Infant choking occurs when a foreign object blocks the airway, preventing normal breathing. Intervention is only necessary when the infant is conscious but cannot clear the obstruction on their own, which is defined as severe choking. The correct first-aid procedure for a responsive infant involves a specific sequence of back blows and chest thrusts designed to dislodge the object.
Identifying Severe Choking in a Responsive Infant
The decision to intervene relies on distinguishing between mild and severe airway obstruction. If the infant is able to cough forcefully, cry loudly, or make strong noises, this indicates that air is still moving past the obstruction. The caregiver should encourage the infant to continue coughing, as forcing intervention when the infant has an effective cough can potentially turn a partial blockage into a complete one.
Severe choking is characterized by an ineffective cough, which is often silent or very weak, or a complete inability to make any sound. The infant may struggle to breathe, and their skin color may begin to change, often turning bluish or darker around the lips and face (cyanosis). This color change indicates the airway is completely blocked and the body is not receiving enough oxygen, requiring immediate action.
The 5-and-5 Procedure: Back Blows and Chest Thrusts
The standardized technique for clearing a severe airway obstruction in a responsive infant involves alternating sets of five back blows and five chest thrusts. This combination is repeated until the object is expelled, the infant begins to breathe, cough, or cry, or until the infant becomes unresponsive. The sequence starts with five back blows, delivered with the infant positioned face-down along the rescuer’s forearm, using the thigh for support.
The infant’s head must be positioned lower than their chest to utilize gravity in helping to dislodge the foreign object. Using the heel of the hand, the caregiver delivers five firm blows directly between the infant’s shoulder blades. Each blow should be distinct and forceful enough to attempt to clear the airway.
If the five back blows do not clear the airway, the caregiver must quickly transition to performing five chest thrusts. The infant is carefully turned face-up onto the opposite forearm, again ensuring the head remains lower than the chest. This downward angle is important for maximizing the effectiveness of the thrusts.
The chest thrusts are applied using two fingers, placed on the center of the breastbone, just below the nipple line. The fingers should push straight down about 1 to 1.5 inches, with each thrust being quick and separate from the others. This action mimics a cough, compressing the air in the lungs to create a forceful expulsion of the foreign object.
Follow-Up Action and Calling Emergency Services
If the obstruction is successfully cleared and the infant begins breathing, crying, or coughing effectively, the rescue procedure can be stopped. Even if the infant appears to have recovered completely, a medical professional should always examine the baby after a severe choking episode. This is necessary to check for any residual injuries, such as internal bruising from the thrusts, or small airway damage.
The moment a severe choking episode is recognized, the caregiver should immediately instruct a nearby person to call 911 or the local emergency number. If the caregiver is alone, they should begin the 5-and-5 procedure immediately. After performing the procedure for approximately two minutes (about five cycles), the lone rescuer should pause to call emergency services themselves.
A change in the infant’s responsiveness signals an immediate change in the rescue protocol. If the infant becomes unresponsive (stops moving, goes limp, or loses consciousness), the caregiver must immediately place them on a firm, flat surface and begin cardiopulmonary resuscitation (CPR), starting with chest compressions. At this point, back blows and chest thrusts are no longer performed, and the focus shifts entirely to CPR while waiting for emergency medical services.