The immediate response to an infant choking emergency requires a specific sequence of actions distinct from the abdominal thrusts (Heimlich Maneuver) used for older children and adults. For a baby under one year old, the traditional method is contraindicated due to the risk of internal injury and is less effective for their small airway anatomy. The correct procedure involves alternating cycles of back blows and chest thrusts to generate the necessary pressure to expel the obstruction.
Recognizing Severe Choking in an Infant
Identifying a severe airway obstruction is important because a delay of just four minutes can lead to brain damage due to lack of oxygen. If an infant is coughing forcefully, crying loudly, or making strong sounds, the airway is only partially blocked. The rescuer should allow the baby to continue attempting to clear the object on their own, as the infant’s own forceful cough is the most effective defense.
Intervention is required when the infant’s cough is weak, silent, or completely absent, indicating a severe or complete blockage. Other signs include an inability to cry or make any sound, a high-pitched sound (stridor) when trying to inhale, or a distressed facial expression. A baby’s skin or lips turning pale or bluish (cyanosis) signals a significant lack of oxygen and demands immediate action.
Step-by-Step Infant Choking Rescue Procedure (Back Blows and Chest Thrusts)
The first step is to support the infant in a position that uses gravity to assist in dislodging the object. Hold the baby face-down along your forearm, using your thigh for support, ensuring the infant’s head is lower than their chest. Use your hand to support the baby’s jaw and head, being careful not to obstruct the throat.
Deliver up to five firm back blows between the infant’s shoulder blades using the heel of your free hand. These blows should be forceful enough to push the foreign object upward. If the object is not expelled, quickly transition the baby to the next position.
Support the infant’s head and neck while turning them face-up along your opposite forearm or lap, ensuring the head remains lower than the chest. This lower-head positioning is important for infant choking rescue. You will then deliver five chest thrusts.
Place two fingers in the center of the infant’s chest, directly on the breastbone just below the nipple line (the same location used for CPR chest compressions). Deliver up to five quick, downward chest thrusts that compress the chest about 1.5 inches deep. These thrusts rapidly increase the pressure within the chest cavity, aiming to force the object out of the trachea.
The sequence of five back blows followed by five chest thrusts constitutes one cycle. Repeat this alternating cycle continuously until the foreign object is dislodged and the baby can breathe, cough, or cry, or until the infant becomes unresponsive. After each set, check the mouth for a visible object, but never perform a blind finger sweep as this can push the object further down the airway.
When to Call Emergency Services and Post-Rescue Care
If you are alone with the baby, begin the back blow and chest thrust cycles immediately. Current guidelines suggest performing two minutes of care (about five cycles), and then calling 911 or the local emergency number yourself. If another person is present, that individual should call emergency services immediately while the rescuer begins the procedure.
If the infant becomes unresponsive during the rescue attempt, stop all back blows and chest thrusts. Gently lower the baby onto a firm, flat surface, and begin infant cardiopulmonary resuscitation (CPR), starting with chest compressions. Before attempting rescue breaths, look inside the baby’s mouth; if the object is clearly visible and accessible, it may be removed, but do not attempt blind probes.
Any infant who has experienced a severe choking episode, even if the object was successfully cleared, requires examination by a medical professional. The forceful nature of both back blows and chest thrusts carries a risk of internal injury, such as bruising. Medical evaluation ensures there is no residual damage and that the airway is completely clear.
Common Choking Hazards and Prevention Strategies
A wide variety of household items and foods pose a choking risk to infants, particularly those under five years of age. Common food hazards include round, firm items that can completely block an infant’s airway, such as:
- Whole grapes
- Hot dogs
- Raw carrot chunks
- Sticky foods like peanut butter or hard candies
- Popcorn and nuts
Regarding non-food items, anything that can fit entirely into a child’s mouth is a threat, including:
- Coins
- Marbles
- Small toy parts
- Pen caps
Button batteries are particularly dangerous due to their size and the chemical burns they can cause if swallowed. Proactive prevention involves cutting all food into pieces no larger than a child’s fingertip and ensuring the child is sitting upright during mealtimes. Caregivers should routinely check play areas for small objects and adhere to age recommendations on toys. Constant supervision during feeding and playtime is the most effective prevention strategy.