Choking occurs when a foreign object, often food, becomes lodged in the throat or windpipe, obstructing the flow of air. This is a medical emergency, as the brain can only survive a few minutes without oxygen. Without immediate intervention, choking can lead to severe brain damage or be fatal.
Identifying Choking
Recognizing the signs of choking is the first step in providing aid. A person who is truly choking will be unable to speak, cough forcefully, or breathe. They may make high-pitched noises or no sound at all while attempting to breathe. A universal sign of distress is when a person clutches one or both hands to their throat.
Their skin, lips, or nails might turn blue or gray due to lack of oxygen. They may also appear panicked or confused before losing consciousness. If a person can still cough forcefully or speak, they are likely experiencing a partial obstruction and should be encouraged to continue coughing, as this may dislodge the object.
First Aid for Choking in Adults and Children
When an adult or a child over one year old is choking and cannot cough, speak, or breathe, immediate first aid is necessary. The recommended approach involves a combination of five back blows and five abdominal thrusts. To administer back blows, stand to the side and behind the person, supporting their chest with one arm. Bend them forward at the waist so their upper body is nearly parallel to the ground, then deliver five distinct, firm blows between their shoulder blades with the heel of your hand.
If back blows do not clear the airway, proceed with five abdominal thrusts. Stand behind the person, wrap your arms around their waist, and tilt them slightly forward. Make a fist with one hand, place the thumb side just above their navel, and grasp it with your other hand. Deliver five sharp, upward, and inward thrusts into the abdomen. Continue alternating between five back blows and five abdominal thrusts until the object is dislodged or the person becomes unresponsive.
If you are alone and choking, you can perform abdominal thrusts on yourself. Make a fist with one hand, place the thumb side just above your navel, and grasp it with your other hand, then quickly and forcefully thrust your hands inward and upward. Alternatively, lean over a firm surface like a countertop, chair back, or railing, pressing your upper abdomen against the edge and thrusting your body downward and inward. For individuals who are pregnant or obese, chest thrusts are recommended instead of abdominal thrusts. Position yourself behind the person, wrap your arms around their chest, place your fist on the middle of their breastbone, and thrust inward.
First Aid for Choking in Infants
First aid for an infant under one year old who is choking differs from that for adults and older children. A combination of back blows and chest thrusts is used. To begin, hold the infant face-down along your forearm, supporting their head and neck with your hand, ensuring their head is lower than their chest. Deliver up to five firm back blows between their shoulder blades using the heel of your hand.
If the obstruction remains after back blows, turn the infant face-up, supporting their head and neck. Place two fingers in the center of their chest, just below the nipple line. Administer up to five quick chest thrusts, compressing the chest about 1.5 inches deep. Continue alternating between five back blows and five chest thrusts until the object is dislodged or the infant becomes unconscious. Check the infant’s mouth for the object after each set of maneuvers.
When to Get Medical Help
Even after an object has been successfully dislodged, seeking medical attention is important. A healthcare provider can assess for any internal injuries that may have occurred during the choking incident or from the first aid maneuvers. This is especially important if the choking episode was severe, lasted for a prolonged period, or if the person experiences lingering symptoms.
Call emergency services immediately if the person becomes unresponsive, if the object cannot be dislodged, or if they continue to have difficulty breathing, persistent coughing, wheezing, or difficulty swallowing after the incident. If the person loses consciousness at any point during or after the choking event, start cardiopulmonary resuscitation (CPR) if trained, and ensure emergency medical help is on the way.
Preventing Future Choking Incidents
Preventative measures can significantly reduce the risk of choking for both adults and children. For adults, cut food into smaller pieces and chew thoroughly. Eat slowly, avoid talking or laughing while chewing, and limit alcohol consumption during meals. Sitting upright and focusing on the meal rather than distractions are also helpful practices.
For children, strict supervision during meals is paramount. Food should be cut into small, manageable pieces, and hard foods may need to be cooked, grated, or mashed to soften them. Common choking hazards for young children include hot dogs, whole grapes, nuts, hard candies, popcorn, and large chunks of meat or cheese. Non-food items such as small toys, coins, balloons, and button batteries should be kept out of reach. Ensuring children eat while seated and are not running or playing with food in their mouths also contributes to safety.