A responsive choking infant is a child under one year of age who is conscious but has a foreign object partially or completely blocking their airway. Choking is a leading cause of accidental injury and death in infants because their small airways are easily obstructed by small objects or food. Immediate action is necessary to clear the blockage and restore normal breathing. The steps taken in these first moments determine the outcome of the emergency.
Identifying a Severe Choking Emergency
Intervention depends entirely on the infant’s ability to move air. If the infant has a mild, or partial, obstruction, they can usually produce a loud cough or cry. This forceful movement of air often allows the infant to dislodge the object themselves, and the caregiver should observe them closely without interfering.
A severe obstruction demands immediate intervention. The most concerning signs are an inability to cry or make any sound, or a cough that is weak or silent. The infant may attempt to breathe, but only a high-pitched sound or no sound at all will be heard. As oxygen levels drop, the infant’s skin may turn pale or blue (cyanosis), indicating a life-threatening emergency. Intervention is only performed when the cough is ineffective or absent, confirming a complete blockage of the airway.
Step-by-Step Execution of Back Blows and Chest Thrusts
The standardized technique to relieve a severe choking obstruction in a conscious infant involves a cycle of five back blows and five chest thrusts. This sequence creates an artificial cough mechanism, generating pressure to expel the foreign object. The procedure begins with the infant positioned face-down along the rescuer’s forearm, which can be rested on a thigh for additional support. Ensure the infant’s head remains lower than their chest to utilize gravity in moving the obstruction.
The caregiver delivers five distinct, firm back blows using the heel of one hand directly between the infant’s shoulder blades. These blows must be sharp and forceful enough to dislodge the item, but not aggressive enough to cause injury. The goal is to clear the airway with the minimum necessary force, checking after each blow to see if the obstruction has been relieved.
If the object remains lodged after the back blows, the infant is carefully turned face-up while supported along the rescuer’s other forearm. The head must again be positioned lower than the chest. The caregiver then uses two fingers (typically the index and middle fingers) to perform five rapid chest thrusts. These thrusts are delivered on the center of the breastbone, just below the nipple line.
Each chest thrust should compress the chest approximately one-third of its depth (about 1.5 inches), similar to the depth used in infant cardiopulmonary resuscitation (CPR). The thrusts must be quick and forceful, aiming to compress the air within the lungs to push the object out. The caregiver must continue alternating the cycle of five back blows and five chest thrusts until the infant successfully coughs out the object, begins to cry forcefully, or becomes unresponsive. Once the obstruction is cleared, the infant should be breathing normally and may cry or cough vigorously.
When to Call for Help and Follow-Up Care
When a severe choking emergency is identified, the caregiver should immediately shout for help. If a second person is present, instruct them to call emergency services. If the caregiver is alone, they must initiate the back blow and chest thrust sequence immediately and continue uninterrupted for two full minutes before pausing to make the emergency call themselves. This two-minute period of continuous care prioritizes immediate life-saving action, as brain damage can occur quickly without oxygen.
A change in the infant’s responsiveness signals the need to stop the alternating sequence and immediately escalate care. If the infant becomes unresponsive, meaning they become limp or lose consciousness, they should be placed on a firm, flat surface. The caregiver must then transition to performing CPR, which is the next step in the emergency protocol for an unconscious, non-breathing infant.
Even if the back blows and chest thrusts successfully remove the foreign object and the infant appears to recover fully, a medical evaluation is necessary. The force applied during the rescue maneuvers, particularly the chest thrusts, can potentially cause internal injuries or trauma to the airway that might not be immediately obvious. A medical professional needs to ensure no fragments of the object remain in the airway or lungs, which could later lead to complications like aspiration pneumonia or continued respiratory distress. Seeking professional medical attention ensures a thorough check for any residual damage and confirms the infant is stable after the traumatic event.