For an infant under one year old who is conscious but choking, the medically recommended first-aid procedure involves alternating between back blows and chest thrusts. The exact count for this life-saving intervention is a repetitive cycle of five back blows followed immediately by five chest thrusts. This cycle continues until the foreign object is expelled or the infant becomes unresponsive. Determining if this specific procedure is necessary requires first understanding the difference between a mild and severe airway obstruction.
Identifying Severe Choking in a Responsive Infant
When an infant encounters an airway obstruction, quickly assess the severity of the blockage. A mild airway obstruction is indicated if the infant is able to cough forcefully, cry loudly, or make high-pitched sounds. In these cases, the infant’s strong cough is often the most effective mechanism for clearing the obstruction, and intervention is not yet required. Stay near the infant and encourage them to continue coughing, but be ready to act if the situation worsens.
A severe airway obstruction demands immediate intervention. This is present if the infant cannot cry, cannot make any sound, or has a cough that is silent and weak. Other alarming signs include a bluish discoloration around the lips or fingertips, known as cyanosis, or if the infant appears distressed and unable to breathe. This procedure is reserved only for an infant who is conscious and responsive but shows clear signs of severe airway blockage.
Performing the 5-and-5 Cycle
The technique for clearing a severe obstruction in a responsive infant involves the precise application of five back blows and five chest thrusts, repeated in an alternating cycle. This method uses a rapid increase in pressure within the lungs to attempt to push the object out of the airway. Abdominal thrusts are not performed on infants due to the significant risk of internal organ damage.
The cycle begins with five back blows, which requires specific positioning for safety and effectiveness. Hold the infant face-down along your forearm, resting the forearm on your thigh for added support. Ensure the infant’s head remains lower than their chest, using gravity to assist in dislodging the object. Support the infant’s head by cradling their jaw with your hand.
Deliver five distinct, forceful blows using the heel of your hand directly onto the infant’s back, specifically between the shoulder blades. The force must be sharp and quick, aiming to create strong pressure in the airway that can expel the blockage. After the five blows, check the infant’s mouth to see if the object has been dislodged and can be safely removed.
If the object is not cleared, immediately transition to chest thrusts. Sandwich the infant between your two forearms, supporting the back of their head and neck with one hand. Gently turn the infant face-up onto your other forearm, again ensuring the head remains lower than the chest. Place two fingers in the center of the infant’s chest, on the lower half of the breastbone just below the nipple line. Deliver five quick, downward chest thrusts, compressing the chest approximately one-third to one-half the depth of the chest. These thrusts force air from the lungs, mimicking a cough. Continue to alternate between the five back blows and five chest thrusts until the object is expelled, the infant begins to cry or breathe, or the infant becomes unresponsive.
When to Stop and Transition to Unresponsive Care
The 5-and-5 cycle is a continuous process that should only be interrupted in two specific scenarios. The first is if the obstruction is cleared, which is evident if the infant begins to cry, cough forcefully, or breathe normally. Even if the infant appears fine after the object is cleared, emergency medical services (911 or local equivalent) should be called immediately for a follow-up assessment, as internal injuries may have occurred from the thrusts or the blockage itself.
The second scenario is if the infant becomes unresponsive, meaning they stop moving or become limp. If this occurs, immediately stop the back blow and chest thrust cycle. Gently place the infant onto a firm, flat surface, and immediately activate emergency services if you have not already done so. If you are alone, perform one minute of immediate care before pausing to call for help. Once the infant is unresponsive, the procedure transitions from choking relief to cardiopulmonary resuscitation (CPR), starting with chest compressions. The focus shifts to providing sets of compressions and rescue breaths, checking the mouth for the object only before giving breaths.