Choking occurs when a solid object becomes lodged in the throat or windpipe, blocking the flow of air. In adults, it could be a piece of food and in children, it’s usually a small piece of food or toy. Because choking cuts off oxygen to the brain, first aid must be done as quickly as possible.
Signs of choking include:
- Clutching the neck and trying to retch
- Difficulty breathing or noisy breathing
- Inability to cough forcefully
- Skin, lips and nails turning blue or dusky
- Loss of consciousness
The Red Cross recommends a “five-and-five” approach to delivering first aid:
- Give 5 back blows. First, deliver five back blows between the person’s shoulder blades with the heel of your hand.
- Give 5 abdominal thrusts. Perform five abdominal thrusts (also known as the Heimlich maneuver).
- Alternate between 5 blows and 5 thrusts until the blockage is dislodged.
According to the American Heart Association, it’s OK not to use back blows, if you haven’t learned the technique. Both approaches are acceptable. They recommend the abdominal thrusts only (Heimlich maneuver)
- Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
- Make a fist with one hand. Position it slightly above the person’s navel.
- Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
- Perform a total of 5 abdominal thrusts, if needed. If the blockage still isn’t dislodged, repeat the five-and-five cycle.
If you’re the only rescuer, perform back blows and abdominal thrusts and then call for help or move the victim to the nearest health center. If another person is available, have that person call for help while you perform first aid.
If the person becomes unconscious, perform standard CPR with chest compressions and rescue breaths.
To perform abdominal thrusts (Heimlich maneuver) on yourself:
First, if you’re alone and choking, call for help immediately. Then, although you’ll be unable to effectively deliver back blows to yourself, you can still perform abdominal thrusts to dislodge the item.
- Place a fist slightly above your navel.
- Grasp your fist with the other hand and bend over a hard surface — a countertop or chair will do.
- Shove your fist inward and upward
To clear the airway of a pregnant woman or obese person:
- Position your hands a little bit higher than with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs.
- Proceed as with the Heimlich maneuver, pressing hard into the chest, with a quick thrust.
- Repeat until the food or other blockage is dislodged or the person becomes unconscious.
To clear the airway of a choking infant younger than age 1:
- Assume a seated position and hold the infant facedown on your forearm, which is resting on your thigh.
- Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object.
- Hold the infant faceup on your forearm with the head lower than the trunk if the above doesn’t work. Using two fingers placed at the center of the infant’s breastbone, give five quick chest compressions.
- Repeat the back blows and chest thrusts if breathing doesn’t resume. Call for emergency medical help.
- Begin infant CPR if one of these techniques opens the airway but the infant doesn’t resume breathing.
If the child is older than age 1, give abdominal thrusts only.
***To prepare yourself for these situations, learn the Heimlich maneuver and CPR in a certified first-aid training course.