An infant airway obstruction occurs when an object, often food or a small toy, blocks the child’s windpipe, making breathing difficult or impossible. A blocked airway prevents oxygen from reaching the lungs and brain, leading to brain damage in as little as four minutes. Knowing immediate actions can significantly impact an infant’s outcome.
Recognizing Airway Obstruction
Distinguishing between gagging and choking is important for appropriate intervention. Gagging is a natural reflex, often noisy with coughing, sputtering, or retching, and the infant’s face may turn red. This reflex helps bring food forward in the mouth, and it is advised to let the infant work through it.
Choking indicates a severe airway blockage. Signs of choking include an inability to cry or make much sound, or being completely silent. The infant may struggle to breathe, show weak or ineffective coughing, or make high-pitched sounds when inhaling. The skin around the lips, or the entire face, may turn pale or bluish due to lack of oxygen. A panicked or confused appearance can also be present.
Performing Life-Saving Techniques
When an infant under one year old is choking and cannot cough, cry, or breathe, specific first-aid techniques dislodge the object. The recommended approach involves a sequence of back blows and chest thrusts. Perform five back blows followed by five chest thrusts, repeating this cycle until the object is expelled or the infant becomes unresponsive.
To administer back blows, position the infant face-down along your forearm, using your thigh or lap for support. Ensure the infant’s head is lower than their body, supporting their head and neck with your hand. Deliver up to five firm, quick blows between the infant’s shoulder blades using the heel of your free hand. After each blow, check to see if the object has been expelled.
If back blows do not clear the airway, turn the infant face-up, supporting their head and back. Rest the infant along your forearm, again with their head lower than their chest. Place two fingers on the middle of the breastbone, just below the nipples. Administer up to five quick chest thrusts, compressing the chest about one-third to one-half of its depth, typically about 1.5 inches deep. These thrusts effectively squeeze air out of the lungs, potentially dislodging the blockage.
Continue alternating between five back blows and five chest thrusts until the object is removed or emergency help arrives. Do not attempt to remove the object with your fingers unless you can clearly see it, as this could push it further down.
Emergency Response and Next Steps
If the infant’s airway obstruction is not cleared and they become unresponsive, additional steps are necessary. If you are alone, shout for help and begin first aid. If another person is present, instruct them to call 911 or your local emergency number immediately while you start performing the back blows and chest thrusts. If alone, after one minute of performing the techniques, call emergency services yourself.
If the infant becomes unconscious, place them on a firm, flat surface. Begin infant cardiopulmonary resuscitation (CPR), starting with chest compressions. If you see the object in the infant’s mouth, you may attempt to remove it with your finger, but only if it is clearly visible and easy to grasp. Continue CPR until emergency medical services arrive or the infant shows signs of recovery. Always seek medical attention even after the obstruction is cleared, as there could be internal injuries or remaining fragments.
Prevention Strategies
Preventing infant airway obstructions involves careful supervision, proper food preparation, and hazard removal within the home. Always supervise infants closely during meals and play, ensuring they are seated upright. Do not allow infants to crawl, walk, or run with food in their mouths.
Food should be prepared appropriately for an infant’s developmental stage. Cut food into small, manageable pieces, generally no larger than half an inch. Foods like hot dogs and grapes should be cut lengthwise and then into smaller pieces, not in rounds. Hard fruits and vegetables should be cooked until soft and easily pierced with a fork. Avoid giving whole nuts, seeds, popcorn kernels, hard candies, and marshmallows to infants.
Beyond food, many household items pose choking risks. Small objects such as coins, marbles, button batteries, pen caps, and small toy parts should be kept out of an infant’s reach. Balloons, especially uninflated or broken ones, are significant choking hazards. Regularly check under furniture and between cushions for small items that infants might find.