Choking

Definition: When food, a small object, or liquid blocks the airway and prevents normal breathing. Choking can range from mild, where the child is still coughing or making sound, to severe, where the airway is fully blocked and the child cannot breathe at all. Severe choking is a life threatening emergency that requires immediate action.

Parent Tip: The single most important skill in a choking emergency is telling the difference between mild and severe choking, because they look different and require different responses.

Mild Choking (airway partially blocked)

• Child is coughing, crying, or making sounds
• Child may have a red, flushed face
• What to do: Stay calm, stay close, and encourage the child to keep coughing. A strong cough is more effective at clearing the airway than anything you can do with your hands. Do not slap them on the back, put your fingers in their mouth, or give them water.

Severe Choking (airway fully blocked)

• Child cannot cough, cry, breathe, or make any sound
• Child may have a panicked or wide eyed look
• Older children may clutch their throat with their hands
• Lips or face may turn bluish or gray
• What to do: Act now. Have someone call 911 while you begin the steps below. Every second matters.

For Infants Under 1 Year

Do not use abdominal thrusts on infants. Their organs sit too close to the surface and can be injured.

• Position the baby face down along your forearm, supporting their head and jaw with your hand, making sure not to cover their mouth. Their head should be lower than their chest.
• Give 5 firm back blows between the shoulder blades using the heel of your free hand.
• Flip the baby face up along your other forearm, head still lower than the chest.
• Give 5 firm chest thrusts on the breastbone using the palm of one hand, letting the chest fully rise back up between each thrust.
• Repeat alternating 5 back blows and 5 chest thrusts until the object comes out or the baby becomes unresponsive.
• If the baby becomes unresponsive, begin infant CPR.

For Children Over 1 Year and Adults

Under current AHA 2025 guidelines, the response now alternates 5 back blows with 5 abdominal thrusts, similar to the infant pattern. This is a recent change from older protocols that used abdominal thrusts alone.

• Stand or kneel behind the child or person, slightly lower than or level with them.
• Lean them forward and give 5 firm back blows between the shoulder blades using the heel of your hand.
• If the object has not come out, give 5 abdominal thrusts: make a fist and place the thumb side just above the belly button and well below the breastbone. Wrap your other hand around your fist and pull sharply inward and upward.
• Continue alternating 5 back blows and 5 abdominal thrusts until the object comes out or the person becomes unresponsive.
• If the person becomes unresponsive, lower them to the ground and begin CPR.
• For pregnant or significantly larger people, use chest thrusts in place of abdominal thrusts.

Common Choking Hazards for Children Under 4:

• Whole grapes, cherry tomatoes, blueberries (always cut in quarters lengthwise)
• Hot dogs cut into round coins (cut lengthwise then into small pieces instead)
• Hard candy, gum, marshmallows
• Popcorn, nuts, raw carrots, raw apple chunks
• Small toys, coins, beads, batteries, magnets

A good rule: if it fits through a toilet paper tube, it is a choking hazard for a child under 3.

Why It Matters: Most choking episodes resolve before EMS arrives because a parent or caregiver did the right thing in the first 60 seconds. A child's airway is much smaller than an adult's, so a partial obstruction can become complete in seconds. Knowing the technique and acting fast is what saves lives. Hands on practice in a CPR and First Aid class is the best way to feel confident, because muscle memory is what carries you through the real moment when panic sets in.

Related Terms: Abdominal Thrusts, Airway, Back Blows, Chest Thrusts, CPR, Heimlich Maneuver, LifeVac, Rescue Breathing, Unconsciousness

Written and reviewed by Jeremy Manke, Firefighter / Paramedic (22 years of emergency service)

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