The inability of an infant to breathe due to a foreign object requires immediate, specific action. An “infant” in cardiopulmonary resuscitation (CPR) protocols is defined as a child under the age of one year. The techniques used on them differ substantially from those for older children and adults. These differences exist because an infant’s anatomy is delicate and requires less forceful maneuvers, particularly in the chest and airway. This information outlines current emergency guidelines but is not a substitute for hands-on, formal training in CPR and first aid.
Protocol for a Responsive Choking Infant
When an infant is choking but remains conscious, the immediate goal is to dislodge the obstruction. If the responsive infant cannot cough forcefully, cry, or make a sound, they have a complete airway obstruction, and intervention must begin. The rescuer should initiate the “five and five” technique, which alternates between five back blows and five chest thrusts.
The infant should be positioned face-down along the rescuer’s forearm, with the head lower than the chest. The rescuer delivers five firm back blows using the heel of their free hand, striking the infant between the shoulder blades.
If the obstruction remains, the infant is immediately turned over and positioned face-up, with the head still lower than the chest. Five rapid chest thrusts are then administered using two fingers placed on the breastbone just below the nipple line. The cycle of five back blows and five chest thrusts is repeated until the object is expelled, the infant begins to breathe, or the infant becomes unresponsive.
A solitary rescuer should perform two minutes of this five-and-five care before pausing to call 9-1-1 or the local emergency number. This initial period of care is prioritized because immediate action is more beneficial than an immediate phone call, as the infant’s condition is often quickly resolved by clearing the airway.
The Shift to Unresponsive Care: Airway and Initial Breaths
The transition to CPR begins the moment the infant loses consciousness and becomes unresponsive, signaling a failure of the back blows and chest thrusts. The infant must be gently lowered onto a firm, flat surface to provide a stable platform for compressions. At this point, the rescuer must immediately shout for help, or if alone, begin the next steps before calling EMS after two minutes of care.
The first action is to open the airway to attempt rescue breathing. The rescuer uses the head tilt-chin lift maneuver, gently tilting the head to a neutral or slightly “sniffing” position. This position is less extended than for an adult to avoid collapsing the infant’s soft trachea. After opening the airway, the rescuer should visually check the mouth for the foreign object.
Never perform a blind finger sweep, as this can inadvertently push the object deeper into the airway. Only if the object is clearly visible and within easy reach should the rescuer attempt to remove it with a finger. The rescuer delivers two gentle rescue breaths, covering both the infant’s mouth and nose with their own mouth. Each breath should last about one second and be just enough to make the chest visibly rise.
If the chest does not rise with the first breath, the rescuer should immediately reposition the head and attempt the second breath. If the second breath is also ineffective, the rescuer proceeds directly to chest compressions, as the airway obstruction is still present. These initial two breaths are the primary difference between CPR for a choking victim and standard CPR.
Infant CPR Mechanics: Compressions and Cycles
The rescuer begins cycles of chest compressions and rescue breaths. The technique for infant chest compressions is highly specific to ensure efficacy and minimize the risk of injury to the infant’s delicate rib cage and internal organs. For a single rescuer, the compression technique involves using two fingers—typically the index and middle fingers—placed on the center of the breastbone, just below the imaginary line connecting the nipples.
The compressions must be delivered at a depth of approximately 1.5 inches, which is roughly one-third the depth of the infant’s chest. The rate of compressions is between 100 and 120 per minute, which is the same rate recommended for all age groups. It is important to allow the chest to fully recoil after each compression, ensuring the heart can refill with blood between pushes.
The standard cycle ratio for a single rescuer is 30 compressions followed by 2 rescue breaths. If a second trained rescuer is present, the preferred technique shifts to the two-thumb encircling method for compressions. The ratio changes to 15 compressions to 2 breaths, which provides more frequent ventilation.
After each full cycle of compressions and breaths, the rescuer must quickly check the infant’s mouth again for the foreign object before attempting the next set of rescue breaths. If an object is seen, it can be removed; otherwise, the cycles continue until EMS arrives, the infant becomes responsive, or a more advanced provider takes over care.