Airway obstruction is the most common cause of cardiopulmonary arrest in children. Maintaining an open airway is the first action in pediatric emergency care. When a child becomes unconscious, muscle relaxation often causes the tongue to fall back and block the upper airway, requiring immediate repositioning. This information is for general guidance and is not a substitute for certified, hands-on training in pediatric life support.
The Critical Difference: Infants Versus Older Children
The anatomical structure of a child’s airway differs significantly from an adult’s, dictating the techniques used to open it. Infants and young children have a proportionally larger tongue, making them prone to obstruction when muscle tone is lost. Their trachea is softer and narrower, meaning it can be easily compressed or kinked.
In infants, the larynx is situated higher and more anteriorly. Additionally, a large occiput (back of the head) causes the neck to flex when the child lies flat, which can close the airway. Therefore, excessive backward tilting of the head (hyperextension) must be avoided in infants, as it can worsen the obstruction.
Non-Traumatic Airway Opening
When no spinal injury is suspected, the standard procedure is the Head Tilt-Chin Lift maneuver. This technique lifts the chin and moves the tongue away from the posterior pharynx (back of the throat). The child must first be placed on their back on a firm, flat surface.
For a child, place one hand on the forehead and gently tilt the head backward to achieve the “sniffing position,” aligning the oral and pharyngeal axes for maximum air passage. Use two fingers of the other hand to lift the bony part of the chin upward. Be careful not to press on the soft tissue under the chin, which could compress the airway. For an infant, the head should only be tilted slightly past the neutral position, as over-extension can obstruct the flexible airway.
Airway Opening When Spinal Injury is Suspected
If trauma suggests a head, neck, or spinal injury, the Head Tilt-Chin Lift maneuver must not be used. Tilting the head backward could cause movement in the cervical spine, potentially leading to further damage. In these situations, the Jaw Thrust maneuver is the preferred technique because it opens the airway while minimizing neck movement.
The rescuer should kneel at the child’s head and stabilize it with their hands. Place two or three fingers of each hand under the angles of the child’s lower jaw. The jaw is then gently lifted upward and forward, without tilting or extending the head, to displace the lower jaw. This action pulls the tongue and soft tissues forward, clearing the airway.
Management of Foreign Body Obstruction
Intervention for foreign body obstruction depends on the child’s age and consciousness level. If the conscious child has an effective cough, encourage them to continue coughing. If the cough becomes ineffective, or if the child cannot vocalize or breathe, immediate intervention is necessary to increase pressure in the chest and abdomen to expel the object.
Infants Under One Year
For conscious infants under one year of age, the rescuer delivers a sequence of five back blows followed by five chest thrusts. The infant is supported face-down on the rescuer’s forearm for back blows, then turned face-up for chest thrusts delivered over the breastbone. Abdominal thrusts (Heimlich maneuver) are not performed on infants due to the risk of damaging the infant’s large and unprotected liver.
Children Over One Year
For conscious children over one year of age, the protocol involves five back blows followed by five abdominal thrusts. Abdominal thrusts are delivered by standing behind the child, wrapping the arms around their abdomen, and delivering quick, upward thrusts just above the navel.
If the infant or child becomes unconscious, the rescuer must immediately begin cardiopulmonary resuscitation (CPR), starting with chest compressions. Before attempting rescue breaths during CPR, check the mouth for a visible foreign object to remove it.