If a child is choking and cannot cough, speak, cry, or breathe, you need to act immediately with a cycle of back blows and thrusts to force the object out. The technique differs depending on whether the child is under or over 1 year old, so knowing both methods matters. Here’s exactly what to do.
How to Tell If a Child Is Truly Choking
Not every cough or gag during eating means a child needs intervention. A child who is coughing forcefully is still moving air through their airway and should be allowed to keep coughing to clear the object on their own. Encourage them to keep coughing, but don’t slap their back or interfere, as this can actually make things worse.
The emergency starts when coughing stops working. Signs of a complete blockage include:
- Silent coughing: the child is trying to cough but no sound or very little sound comes out
- Inability to cry, speak, or make noise
- Bluish skin color, especially around the lips and fingernails
- The universal choking sign: an older child may clutch their throat with both hands
- Panicked expression with wide eyes and obvious distress
Infants often show silent distress with an ineffective cough and skin turning blue. They won’t grab their throat the way an older child might, so you have to watch their breathing and skin color closely.
For Infants Under 1 Year: Back Blows and Chest Thrusts
The 2025 American Heart Association guidelines recommend repeated cycles of 5 back blows followed by 5 chest thrusts for infants. Do not use abdominal thrusts on a baby, as their internal organs are too fragile and easily injured.
Giving Back Blows
Sit or kneel and rest the infant face-down along your forearm, using your thigh to support your arm. Cradle the baby’s head in your hand, with your thumb and forefinger supporting the jaw on either side. The infant’s head must be lower than their chest. With the heel of your other hand, deliver 5 firm strikes between the shoulder blades. Use enough force to actually dislodge the object. These need to be deliberate, sharp blows, not gentle pats.
Giving Chest Thrusts
If the object doesn’t come out after 5 back blows, flip the infant face-up on your forearm, still supported by your thigh, still keeping the head lower than the chest. Place the heel of your hand on the center of the breastbone, just below the nipple line. Give 5 quick chest thrusts, pressing about 1½ inches deep. The updated guidelines now recommend this heel-of-hand technique rather than the older two-finger method, because it generates deeper, more effective compressions.
Keep alternating 5 back blows and 5 chest thrusts until the object comes out, the baby starts breathing or crying, or the baby becomes unconscious.
For Children Over 1 Year: Back Blows and Abdominal Thrusts
The 2025 guidelines introduced an important change for children over age 1: the sequence now starts with back blows before moving to abdominal thrusts. Previously, the recommendation went straight to abdominal thrusts. The updated cycle is 5 back blows followed by 5 abdominal thrusts, repeated until the airway is clear or the child becomes unresponsive.
For back blows on a larger child, stand or kneel behind them and lean the child forward. Deliver 5 firm strikes between the shoulder blades using the heel of your hand.
For abdominal thrusts, stand or kneel behind the child and wrap your arms around their waist. Make a fist and place it just above the belly button and below the rib cage. Grab that fist with your other hand. Pull sharply inward and upward, as if trying to lift them off the ground. Repeat 5 times in quick succession. Each thrust should be a distinct, forceful motion, not a squeeze.
If the Child Becomes Unconscious
If a choking child goes limp and stops responding, lower them gently to the floor on their back. If you’re alone, perform 2 minutes of CPR before calling 911. If someone else is with you, have them call 911 immediately while you start CPR. Begin with chest compressions following the standard sequence of compressions, then airway, then breaths.
Each time you open the airway to give a breath, look inside the mouth. If you can see the object, carefully remove it. If you cannot see it, do not stick your fingers in and sweep around blindly. Blind finger sweeps can push the object deeper, and in documented cases have caused objects to lodge in the airway or injured the tissue at the back of the throat, turning a bad situation into a worse one. Only remove what you can clearly see.
When to Call 911
If another person is present, have them call 911 the moment you recognize a complete airway obstruction while you begin back blows and thrusts. If you’re alone with the child, perform the back blow and thrust cycles first. If the object doesn’t come out within about 2 minutes, or if the child loses consciousness, call 911 and then continue your efforts.
Even after successfully clearing the airway, the child should be evaluated by a medical professional. Choking and the first aid used to treat it can both cause internal injuries. Abdominal thrusts can bruise organs, and chest thrusts can affect the ribcage, particularly in infants.
Warning Signs After a Choking Episode
Sometimes a piece of the object breaks off and enters the lung without anyone realizing it. In the days after a choking episode, watch for a persistent cough, fever, difficulty swallowing or speaking, shortness of breath, or wheezing. These can signal that part of the object ended up in the lung or that the voice box was injured during the episode. Any of these symptoms need prompt medical attention.
Foods That Cause the Most Choking in Children
The shape, size, and texture of food matter more than most parents realize. The CDC identifies these as the highest-risk foods for young children:
- Round, firm foods: whole grapes, cherry tomatoes, hot dogs, whole berries, melon balls, and round candies. These are the perfect size and shape to seal a small airway.
- Hard or raw foods: raw carrot sticks, raw apple pieces, whole nuts and seeds, popcorn, corn chips, and pretzels
- Sticky or chewy foods: chunks of peanut butter eaten by the spoonful, marshmallows, gummy candies, chewy fruit snacks, and chewing gum
- Tough proteins: large chunks of meat, sausages, string cheese, and fish with bones
Cut grapes and cherry tomatoes lengthwise into quarters, not circles. Slice hot dogs lengthwise, then into small pieces. Cook hard vegetables until soft. Spread nut butters in a thin layer rather than giving a child a glob on a spoon. These simple prep steps eliminate most of the risk.
Other Prevention Basics
Children should always sit upright while eating, never walking, running, or lying down. Keep small household objects like coins, button batteries, marbles, and small toy parts out of reach. For babies and toddlers, get down to their level periodically and scan the floor for anything small enough to fit through a toilet paper tube, which is roughly the size of a young child’s airway.
The best time to learn choking first aid is before you need it. Practicing on a doll or mannequin, even once, makes a significant difference in your ability to act quickly when seconds matter. The Red Cross and American Heart Association both offer in-person and online courses that walk you through the motions.