An infant choking emergency requires immediate and precise action to clear a blocked airway. The proper technique for delivering chest thrusts is necessary, as a fragile infant’s anatomy demands controlled yet effective force. Understanding how deep to press, where to place the fingers, and the correct sequence of care is essential. This guide focuses on the specific mechanics of chest thrusts, which are essential for clearing an infant’s airway when they are conscious but unable to breathe.
Recognizing Severe Airway Obstruction in Infants
The initial step in any choking emergency is correctly assessing the severity of the airway obstruction. If an infant is able to cough forcefully, cry loudly, or make other vocal sounds, the obstruction is considered mild, and intervention should be limited to encouraging the infant to continue coughing.
The need for chest thrusts arises when the obstruction is severe and the infant is conscious but cannot move air effectively. Signs of a severe blockage include a silent or very weak cough, an inability to cry or make any sound, or the infant’s skin turning a pale or bluish color, particularly around the mouth and nose. These signs indicate that oxygen flow is dangerously restricted, and manual intervention is necessary to dislodge the foreign object.
The Essential Mechanics of Infant Chest Thrusts (Depth and Placement)
The correct depth for infant chest thrusts is designed to maximize internal chest pressure while minimizing the risk of injury to the infant’s delicate structure. Guidelines recommend pressing down approximately one-third the depth of the chest, which translates to about 1.5 inches (4 centimeters) for an average infant.
To deliver these thrusts, the precise placement of the fingers is paramount. Rescuers should use two fingers, typically the index and middle fingers, placed on the center of the breastbone, just one finger-width below the imaginary line connecting the infant’s nipples. The thrusts must be delivered with a quick, firm, and rhythmic motion, ensuring the chest is allowed to fully recoil between each push. This full recoil is necessary to allow the chest cavity to return to its normal shape, which helps generate the force needed to create an artificial cough and dislodge the obstruction.
The Alternating Protocol: Back Blows and Chest Thrusts
Chest thrusts are part of a standardized, alternating sequence for a conscious choking infant. This protocol begins with correctly positioning the infant, who should be held face-down along the rescuer’s forearm with their head supported and positioned lower than their trunk. This head-down angle uses gravity to assist in expelling the object.
The first action is to deliver five firm back blows using the heel of the hand between the infant’s shoulder blades. Immediately following the back blows, the infant is turned face-up, with the head still lower than the chest, to deliver five chest thrusts using the precise mechanics described above. The process of giving five back blows followed by five chest thrusts must be continuously repeated until the foreign object is expelled, the infant begins to breathe, or the infant becomes unresponsive.
Immediate Action Following Successful Clearing or Unresponsiveness
Once the airway is successfully cleared and the infant is coughing, crying, or breathing normally, the intervention should stop. It is imperative to call emergency medical services immediately, even if the infant appears to have fully recovered. The force used to clear the airway can potentially cause hidden internal injuries, and a medical professional must assess the infant to ensure there is no residual damage.
If, at any point during the alternating protocol, the infant becomes unresponsive, the rescuer must immediately place them on a firm, flat surface and transition to the full cardiopulmonary resuscitation (CPR) protocol. When performing CPR on an unresponsive choking infant, the focus remains on chest compressions. The rescuer should check the mouth for the object before attempting rescue breaths. If the object is visible, it can be removed with a finger, but no blind finger sweeps should be performed, as this risks pushing the object deeper into the airway.