Stand behind the child. Wrap your arms around the child's waist.

• Make a fist with one hand, thumb side in. Place your fist just below the chest and slightly above the navel.

• Grab your fist with the other hand.

• Press into the abdomen with a quick upward push. This helps to make the object or food come out of the child's mouth.

• Repeat this inward and upward thrust until the piece of food or object comes out.

• Once the object comes out, take your child to the doctor. A piece of the object can still be in the lung. Only a doctor can tell you if your child is OK.

• Since someone is already on the phone with 911, tell him or her immediately if the child passes out.

Treating infants (less than 1 year old)

If a choking infant can no longer breathe, cough, or make sounds, have someone call 911 immediately. Next, place the baby face down on your forearm. Your arm should be resting on your thigh. With the heel of your other hand, give the child five quick, forceful blows between the shoulder blades.

If this fails, turn the infant on her back so that the head is lower than the chest. Place two fingers in the center middle of the breast bone, just below the nipples. Press inward rapidly five times. Continue this sequence of five back blows and five chest thrusts until the foreign object comes out or until the infant loses consciousness (passes out). If the infant passes out, tell 911 immediately. Never put your fingers into the infant's mouth unless you can see the object. Doing so may push the blockage farther into the airway.

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Few sounds are more alarming than that of a child who is choking. Understanding how to prevent choking, as well as what to do when choking occurs, can save your child’s life.

Nearly two thirds of children who choke to death are three years of age or younger. Most of these deaths can be avoided.

If a child is choking, first find out if the child can breathe, cry or speak. A strong cough generally means the airways is not completely blocked, and the child may be able to dislodge the blockage by coughing.

Only begin first aid if the child cannot breathe at all, or the child's airway is so blocked that there's only a weak cough and a loss of color.

Conscious Infant (Under one year old)

• Support head and neck with one hand. Place the infant face down over your forearm, head lower than torso, supported on your thigh.
• Deliver up to five back blows, forcefully, between the infant’s shoulder blades using the heel of your hand.
• While supporting the head, turn the infant face up, head lower than torso.
• Using two or three fingers, deliver up to five thrusts in the sternal (breastbone) region. Depress the sternum ½ to 1 inch for each thrust. Avoid the tip of the sternum.
• Repeat both back blows and chest thrusts until the foreign body is expelled or the infant becomes unconscious.
• Do not perform blind finger sweeps or abdominal thrusts on infants.
• Alternative method: Lay the infant face down on your lap, head lower than torso and firmly supported. Perform up to five back blows. Turn the infant on his or her back as a unit and perform up to five chest thrusts.

Unconscious Infant (Under one year old)

• Shout for help. Call 911 or the local emergency number.
• Perform the tongue-jaw lift. (Grip on the jaw by placing your thumb in the infant’s mouth and grasping the lower incisor teeth or gums; the jaw then lifts upward.) If you see the foreign body, remove it.
• If trained to do so, begin rescue breathing.
• Perform the sequence of back blows and chest thrusts as described for a conscious infant.
• After each sequence of back blows and chest thrusts, look for the foreign body and, if visible, remove it.
• Resume rescue breathing.
• Continue with the sequence of back blows and chest thrusts, and, after each sequence continue to check for the foreign body, which should be removed.
• If the foreign body is removed and the infant is not breathing, begin CPR.

Conscious Child (Over one year old)

• To dislodge an object from the airway of a child perform abdominal thrusts (the Heimlich Maneuver) as described for adults. Avoid being overly forceful in order to avert injury to ribs and internal organs (use your best judgment).

Unconscious Child (Over one year old)

• If the child becomes unconscious, continue as for an adult, except:
• Do not perform a blind finger sweep in children up to 8 years old. Instead, perform a tongue-jaw lift and remove the foreign body only if you can see it.

ACEP also provides information on how to perform CPR for an adult.  CPR instructions for an adult. 

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