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How to help a child who is choking

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 3 minutes read

Children have much narrower airways than adults and a delightful curiosity to put objects into things – their mouth, nose, or ear, for example. This puts them at high risk of choking on things – even a grape can pose a threat.

While it’s awful to think about, it can feel empowering to learn what to do when an object blocks the airways so that you can help your child in an emergency. We’ll talk you through it.

Those aged less than one year are treated slightly differently, and it’s best to learn this technique from a live or online demonstration.

This article may be a good starting point, but for added confidence, you could always find a local first aid course that covers choking and other emergencies – the American Red Cross is one provider.

How to I recognize choking?

Choking occurs when the airway to the lungs is blocked by food or a foreign object like a toy, peanut, or a battery. It may be fully blocked, preventing them from breathing, or it may be partially blocked, and they may still be able to breathe, cough, cry, and talk a little.

They will clutch at their neck, chest, or stomach and look very distressed. They may suddenly start coughing, even though they are not ill. And you might see evidence of the culprit, such as marbles or toy figurines.

Avoid the instinct to blindly put fingers down their throat – you may push an object further and cause a serious injury. If something is seen in their mouth, you can take this out.

What do I do first?

First, assess the situation and try to remain calm so that they can stay calm. If they are coughing loudly, bend them slightly forward, sit with them, and encourage them to cough. This means their airway is not obstructed.

Start five back blows if they cannot speak or cry and find it difficult to breathe in. Bend them slightly forward and hit them fairly firmly with the heel of your hand between their shoulder blades. This should propel any blockage out by the pressure of the jolt. For a small child, it's best to lay them face down across your lap and give the back blows, ensuring their face is unobstructed.

If they are unconscious, call for someone nearby to help or – if alone – call 911 for an ambulance, and start two breaths, then 30 chest compressions in a repeated sequence, if you know CPR (cardiopulmonary resuscitation). If you don’t feel confident with this, the ambulance call handler will talk you through it.

What do I do next?

If five back blows have been unsuccessful, you should proceed to five abdominal thrusts, previously called the Heimlich maneuver. This is only for those over one year – it’s a slightly different technique for babies.

Stand or kneel behind your child and hug your arms around them, with hands meeting just under their ribs. Avoid applying pressure to the ribs themselves. Clasp one hand in a fist, with the other hand over it, and pull inwards and upwards in one sharp movement.

This should create pressure in the lungs to propel the blockage out of the mouth.

When should I call an ambulance?

If they are coughing at first, try these procedures, and if unsuccessful with five back blows and five abdominal thrusts, call 911 for an ambulance.

Keep repeating the sequence while you wait for help. Call back if anything changes in their condition in the meantime.

If your child is unconscious and has stopped breathing, call an ambulance immediately and start two breaths and 30 chest compressions if you feel confident. Alternatively, stay on the phone with the call handler while they talk you through how to do CPR.

Keep going (or swap in with another bystander) until help arrives. It should come quickly.

Even if you dislodge an object, it’s best to get your child checked out, as damage may have been caused by the object and the techniques used to dislodge it.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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