The head-tilt chin-lift is a two-handed technique that opens an unconscious person’s airway by repositioning the tongue and soft tissues that have collapsed backward. It takes about two seconds to perform and is the first step in basic life support before delivering rescue breaths. The 2025 American Heart Association guidelines confirm it remains the preferred method for opening an airway in an unresponsive person without suspected neck injury.
Why an Unconscious Person’s Airway Closes
When someone loses consciousness, the muscles throughout the throat relax. The tongue falls backward against the rear wall of the throat, the soft palate drops down to block the nasal passage, and the small flap that normally covers the windpipe during swallowing (the epiglottis) sags into the airway opening. Together, these soft tissues can completely seal off airflow even though there’s no foreign object present.
The head-tilt chin-lift works by physically pulling these structures forward and away from the back of the throat. Tilting the head stretches the front of the neck, which lifts the epiglottis off the airway. Lifting the chin pulls the jawbone forward, and because the tongue is anchored to the jaw, the tongue moves forward too, clearing the passage behind it.
Step-by-Step Technique
Start with the person lying face up on a firm, flat surface. Kneel beside their head.
- Forehead hand: Place the palm of one hand on the person’s forehead. Apply firm, steady pressure to tilt the head backward. For an adult, this means extending the neck so the chin points upward.
- Chin hand: Place the tips of your index and middle fingers under the bony edge of the chin (the front of the jawbone). Pull upward to lift the jaw forward and open the mouth slightly.
Hold both positions at the same time. The forehead tilts back while the chin lifts up. You should be able to see the airway open as the jaw moves forward. If the person begins breathing, you may hear or feel air movement. If they don’t, this position is what you maintain while giving rescue breaths during CPR.
The Most Common Mistake
The single most frequent error is pressing on the soft tissue under the chin instead of gripping the bone. The fleshy area beneath the jaw sits directly over the airway. Pushing into it compresses the very passage you’re trying to open. Always hook your fingertips under the hard, bony ridge of the jawbone itself. If you feel soft, squishy tissue, reposition your fingers forward until you’re on bone.
Another common problem is not tilting the head back far enough. A tentative, shallow tilt often fails to clear the tongue from the throat. For an adult, the extension should be noticeable, with the face pointing toward the ceiling rather than straight ahead.
Adjustments for Infants and Children
An infant’s airway is shorter and narrower than an adult’s, and the head is proportionally larger. Overextending a baby’s neck can actually kink the soft, flexible airway and make the obstruction worse. For newborns and infants, keep the head in a neutral position, meaning the face looks straight up at the ceiling with no backward tilt. A small folded towel placed under the shoulders and neck can help maintain this alignment.
As children get older, they gradually need more neck extension to open the airway, approaching the adult technique by school age. The general guideline across all ages is to align the ear with the notch at the top of the breastbone when viewed from the side. If those two landmarks are level, the airway is typically in good position.
When Not to Use This Technique
If the person has signs of head or neck trauma, such as a fall from height, a car crash, or a diving injury, tilting the head backward risks worsening a cervical spine injury. In these situations, the recommended alternative is the jaw-thrust maneuver. Instead of tilting the head, you place your fingers behind the angles of the jaw on both sides and push the entire lower jaw forward without moving the neck. This lifts the tongue off the airway through the same basic principle but keeps the head and spine in a neutral position.
The jaw thrust is harder to perform and typically taught in professional-level training courses. If you attempt it and still can’t get the airway open, the 2025 AHA guidelines are clear: go ahead and use the head-tilt chin-lift anyway. A patent airway outweighs the risk of further spinal damage, especially in cardiac arrest, because without oxygen nothing else matters.
Putting It Into Practice
The head-tilt chin-lift is one of the simplest and most effective interventions in emergency care, but technique matters. Practice the hand placement so it becomes automatic: palm on forehead, fingertips on the bony chin, tilt and lift simultaneously. If you’re performing CPR, you’ll need to re-establish this position before every set of rescue breaths, since chest compressions can shift the head.
Once the airway is open, look for chest rise, listen for breathing sounds, and feel for air against your cheek. If the person is breathing on their own and you don’t suspect a spinal injury, rolling them into a recovery position (on their side) helps keep the airway clear without you holding it open continuously.