Choking is a common emergency for caregivers of infants. Their small airways and tendency to explore the world orally make them vulnerable to complete airway obstruction. Swift and correct intervention is paramount, as oxygen deprivation can lead to irreversible damage in minutes. Understanding the steps to clear a blocked airway is the most important preparation a caregiver can undertake.
Recognizing Severe Airway Obstruction
The immediate priority in a potential choking situation is determining the severity of the blockage. A mild obstruction is indicated if the infant can still cough forcefully, cry loudly, or make other sounds. In these cases, the caregiver should not intervene physically but monitor the infant closely, allowing them to try to dislodge the object.
A severe airway obstruction requires immediate action because the infant cannot move enough air to cough or breathe effectively. Signs include a weak or silent cough, an inability to cry or make noise, or a change in skin color, such as turning blue or pale around the lips. When a severe obstruction is recognized, the caregiver should immediately instruct a bystander to call 911. If the caregiver is alone, they must begin the rescue procedure immediately and only pause to call for help after one minute of care.
Performing Back Blows and Chest Thrusts
The standard procedure for a conscious infant with a severe airway obstruction involves a cycle of five back blows followed by five chest thrusts. This sequence is designed to create a rapid increase in pressure within the airway to expel the foreign object. The first step involves careful positioning to ensure maximum effectiveness and safety during the maneuvers.
The infant must be held face-down along the caregiver’s forearm, with the head lower than the chest to use gravity as an aid. The caregiver uses their thigh or lap for support and holds the infant’s jaw to stabilize the head, taking care not to compress the soft tissues of the throat. This angled position is maintained while delivering the first set of five back blows.
Each back blow is delivered forcefully and rapidly with the heel of the hand, aiming directly between the infant’s shoulder blades. After completing the five back blows, the caregiver must then swiftly turn the infant over to administer chest thrusts.
To transition, the infant is sandwiched between the caregiver’s forearms, maintaining the head-lower-than-chest position. They are then turned face-up onto the opposite forearm or lap. The five chest thrusts are applied to the lower half of the breastbone, specifically just below the nipple line.
These thrusts are administered using only two fingers to avoid injury to the infant’s small ribcage and internal organs. The depth of the chest thrusts should be approximately one-third the depth of the infant’s chest, which is generally about 1.5 inches (4 centimeters). Following the five chest thrusts, the infant is immediately repositioned for the next cycle of five back blows.
This cycle of five back blows and five chest thrusts is repeated without interruption until the foreign object is expelled and the infant can breathe, cough, or cry effectively. Alternatively, the sequence continues until the infant becomes unresponsive, which signals a change in the required rescue procedure.
A crucial safety note involves inspecting the mouth only if the object is clearly visible and easily reachable. Caregivers must never attempt a blind finger sweep, as this action risks pushing the foreign body further down the airway. Only when the object is seen can it be carefully removed using a hooking motion with a finger.
Responding to Unconsciousness and Starting Rescue Breaths
If the infant becomes unresponsive while the back blow and chest thrust sequence is being performed, the rescue protocol must immediately transition to modified cardiopulmonary resuscitation (CPR). The first step upon recognizing unresponsiveness is to carefully place the infant onto a firm, flat surface. The caregiver must ensure that emergency medical services have been called or activate the call themselves if they are alone.
The next action is to open the airway using the head-tilt/chin-lift maneuver. After opening the airway, the caregiver attempts to deliver an initial rescue breath. This breath should be a gentle puff of air, covering both the infant’s mouth and nose, lasting about one second.
If the first breath does not cause the chest to rise, the caregiver repositions the head and attempts a second rescue breath. If both breaths are unsuccessful, it indicates the airway remains blocked, and the caregiver must immediately begin chest compressions. These compressions are performed using the same two-finger technique and location on the breastbone as the chest thrusts, aiming for a depth of about 1.5 inches.
The rescue sequence for an unresponsive, choking infant is modified to incorporate a visual check for the foreign object. After every set of 30 chest compressions and before attempting rescue breaths, the caregiver should quickly look inside the infant’s mouth. If the object is visible, it is removed; otherwise, the cycle of compressions and attempted breaths continues. The sequence is interrupted only when the object is removed, the infant shows signs of recovery, or trained help arrives to take over.