Choking in infants is a sudden, life-threatening emergency requiring immediate intervention. Rescue instructions are specific to infants under one year old due to their size and physical structure. A “responsive” infant is conscious and may still be attempting to make sounds or movements. Acting quickly is paramount, as a completely blocked airway can lead to loss of consciousness within minutes. The first aid steps detailed here are designed to create a forceful, artificial cough to dislodge the obstruction.
Recognizing the Signs of Choking
Identifying true choking requires distinguishing it from a simple gag or a strong cough where the infant can clear the airway themselves. An infant who is truly choking will exhibit weak or ineffective coughing that produces little sound. The baby may be unable to cry or make any noise at all, signaling a complete or severe airway blockage. This lack of effective noise is often referred to as a “silent cough” and requires immediate action.
Physical signs of distress include labored breathing where the chest and ribs pull inward. When oxygen is severely restricted, a blue discoloration, known as cyanosis, may appear around the lips, face, or skin. If the infant is coughing forcefully or has a strong cry, the airway is only partially blocked, and intervention should be withheld while the infant is encouraged to continue coughing.
The 5-and-5 Immediate Action Protocol
When a responsive infant shows signs of severe choking, the protocol involves alternating five back blows with five chest thrusts. If you are alone, perform the first two minutes of the 5-and-5 sequence before pausing to call 911 or your local emergency number. If another person is present, they should activate emergency services immediately while you begin the procedure.
To deliver 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 chest, allowing gravity to assist in dislodging the object. Use the heel of one hand to deliver five firm blows between the infant’s shoulder blades. The blows should be strong enough to create a vibration in the airway, scaled appropriately for the baby’s size.
After the back blows, carefully turn the infant face-up onto your other forearm, keeping the head lower than the chest. To perform chest thrusts, place two fingers in the center of the chest, just below the nipple line on the breastbone. Deliver five quick chest thrusts, pressing down about 1.5 inches, to rapidly increase the pressure inside the lungs. Repeat the cycle of five back blows and five chest thrusts continuously until the object is expelled, the infant breathes forcefully, or the infant becomes unresponsive.
Transitioning to CPR if the Infant Becomes Unresponsive
If the obstruction is not cleared and the infant becomes unresponsive, the immediate action protocol must stop. The situation transitions into a cardiac emergency, and the caregiver must immediately lower the infant onto a firm, flat surface to begin infant Cardiopulmonary Resuscitation (CPR). If emergency services have not yet been called, this must be done immediately.
CPR is initiated with chest compressions to circulate remaining oxygenated blood and potentially dislodge the object. Check the infant’s mouth for the foreign object only after each set of compressions and before attempting rescue breaths. If the object is clearly visible, it can be removed with a finger. A blind finger sweep must never be performed, as it risks pushing the blockage further down the airway.
Essential Prevention Strategies
Proactive measures are the most effective way to minimize the risk of infant choking. A primary strategy is ensuring that all foods are age-appropriate in texture, size, and shape. For infants transitioning to solids, foods should be grated, mashed, or pureed, or cut into small pieces no larger than one-half inch.
Round, firm foods like grapes, cherry tomatoes, and hot dogs must be cut lengthwise into thin strips or quarters. Sticky foods, such as nut butter, and hard foods like nuts, popcorn, and hard candies are significant choking hazards and should be avoided. Supervision is essential; infants must be seated upright in a high chair and watched closely during all mealtimes. Caregivers must also conduct regular sweeps of the play area to remove common non-food hazards, including coins, small toy parts, and button batteries.