Maintaining an open airway in children is a life-saving skill for parents and caregivers. Children’s airways can obstruct rapidly, requiring swift action to prevent serious outcomes. Understanding how to respond in emergencies is important, as situations can escalate quickly.
Key Differences in Children’s Airways
A child’s airway differs notably from an adult’s, making it more susceptible to obstruction. It is smaller in diameter and shorter, with a proportionally larger tongue. The larynx is higher and more anterior, and the epiglottis is often larger, floppier, and narrower. The narrowest point is typically at the cricoid cartilage, below the glottis.
A child’s trachea has softer cartilage, making it flexible and prone to collapse. Infants have a larger occiput, which can cause neck flexion and airway compromise when lying flat. These anatomical distinctions, combined with a higher metabolic rate, make children vulnerable to respiratory distress, requiring specific airway management.
Identifying an Airway Obstruction
Recognizing airway obstruction signs is the first step. For a conscious child, a partially obstructed airway may present with noisy breathing like wheezing, stridor, or gasping. They might gag, cough weakly, or clutch their throat. If a child is coughing forcefully, speaking, or crying effectively, the airway is not completely blocked, and immediate intervention may not be necessary beyond observation.
A complete airway obstruction is a medical emergency. A conscious child will be unable to cry, speak, or cough forcefully, and may panic. Their skin, especially around the lips, may turn bluish (cyanosis) due to lack of oxygen. If the child becomes unresponsive, they will lose consciousness and show no signs of breathing or effective coughing.
Techniques for a Choking Child
When a conscious child is choking, action is necessary to dislodge the object. Avoid blind finger sweeps, as this can push the object further into the airway. If the child is coughing forcefully, encourage them to continue. If coughing is ineffective, or the child cannot cough, speak, or breathe, intervention is required.
For infants under one year old, support them face-down along your forearm, head lower than their body. Deliver up to five firm back blows between the shoulder blades. If the object doesn’t dislodge, turn the infant face-up, supporting their head. Place two fingers just below the nipple line in the center of their chest and give up to five quick chest thrusts, compressing about 1.5 inches deep. Alternate five back blows and five chest thrusts until the object is expelled or the infant becomes unresponsive. Abdominal thrusts are not recommended for infants due to internal organ damage risk.
For children over one year old, stand or kneel behind them, wrapping your arms around their waist. Make a fist with one hand, place it just above the navel, and grasp it with your other hand. Deliver up to five quick inward and upward abdominal thrusts, as if lifting the child. You can also alternate five back blows with five abdominal thrusts. Continue these cycles until the object dislodges, the child can breathe, or they become unresponsive. If the child becomes unresponsive, immediately call for emergency medical assistance and begin CPR if necessary.
Techniques for an Unresponsive Child
When a child is unresponsive and their airway needs opening, specific maneuvers are used. The Head-Tilt Chin-Lift is the primary technique when no spinal injury is suspected.
To perform, place one hand on the child’s forehead and gently tilt the head back. Simultaneously, place fingers of your other hand under the bony part of the chin and lift gently upward, avoiding pressure on soft tissues that could obstruct the airway. This moves the tongue away from the back of the throat, opening the airway. For infants, a neutral head position is typically sufficient, while older children may require a slight head tilt to the “sniffing” position.
If a spinal injury is suspected, the Jaw-Thrust maneuver is the preferred method to open the airway, as it minimizes neck movement. To perform, place the heels of your hands on either side of the child’s head or forehead, and use your fingers to grasp the angles of the jawbone. Gently lift the jaw forward and upward without tilting the head. This moves the lower jaw and tongue forward, clearing the airway while protecting the cervical spine. After performing either maneuver, quickly check for breathing; if the child is not breathing or showing signs of life, begin cardiopulmonary resuscitation (CPR) without delay.
Seeking Emergency Medical Assistance
In any situation involving a child with an airway obstruction, call for emergency medical assistance immediately. Whether the child is choking, unresponsive, or experiencing severe breathing difficulties, dialing 911 or your local emergency number is the first step. Even if the obstruction is cleared, seek medical evaluation to ensure no residual issues or injuries.
When speaking with the emergency dispatcher, remain calm and provide essential information. Clearly state the nature of the emergency, your exact location, and who needs help. Stay on the line until instructed otherwise, as the dispatcher may provide further guidance while help is en route.