Food lodged after swallowing can range from minor discomfort to a life-threatening emergency. It is important to distinguish between choking, which is a complete airway obstruction, and a food impaction in the esophagus (the tube leading to the stomach). Choking involves the windpipe, prevents breathing, and demands immediate action. An esophageal impaction blocks the passage of food but allows the person to continue breathing and speaking. Understanding this difference determines the appropriate response.
Recognizing and Responding to Severe Choking
Severe choking occurs when the airway is completely blocked, identifiable by the inability to speak, cough, or breathe, often accompanied by clutching the throat. Immediate action is required; the first step is to call 911 or local emergency services, or have a bystander do so. The goal is to create a forced cough using sudden pressure to clear the obstruction from the windpipe. Bystanders should perform five back blows followed by five abdominal thrusts until the object is dislodged or the person becomes unresponsive.
The sequence begins with up to five back blows delivered between the shoulder blades. The person providing aid should position themselves slightly to the side and behind the victim, supporting the chest with one arm. The victim must be bent forward at the waist so the upper body is parallel to the ground before striking the back firmly with the heel of the free hand. This forward position helps gravity assist in dislodging the object.
If back blows fail, the rescuer must immediately transition to administering up to five abdominal thrusts (the Heimlich maneuver). Standing behind the victim, the rescuer wraps their arms around the victim’s waist, placing a closed fist just above the navel and below the ribcage. The other hand grasps the fist, and the rescuer delivers quick, forceful inward and upward pulls. This action compresses the diaphragm, forcing residual air from the lungs to push the foreign object out of the windpipe.
These two maneuvers should be alternated continuously until the object is expelled or the victim loses consciousness. If the person becomes unresponsive, they should be gently lowered to the floor, and rescue breaths and chest compressions (CPR) should be initiated. If CPR is necessary, check the mouth for any visible obstruction between compressions and remove it if possible.
Addressing Food That Feels Stuck
When food is felt to be stuck lower down, typically in the chest area, it is an esophageal impaction, sometimes referred to as “steakhouse syndrome.” This non-emergency situation involves the food tube, not the windpipe. The first step is to remain calm, as many impactions resolve spontaneously as the esophageal muscles relax and peristalsis continues.
Gentle attempts to clear the food can include swallowing small sips of water to lubricate the food bolus. Drinking a carbonated beverage, such as soda, may also help, as the gas released upon swallowing can mechanically push the impacted food along. However, if the person is drooling excessively or unable to swallow their own saliva, no further food or liquid should be ingested, as this indicates a complete esophageal blockage.
Home remedies should only be attempted if the person is stable and breathing without difficulty. The ability to swallow saliva confirms a partial obstruction. Abdominal thrusts are ineffective and potentially harmful for an esophageal impaction since the food is in the digestive tract, not the airway. A forceful, dry cough should be avoided, as it can increase the risk of irritation or damage to the esophagus lining.
Specific Situations and When to Seek Professional Aid
Specific modifications to the abdominal thrust procedure are necessary for certain individuals. For pregnant individuals or those with obesity, standard abdominal thrusts are replaced with chest thrusts delivered to the breastbone. A person alone can attempt a self-Heimlich maneuver by quickly thrusting their closed fist inward and upward while leaning over a firm object, such as a chair back or counter edge.
Infants under one year old require a different technique, relying on a sequence of five back blows followed by five gentle chest thrusts. The infant is held face-down across the rescuer’s forearm for back blows, then turned face-up for chest thrusts delivered with two fingers to the breastbone. For all variations, the goal remains the same: to create a sudden pressure increase to force the obstruction out of the airway.
Medical attention is required if impaction symptoms persist for more than a few hours, or beyond 12 to 24 hours. Urgent medical care is necessary if the person experiences severe chest pain, vomiting, or an inability to swallow saliva. An endoscopy may be needed to gently push the impacted food into the stomach or extract it directly to prevent complications.