New AHA Choking Guidelines (2025-2030): Essential Tips for Parents

As a PA-certified paramedic and firefighter with over 20 years of experience, I teach choking response every week. When the American Heart Association updates its guidelines, it matters — because what I teach in my classes changes, and what you need to know as a parent changes with it.

The 2025-2030 AHA guidelines include specific updates to choking response for children and infants. Here is exactly what changed and what it means for you.

What Changed in the 2025 AHA Choking Guidelines

For Children Age 1 to Onset of Puberty — Complete Airway Obstruction

The updated guidelines now specify that for a child with a complete airway obstruction — meaning they cannot breathe, cannot cry, and have a silent or absent cough — you begin with 5 back slaps followed by 5 abdominal thrusts.

This is a meaningful change from previous guidance. Back slaps now come first, before abdominal thrusts.

Here is the correct sequence:

1. Confirm it is a complete airway obstruction — the child cannot breathe, speak, or cough effectively
2. Position yourself behind the child, lean them slightly forward
3. Give 5 firm back slaps between the shoulder blades with the heel of your hand
4. Give 5 abdominal thrusts — one finger above the belly button, pulling inward and upward in a J-shape
5. Continue alternating 5 back slaps and 5 abdominal thrusts until the object comes out or the child becomes unresponsive

If the child becomes unresponsive, lower them carefully to the ground and start CPR. Before giving rescue breaths, look in the mouth — if you can see the object, remove it. Do not perform blind finger sweeps. Blind finger sweeps could push the object deeper or cause bleeding. Give 2 rescue breaths and continue CPR until the object is dislodged or emergency services arrive. When giving rescue breaths, you may or may not see the chest rise. If the chest rises, the object has moved and allowed air to get in. If the chest does not rise, the object is still blocking the airway. 

For Infants Under 1 Year — Complete Airway Obstruction

The 2025 guidelines also updated the infant choking response. The two-finger technique for chest thrusts has been replaced. You now use the palm of one hand for chest thrusts.

Here is the correct sequence for infants:

1. Hold the infant face down on your forearm with the head lower than the chest, supporting the head. If the baby is heavier, sit down and support them. 
2. Give 5 firm back blows between the shoulder blades with the heel of your other hand.
3. Turn the infant face up into the other hand, supporting the head
4. Give 5 chest thrusts using the palm of one hand on the center of the chest
5. Continue alternating 5 back blows and 5 chest thrusts until the object comes out or the infant becomes unresponsive

Never perform abdominal thrusts on an infant. If the infant becomes unresponsive, start call 911 and start CPR. Look in the mouth before giving rescue breaths — remove the object only if you can clearly see it. No blind finger sweeps.

Mild Choking vs. Complete Airway Obstruction — Know the Difference

These guidelines apply only to a complete airway obstruction. Knowing the difference matters because the response is completely different.

Mild choking means the child is still coughing forcefully, crying, or making noise. Their airway is partially open. In this case, do not intervene with back slaps or abdominal thrusts. Encourage them to keep coughing — coughing is the most effective way to dislodge an object and your intervention can make things worse if the airway is still partially open.

Complete airway obstruction means the child cannot breathe, cannot make noise, and their cough has become silent or they have gone limp. This is when you act immediately using the 5 and 5 sequence above.

What About Anti-Choking Devices Like LifeVac?

Parents frequently ask me about anti-choking suction devices like LifeVac, especially since LifeVac received FDA De Novo authorization in March 2026 as the first and only FDA-authorized suction anti-choking device in the United States.

It is important to be clear: LifeVac is not currently recognized by the American Heart Association in its choking guidelines. The FDA authorization and AHA recognition are completely separate things. The AHA's 2025-2030 guidelines do not include anti-choking devices in the standard choking response protocol.

As a paramedic my position is this: learn the hands-on technique first and practice it until it is muscle memory. The 5 and 5 sequence works without any device, without batteries, and without having to locate something in a moment of panic. If you want an additional layer of protection in your home after mastering the technique, LifeVac can be a reasonable supplemental tool — but it is not a replacement for knowing what to do with your hands.

We carry LifeVac at The Life Safety Pro if you want to add it to your home safety supplies. We also offer a Complete Home Safety Bundle pairing it with our Large Children's First Aid Kit.

Why These Guidelines Changes Matter

Guidelines are updated based on new research and real-world outcomes data. The shift to back slaps first in the 2025 guidelines reflects evidence that back blows can be highly effective at dislodging airway obstructions — and the palm technique for infant chest thrusts reflects improved understanding of how to generate effective force on an infant's small chest.

As an instructor these changes are already incorporated into every class I teach. If you took a CPR or choking response class before 2025, it is worth taking a refresher to make sure you know the current protocol.

Choking Prevention — What Every Parent Should Be Doing

The best choking emergency is the one that never happens. Here are the most important prevention steps:

For infants and toddlers under 3 — this age group is at highest risk. Always supervise meals. Cut grapes and cherry tomatoes lengthwise — not into coin shapes. Cut hot dogs lengthwise before slicing. Avoid whole nuts, popcorn, hard candies, and large chunks of meat or cheese entirely.

For children 3 and older — teach them to sit down while eating, take small bites, chew thoroughly, and never run or play with food in their mouth. Remind them regularly — habits take time to build.

For all ages — get down to your child's level periodically and look for small objects on the floor. Coins, batteries, small toy parts, and button batteries are among the most dangerous. A button battery lodged in the throat causes chemical burns within hours and is a medical emergency.

Remember choking is the silent killer, so if you are preoccupied you might not hear anything at all. 

Be Ready Before You Need To Be

Reading about choking response is a valuable start. But the technique needs to be practiced on a mannequin with a certified instructor before you need it in a real emergency. Panic changes everything — what you practiced becomes automatic. What you only read about does not.

We offer AHA and HSI-certified CPR and choking response classes in Pittsburgh, PA for parents, caregivers, daycares, and businesses. Evening and weekend availability. We come to you.

Our Children's First Aid Kit includes a CPR face shield for choking emergencies that progress to cardiac arrest — because preparation does not stop at knowing the technique.

This article is for general education only and does not replace professional medical advice, diagnosis, or treatment. Choking emergencies can be life-threatening and require immediate action. When in doubt, always call 911 immediately and follow the instructions of emergency dispatchers. If your child is in danger or needs urgent help, call 911 right away. For poisoning or ingestion emergencies call Poison Control at 1-800-222-1222.

Jeremy Manke is a PA Certified Paramedic and Firefighter with over 20 years of experience. AHA and HSI-certified CPR and First Aid Instructor. Stop the Bleed Instructor. Creator of the Children's First Aid and CPR Kit — built to help parents and caregivers respond confidently to life's emergencies.