Choking: Adults, Children & Infants

Choking kills around 5,000 people in the United States every year, making it the fourth leading cause of unintentional injury death. The vast majority of choking deaths involve food. The majority of victims are over 65 years old — but infants under one are also at high risk, and the technique used for adults will kill an infant if applied incorrectly. Choking is a time-critical emergency: complete airway obstruction causes unconsciousness within minutes and death from hypoxic brain injury shortly after.

The key to surviving a choking incident is bystander action in the first 60 seconds. Emergency services cannot arrive fast enough. What you do — or do not do — in that window is everything.

Recognising Choking

Partial Obstruction (Mild Blockage)

The person can still breathe, cough, and may be able to speak. They are distressed and coughing hard.

Action: Encourage them to keep coughing. Do not slap them on the back — this can dislodge the object deeper. Do not attempt abdominal thrusts. Stand by and be ready if the situation deteriorates.

⚠️ An effective cough generates far more airway pressure than any external manoeuvre. A person who is coughing effectively is the best person to clear their own airway. Intervene only if the cough stops being effective.

Complete Obstruction (Severe Blockage)

The person cannot breathe, cannot speak, cannot cough effectively, or can only produce a high-pitched squeaking sound. They may grab at their throat — the universal choking sign.

Action: This is an emergency. Act immediately.

Adult Choking — Responsive

The standard sequence for a choking adult (or child over 1 year) who is responsive:

Step 1: Back Blows (5 attempts)

1. Position yourself at the person's side, slightly behind them
2. Support their chest with one hand — lean them forward so any displaced object will come out of the mouth rather than going deeper
3. Deliver up to 5 firm back blows with the heel of your hand between their shoulder blades
4. After each blow, check if the obstruction has cleared

Step 2: Abdominal Thrusts (5 attempts)

If back blows have not cleared the obstruction:

1. Stand behind the person
2. Place one foot forward for stability
3. Make a fist with one hand and place the thumb side against the person's abdomen — above the navel and below the breastbone (about 5 cm above the navel)
4. Cover your fist with your other hand
5. Give up to 5 sharp upward-and-inward thrusts
6. After each thrust, check if the obstruction has cleared

Repeat the Cycle

Alternate 5 back blows and 5 abdominal thrusts until the object is cleared or the person becomes unconscious.

Call emergency services if not already done — do not stop the cycle to make the call; shout for someone else to call or use speakerphone.

⚠️ Abdominal thrusts can cause internal injuries — even when performed correctly. Any person who receives abdominal thrusts should be evaluated by a doctor, even if they appear completely recovered and the obstruction was cleared successfully.

When the Choking Person Loses Consciousness

If the person loses consciousness:

1. Lower them carefully to the floor
2. Call emergency services immediately if not already done
3. Begin CPR — 30 chest compressions followed by 2 rescue breaths
4. Each time you attempt rescue breaths, look in the mouth for a visible object — if you can see the object, carefully remove it with a finger sweep. Do not perform blind finger sweeps — you may push the object deeper
5. Continue CPR cycles until emergency services arrive or the object is expelled and normal breathing resumes

Chest compressions in CPR create significant airway pressure and can dislodge an object. CPR in an unconscious choking victim is the correct response.

Choking in Pregnant Women and Obese Adults

The pregnant uterus and excess abdominal fat mean abdominal thrusts cannot be positioned correctly. Use chest thrusts instead:

1. Stand behind the person
2. Place your arms under their armpits and around their chest
3. Position your fist on the lower half of the sternum (breastbone), not the upper abdomen
4. Give up to 5 firm backward chest thrusts
5. Alternate with 5 back blows

If unconscious: standard CPR hand position on the sternum is appropriate.

Self-Heimlich (Choking Alone)

If you are choking alone and cannot clear the obstruction by coughing:

Option 1 — Self abdominal thrust:

1. Make a fist and position it just above your navel
2. Cover with your other hand
3. Thrust forcefully inward and upward

Option 2 — Chair back:

1. Find a chair or railing at waist height
2. Drive your upper abdomen firmly against the back of the chair or the railing edge
3. This uses the object's own weight and the thrust to create airway pressure

Before doing either: try to call emergency services — even if you cannot speak, leave the line open and make noise.

Child Choking (Over 1 Year)

The technique for children over 1 year is the same as adults, with one modification:

• Use less force — proportional to the child's size
• Kneel behind younger children to get at the right height
• For younger/smaller children, use only 2 fingers for abdominal thrusts rather than a full fist
• Still alternate 5 back blows with 5 abdominal thrusts

Infant Choking (Under 1 Year)

Infants have a very different airway anatomy and fragile abdominal structures. Never use abdominal thrusts on an infant. The technique is different:

Step 1: Back Blows for Infants (5 attempts)

1. Lay the infant face-down along your forearm, supporting the head with your hand — the head must be lower than the torso
2. Hold the infant securely against your forearm
3. Using the heel of your free hand, give 5 firm back blows between the shoulder blades
4. Check the mouth after each blow — remove any visible object with your little finger

Step 2: Chest Thrusts for Infants (5 attempts)

If back blows have not cleared the obstruction:

1. Turn the infant face-up on your other forearm, still supporting the head — keep head lower than body
2. Using 2 fingers on the centre of the chest (one finger-width below the nipple line), give 5 chest thrusts — firm downward pushes, compressing the chest about one-third of its depth
3. Check the mouth after each thrust

Repeat

Alternate 5 back blows and 5 chest thrusts. Call emergency services (have someone else call if possible — do not stop the sequence).

Unconscious Infant

If the infant loses consciousness:

1. Lay on a firm, flat surface
2. Begin infant CPR (2 fingers, centre chest below nipple line, 30 compressions, 2 small breaths)
3. Before each attempt at rescue breaths, look in the mouth and remove any visible object

⚠️ Never shake an infant to try to dislodge an airway obstruction. Never hold an infant upside down. Never use blind finger sweeps.

Post-Incident Care

After a successful resolution of a choking incident:

• Any person who received abdominal thrusts should be evaluated by a doctor — internal injuries can occur
• Children and infants who received chest thrusts or back blows should be assessed
• If any doubt about whether the object was fully expelled, seek medical review
• The person may cough, have a sore throat, or feel discomfort in the upper abdomen — these are expected after the manoeuvre

Quick Reference

Age Group	Responsive Technique	Unconscious
Adult	5 back blows + 5 abdominal thrusts (alternate)	CPR; check mouth before breaths
Pregnant / obese adult	5 back blows + 5 chest thrusts (alternate)	CPR; standard chest compressions
Child (>1 yr)	5 back blows + 5 abdominal thrusts (less force)	CPR; check mouth before breaths
Infant (<1 yr)	5 back blows + 5 chest thrusts	CPR; check mouth before breaths
Self-choking	Abdominal self-thrust or chair-back thrust	Call emergency services first
Mild cough present	Encourage coughing; do not intervene	N/A
After abdominal thrusts	Medical evaluation recommended	—

This guide provides general choking first-aid information based on current resuscitation guidelines. Hands-on training from a recognised first-aid provider is strongly recommended. Guidelines are updated periodically — confirm current recommendations with your local resuscitation authority.