The process for clearing an obstructed airway in a baby differs significantly from the procedure used for older children and adults. For infants, defined as children under one year of age, traditional abdominal thrusts (the Heimlich maneuver) are not recommended due to the risk of internal injury. Instead, the standard emergency response involves a combination of forceful back blows and chest thrusts designed to create a rapid pressure change to dislodge the foreign object. Recognizing the moment when intervention is required is paramount, as a fully blocked airway can lead to a lack of oxygen in minutes.
Recognizing Infant Choking
It is important to distinguish between true choking and gagging, as intervention is only necessary for the former. Gagging is a protective reflex where the baby may cough, sputter, or turn red, but they are still moving air and should be left alone to clear the obstruction themselves. A baby who is truly choking, however, will be unable to cry, cough forcefully, or make any sound at all because the airway is completely or severely blocked. This silence is the most telling indication that oxygen flow has stopped.
Other physical signs of a complete airway obstruction include an increasingly silent cough or weak breathing attempts. The baby may quickly develop cyanosis, where the skin around the lips, gums, or nail beds begins to turn blue. If the infant appears limp or panicked, they require immediate intervention to remove the foreign object. An infant who can still make loud noises or cough strongly has a partial obstruction and should be monitored closely while encouraging them to continue coughing.
Step-by-Step Procedure for Conscious Infants
For a conscious infant who is choking, the procedure begins by delivering five back blows. Hold the infant face-down along your forearm, using your thigh for support, ensuring the baby’s head is lower than their chest. This downward angle utilizes gravity to help expel the object. Support the head and neck by cradling the jaw with your hand, avoiding pressure on the soft tissues of the throat.
Deliver five distinct, firm blows using the heel of your free hand directly between the infant’s shoulder blades. The force should be enough to create a strong vibration in the airway, but it must be controlled relative to the baby’s size. After the back blows, quickly transition to chest thrusts without delay.
To perform the chest thrusts, place your free forearm along the infant’s back, supporting the head and neck, and turn the baby over so they are facing upward. The infant should rest on your thigh or lap, with their head still positioned lower than their chest. This positioning maintains the mechanical advantage of gravity.
Place two fingers on the center of the baby’s chest, on the lower half of the breastbone just below the nipple line. Give five rapid, downward chest thrusts, compressing the chest about one-third to one-half of its depth (approximately 1.5 inches). Each thrust should be separate and distinct, allowing the chest to fully recoil between compressions.
You must repeat the cycle of five back blows followed by five chest thrusts until the object is expelled, the baby begins to cry or breathe effectively, or the infant loses consciousness. Do not stop the cycle to check for the object unless it is clearly visible in the mouth. Once the object is dislodged, continue to monitor the baby until emergency services arrive.
Action Plan for Unresponsive Infants
If the choking infant becomes unresponsive, limp, or stops breathing, the immediate action plan shifts to life support. Stop the cycle of blows and thrusts immediately, and lower the baby carefully onto a firm, flat surface. Shout for help and have someone call emergency medical services (EMS); if you are alone, call 911 or your local emergency number after one minute of initial CPR.
Before beginning rescue breaths, quickly open the baby’s mouth to check for the foreign object. If you can see the object and can easily scoop it out with one finger, do so, but never attempt a blind finger sweep, as this risks pushing the object further down the airway. Immediately begin infant cardiopulmonary resuscitation (CPR), starting with chest compressions.
Infant CPR involves cycles of 30 chest compressions followed by two rescue breaths. After every 30th compression, inspect the mouth for the object again before attempting the two breaths. If a rescue breath does not cause the chest to rise, reposition the head and try again. Continue this sequence until EMS arrives or the baby begins to respond.
Choking Prevention and Safety
Preventative measures are the most effective way to reduce the risk of infant choking incidents. Supervision during mealtimes is important; infants should always be seated upright in a high chair while eating and never allowed to crawl or walk with food in their mouths. Foods should be cut into pieces no larger than half an inch. Avoid small, hard, or sticky items such as:
- Whole grapes
- Hot dogs
- Raw carrots
- Nuts
- Large spoonfuls of nut butters
The risk of choking extends beyond food, as infants explore their world by putting objects into their mouths. Common household items are frequent choking hazards and must be kept out of reach. A simple rule of thumb for toy safety is that any object that can pass through a toilet paper roll is too small for an infant.
Common Choking Hazards
- Coins
- Small toy parts
- Button batteries
- Pen caps
Latex balloons also present a specific danger because the material can conform to the shape of the airway, making it difficult to dislodge. Caregivers should complete a certified infant CPR and first aid course. This training provides the necessary hands-on practice and confidence to act quickly in an emergency.