Choking occurs when a foreign object, often food, blocks the airway, preventing air from reaching the lungs. This obstruction quickly leads to a severe lack of oxygen, a medical emergency where brain damage can begin within minutes. A rapid response is crucial. This article outlines guidance for recognizing choking and performing appropriate first aid techniques.
Recognizing a Choking Emergency
Recognizing a choking emergency is the first step in providing effective help. Choking involves either a partial or complete airway obstruction. With a partial blockage, the person can still move some air, often indicated by forceful coughing, gagging, or speaking, even if hoarsely. In these situations, encourage the individual to continue coughing, as their own efforts may dislodge the object.
A complete airway obstruction requires immediate intervention. Signs include an inability to speak, cry, or cough effectively. The person might clutch their throat, appear panicked, or make high-pitched squeaking noises when attempting to breathe. As oxygen deprivation progresses, their lips, skin, or nails may turn blue or gray, signaling a dangerous lack of oxygen to the brain.
First Aid for Choking in Adults and Older Children
For an adult or older child experiencing choking, the Heimlich maneuver (abdominal thrusts) is the recommended first aid technique. Stand behind the person and wrap your arms around their waist. Place one clenched fist just above their navel and below the rib cage, then grasp that fist with your other hand. Deliver five quick, upward thrusts into the abdomen, aiming to create an artificial cough that expels the obstruction.
An alternative approach combines five back blows with five abdominal thrusts. To perform back blows, position yourself to the side and slightly behind the person, supporting their chest with one arm while leaning them forward. Deliver five sharp blows between their shoulder blades using the heel of your hand. Alternate between five back blows and five abdominal thrusts until the object is dislodged or the person becomes unconscious. If the person loses consciousness, immediately lower them to the ground, call emergency services, and begin cardiopulmonary resuscitation (CPR) if trained, checking their mouth for the object before each rescue breath.
First Aid for Choking in Infants
First aid for a choking infant (under one year old) differs from adult techniques. If an infant is choking and cannot cough, cry, or breathe effectively, use a sequence of back blows and chest thrusts. Place the infant face down along your forearm, supporting their head and jaw, ensuring their head is lower than their chest. Deliver up to five firm but gentle back blows between their shoulder blades using the heel of your hand.
If the obstruction remains, turn the infant face-up, supporting their head and neck, with their head still lower than their chest. Place two fingers in the center of their chest, just below the nipple line, and deliver up to five quick chest thrusts, compressing the chest about 1.5 inches deep. Alternate between five back blows and five chest thrusts until the object is cleared or emergency medical help arrives. If the infant becomes unresponsive, immediately initiate infant CPR.
Essential Next Steps and Special Situations
After an object has been cleared, seeking medical attention is important, even if the individual appears to have recovered. The forceful nature of choking first aid, particularly abdominal thrusts, can cause internal injuries or leave residual obstruction. A healthcare provider can assess for any unseen damage or complications, such as a lingering cough, chest pain, or changes in voice.
For individuals choking when alone, self-administered abdominal thrusts are an option. Make a fist, place it just above the navel, grasp it with the other hand, and thrust inward and upward. Alternatively, lean over a fixed object, such as a chair back or counter edge, and press your upper abdomen against it to create the necessary upward thrust. If a choking person becomes unconscious, first aid efforts should continue until emergency medical personnel arrive, the obstruction is relieved, or the rescuer is physically unable to continue.
Strategies to Prevent Choking
Preventing choking involves careful practices concerning food and small objects to minimize risks across all age groups. For young children, cut food into small, manageable pieces. Avoid common choking hazards like whole grapes, hot dogs, nuts, hard candies, popcorn, and large chunks of meat, as these can easily block a small airway. Peeling fruits and vegetables, mashing beans, and spreading peanut butter thinly also reduce risk for children.
Establishing safe eating habits aids prevention. Encourage thorough chewing and slow eating, and advise against talking or laughing with food in the mouth. Supervise children during meals, ensuring they sit down to eat and do not run or play with food. For adults, proper chewing and mindfulness while eating also help prevent incidents.
Beyond food, vigilance regarding the environment is important. Keep small household objects such as coins, marbles, small toy parts, and button batteries out of reach of infants and toddlers. Regularly check floors and play areas for misplaced items that could pose a choking hazard. Following age recommendations on toys and inspecting them for loose or broken parts contributes to a safer environment.