The immediate and correct response to an infant choking emergency can prevent serious harm. An airway obstruction in an infant under one year old is a life-threatening situation demanding swift action, as brain damage can begin within minutes. The procedure involves a specific combination of back blows and chest thrusts designed to use rapid pressure changes to dislodge the foreign object. Understanding the precise positioning of the infant is necessary to maximize the technique’s effectiveness and maintain safety.
Identifying the Need for Intervention
Intervention is necessary only when an infant is experiencing severe, ineffective choking, meaning the airway is significantly blocked. If the infant is coughing forcefully, crying, or making loud noises, the obstruction is partial, and you should allow them to continue attempting to clear it themselves. A strong cough is the most effective tool for dislodging a partial obstruction.
Signs requiring immediate action include a silent or very weak cough, inability to cry or make noise, or a high-pitched sound (stridor). A change in skin color, such as pale or bluish lips or face, indicates a lack of oxygen and confirms a complete blockage. The infant may also appear panicked or become unresponsive.
Securing the Infant for Back Blows
The correct positioning of the infant is the foundational step before delivering back blows. You should sit or kneel and rest your forearm on your thigh to create a stable, firm platform for the infant. This stability is necessary to withstand the force of the back blows without causing injury.
The infant is placed face-down (prone) along your forearm, with their head positioned lower than their chest and body; a downward angle of 30 to 45 degrees is recommended. Gravity assists in moving the object out of the airway rather than deeper into it. Your hand cradles the infant’s jaw and cheekbones to support the delicate head and neck.
Avoid putting pressure on the soft tissues of the infant’s throat while maintaining a firm but gentle grip on the jaw. This careful support helps keep the airway aligned and open during the procedure. The forearm acts as a support beam for the body, ensuring the proper head-low orientation is maintained throughout the back blows.
Delivering the Back Blows
Once the infant is securely positioned face-down and head-low on your forearm, deliver up to five firm back blows using the heel of your free hand. The target area is precisely between the infant’s two shoulder blades (scapulae). This location is chosen to create maximum pressure and vibration to dislodge the obstruction.
The force of each blow should be distinct and sharp, directed in a slightly upward and inward vector toward the infant’s head. The goal is to generate a sudden increase in intrathoracic pressure, which can forcibly expel the foreign object. After each blow, check the infant’s mouth to see if the object has been dislodged, but never attempt a blind finger sweep.
Next Steps if Choking Persists
If the object remains lodged after the first five back blows, transition to chest thrusts. Carefully turn the infant over, supporting the head and neck, so the infant is now face-up (supine) along your other forearm or thigh. The head must remain lower than the chest to continue benefiting from gravity.
With the infant face-up, deliver up to five rapid chest thrusts using two fingers placed on the center of the breastbone, just below the nipple line. The thrusts should compress the chest about 1.5 inches deep, roughly one-third the depth of the chest. This action increases internal pressure, attempting to push the object out.
Continue alternating between five back blows and five chest thrusts until the object is expelled, the infant begins to breathe, cry, or cough effectively, or the infant becomes unresponsive. If the infant becomes unresponsive, immediately activate emergency medical services and begin cardiopulmonary resuscitation (CPR). This sequence should be continued until professional help arrives.