A choking incident in an infant is a medical emergency caused by a foreign object partially or completely blocking the airway. This obstruction prevents oxygen from reaching the lungs and brain, creating a time-sensitive situation where brain damage can occur quickly. Immediate, correct intervention is paramount to dislodging the blockage and restoring breathing. Understanding these precise steps is necessary for anyone caring for a baby.
Recognizing Severe Airway Obstruction in Infants
The initial step in managing a choking infant is assessing the severity of the airway obstruction. If the infant is coughing forcefully, crying loudly, or making vocal sounds, the obstruction is mild, meaning air is still moving. Caregivers should not intervene with physical maneuvers but encourage the infant to continue coughing, as this is the most effective way to clear a partial blockage.
A severe airway obstruction requires immediate action because the infant cannot move enough air to cough effectively. Signs include the inability to cry or make any sound, a weak or silent cough, or a high-pitched sound upon inhaling. The infant may also turn pale or blue, especially around the lips and face, due to lack of oxygen. If a severe obstruction is recognized, the caregiver should immediately shout for help. If another person is present, instruct them to call emergency services (911 or local equivalent) while care begins.
The Emergency Sequence: 5 Back Blows and 5 Chest Thrusts
For an infant under one year old with a severe airway obstruction, the standard procedure involves alternating between five back blows and five chest thrusts. This sequence is repeated until the object is expelled, the infant begins to breathe, cry, or cough, or the infant becomes unresponsive. The goal is to generate air pressure in the lungs to force the foreign body out of the windpipe.
To deliver back blows, hold the infant face-down along the rescuer’s forearm, resting it on the thigh. Ensure the infant’s head is lower than the chest, using gravity to assist in dislodging the object. The rescuer must support the infant’s head and neck by cradling the jaw with their hand, avoiding further airway obstruction.
The five back blows are delivered with the heel of the free hand, using quick, firm strikes between the infant’s shoulder blades. Once complete, the infant is carefully turned over, sandwiched between the rescuer’s two forearms. Maintain head support and keep the head lower than the chest during this transition to prepare for the next maneuver.
To deliver chest thrusts, position the infant face-up on the rescuer’s forearm, supported by the thigh. The rescuer places two fingers (typically index and middle) in the center of the infant’s chest, on the breastbone just below the nipple line. Five rapid, downward chest thrusts are administered, aiming for a depth of about 1.5 inches, similar to infant CPR compression depth. After each sequence of five back blows and five chest thrusts, quickly check the infant’s mouth for the foreign object. A blind finger sweep must never be performed, as this risks pushing the object further down the airway.
When the Infant Becomes Unresponsive
If the infant loses consciousness during the back blow and chest thrust sequence, the emergency response must immediately pivot to CPR. Loss of consciousness is identified by the infant becoming limp, stopping movement, and failing to respond when stimulated. The infant should be placed on a firm, flat surface to prepare for chest compressions.
If emergency services were not called earlier, the rescuer must call 911 or the local emergency number now, or send a bystander to do so. The goal shifts from dislodging the object to maintaining oxygenation and circulation until professional help arrives. The rescuer should immediately begin chest compressions, starting the standard CPR cycle.
In infant CPR, the cycle involves 30 chest compressions followed by two rescue breaths for a single rescuer. Compressions are delivered using two fingers on the breastbone at a rate of 100 to 120 per minute, aiming for a depth of about 1.5 inches. After each set of 30 compressions, the rescuer opens the airway and looks for the foreign body. If the object is visible and easily grasped, it should be removed. Two gentle rescue breaths are then given, covering both the infant’s mouth and nose, ensuring the chest visibly rises. This 30:2 cycle continues until the infant responds, an automated external defibrillator (AED) is available, or medical professionals take over.
Follow-Up Care and Prevention
Even if a foreign object is successfully dislodged and the infant appears to recover fully, immediate medical follow-up is necessary. The forceful nature of back blows and chest thrusts can cause minor internal injuries, such as bruising or trauma to airway structures, which a physician must assess. Additionally, a small piece of the object may remain lodged, or the distress may have caused temporary complications requiring evaluation.
Preventing future choking incidents involves constant supervision and hazard reduction. Caregivers should ensure all foods given to infants are appropriately sized and textured. Avoid round, firm items like whole grapes, nuts, and hot dogs unless they are cut into very small pieces. Non-food items that pose a choking risk must be kept entirely out of the infant’s reach.
All primary caregivers should enroll in a certified infant CPR and choking relief course. Hands-on training allows practice of these life-saving skills, building the confidence and muscle memory needed to react quickly and correctly in an emergency. Preparedness and a safe environment are the most effective strategies for protecting an infant from choking.