What to Do If a Child Is Choking: Step-by-Step Guide

First: is it a mild or severe blockage?

This determines everything you do next.

Mild blockage — do not intervene. The child is coughing forcefully, crying, or can speak or make noise. Air is moving. Coughing is more effective than anything you can do with your hands. Stay with them, encourage them to keep coughing, and be ready to act if it worsens.

Severe blockage — act now. Signs include:

• Silent — cannot cough, cry, speak or breathe
• A weak, ineffective cough
• High-pitched noise on inhaling, or no sound at all
• Clutching the throat
• Lips or face turning blue

Children over 1 year old

1. Confirm and tell them what you are doing. Ask "Are you choking? I'm going to help."
2. Send someone to call 911. If you are alone, give relief attempts first, then call.
3. Give abdominal thrusts. Kneel or stand behind the child. Make a fist and place the thumb side just above the navel, well below the breastbone. Grasp with your other hand and give quick inward-and-upward thrusts.
4. Repeat until the object comes out or the child becomes unresponsive.

Each thrust is a separate, deliberate attempt — not a rapid series of weak pushes.

Infants under 1 year old

Never give abdominal thrusts to an infant. Use back blows and chest thrusts.

1. Support the head and neck and lay the infant face-down along your forearm, head lower than the chest, resting your arm on your thigh.
2. Five back blows with the heel of your hand between the shoulder blades.
3. Turn the infant face-up, supporting the head, still head-down.
4. Five chest thrusts — two fingers on the breastbone just below the nipple line, pressing about 1.5 inches.
5. Alternate five and five until the object comes out or the infant becomes unresponsive.

If the child or infant becomes unresponsive

The response changes immediately:

1. Lower them to a firm, flat surface and shout for help. If you are alone and nobody has called, call 911 on speaker.
2. Start CPR, beginning with compressions.
3. Before each set of breaths, look in the mouth. If you see the object and can remove it, do so.
4. Never sweep a finger blindly — you can push the object deeper.
5. Continue until EMS arrives or the child starts breathing normally.

After the object comes out

Get the child evaluated by a clinician, even if they seem fine. Two reasons: abdominal thrusts can cause internal injury, and a partially inhaled object or airway swelling may not show symptoms straight away. If the child was ever unresponsive, that is an emergency department visit, not a wait-and-see.

Prevention, because this is mostly preventable

• Cut round foods lengthwise — grapes, cherry tomatoes, hot dogs
• Avoid whole nuts, popcorn, hard candy and chunks of raw carrot under age 4
• Children eat sitting down, never running, lying down or in a moving car
• Keep coins, button batteries, small magnets and marbles out of reach
• Supervise meals in group settings — choking is silent, so you will not hear it

Bottom line

Judge severity first — a forceful cough is doing more than you can. For children over one, abdominal thrusts. For infants, five back blows and five chest thrusts, alternating. If they go unresponsive, start CPR and check the mouth before each set of breaths. Then get them checked out.

If you care for children, practise this on a manikin before you need it. Our Pediatric First Aid, CPR & AED course covers exactly these skills.