Choking occurs when an object, usually food, lodges in the throat or windpipe, blocking the airway. This obstruction prevents oxygen from reaching the lungs and brain. Because oxygen deprivation can cause brain damage in as little as four minutes, swift action is necessary. Immediately call 911 or your local emergency number, or direct someone nearby to do so, while beginning intervention.
Assisting a Conscious Adult or Older Child
A person who is truly choking cannot speak, cough forcefully, or breathe, and may clutch their throat (the universal distress signal). If the individual can cough strongly or speak, the airway is only partially blocked; encourage them to continue coughing to dislodge the object naturally. For a complete obstruction in an adult or a child over the age of one, use a combination of back blows and abdominal thrusts.
To administer back blows, stand slightly to the side and behind the person. Place one arm across their chest for support, and lean them forward at the waist. This forward position allows gravity to help expel the foreign object once it is loosened. Use the heel of your free hand to deliver five sharp, distinct blows between the person’s shoulder blades. After each blow, quickly check to see if the obstruction has been cleared.
If the five back blows are unsuccessful, transition immediately to five abdominal thrusts, commonly known as the Heimlich maneuver. Stand directly behind the person and wrap your arms around their waist, positioning one foot slightly in front of the other for balance. Make a fist with one hand and place the thumb-side of the fist against the abdomen, exactly above the navel and well below the breastbone.
Grasp your fist with your other hand and deliver a quick, forceful thrust into the abdomen, directing the force inward and upward. This action forcibly compresses the lungs, creating an artificial cough that can dislodge the stuck object. Repeat the five back blows and five abdominal thrusts in an alternating sequence until the object is expelled or the person loses consciousness. Adjust the force used for a child over one year old, using gentle yet firm pressure to prevent internal injury.
Assisting a Conscious Infant
The procedure for a conscious infant (under one year of age) differs from the adult method because abdominal thrusts risk internal organ damage. The technique uses a combination of back blows and chest thrusts. Begin by sitting down and holding the infant facedown along your forearm, resting your arm on your thigh.
Ensure the infant’s head is lower than their chest to use gravity to your advantage. Support the infant’s head and neck by cradling the jaw with your hand. Deliver five gentle but firm back blows with the heel of your hand between the infant’s shoulder blades.
If the object is not dislodged, turn the infant face-up, still supported on your forearm and thigh, keeping the head lower than the chest. Place two fingers on the center of the infant’s breastbone, just below the nipple line. Give five quick chest thrusts, compressing the chest about one and a half inches. Continue to alternate between five back blows and five chest thrusts until the airway clears or the infant becomes unresponsive.
Managing Special Circumstances and Unresponsiveness
Certain physical conditions require modifying the standard Heimlich maneuver. For a person who is pregnant or too large to wrap your arms around, abdominal thrusts must be replaced with chest thrusts.
To perform a chest thrust, stand behind the person and wrap your arms under their armpits and around the chest. Place the thumb side of your fist against the center of the breastbone, grasping your fist with your other hand. Deliver firm, quick thrusts straight back into the chest. This compresses the lungs without placing pressure on the abdomen. Continue alternating between back blows and chest thrusts until the obstruction is relieved.
If the person of any age becomes unresponsive, immediately lower them gently to the floor, lying flat on their back. If emergency services have not yet been called, do so immediately. Begin cardiopulmonary resuscitation (CPR), starting with chest compressions.
Before attempting rescue breaths, open the person’s mouth and look for the foreign object. If you can clearly see the object, remove it with a finger sweep. Never perform a blind finger sweep, as this risks pushing the obstruction further down the airway. If the airway remains blocked, continue with cycles of CPR until help arrives.