Infant choking is a time-sensitive emergency requiring immediate and correct action. Infants, defined as those under one year of age, have small, pliable airways that can become completely blocked by foreign objects, leading to rapid oxygen deprivation. Understanding the standardized procedures for clearing this obstruction can significantly increase the chances of a positive outcome. The specific technique for chest thrusts must be performed precisely to generate the necessary pressure to expel the object.
Assessing the Emergency and Preparing for Action
The initial step involves quickly determining if the infant’s airway is completely obstructed, which dictates the need for intervention. A mild blockage is indicated if the infant can still cough forcefully or produce a strong cry, suggesting air movement. In this case, only observe and encourage them to clear the obstruction themselves. Intervention is required when the infant cannot cry, makes no sound, has an ineffective cough, or begins to turn blue, signaling a severe obstruction.
Activating emergency medical services (EMS) should occur as soon as severe choking is recognized. If another person is present, they should call the emergency number immediately while you begin first aid maneuvers. If the rescuer is alone, they should begin the steps to clear the airway and only call EMS after two minutes of continuous care.
Proper positioning is necessary before any physical intervention begins. The infant must be held in a way that supports the head and neck, as their muscles are not fully developed. For the initial maneuvers, the infant’s head should be consistently lower than their chest, allowing gravity to assist in dislodging the foreign object. This positioning is maintained by supporting the infant along the rescuer’s forearm, often braced against the thigh.
The Combined Technique for Relieving Choking
The standard protocol for a conscious infant suffering from severe choking is the “five-and-five” method, which alternates between back blows and chest thrusts. This technique is designed to create a rapid increase in pressure within the airway to push the object out. The cycle begins with five firm back blows delivered while the infant is face down on the rescuer’s forearm.
The rescuer should use the heel of their hand to strike the infant’s back between the two shoulder blades. Each blow must be distinct and forceful enough to attempt to dislodge the obstruction. Maintaining the infant’s head lower than the rest of the body is important during these blows.
Following the five back blows, the infant is carefully turned face up onto the opposite forearm, ensuring the head remains lower than the chest. This transition must be done while supporting the head and neck to prevent injury. This repositioning prepares the infant for the chest thrusts, the second component of the cycle.
When giving chest thrusts to an infant, the rescuer uses two fingers, typically the index and middle fingers, placed on the center of the breastbone. The precise location is just below the imaginary line connecting the infant’s nipples. This spot is chosen to compress the sternum and generate the necessary pressure without causing injury.
The rescuer delivers five quick chest thrusts, pushing straight down on the bone. The recommended depth for these thrusts is approximately 1.5 inches, or about one-third the depth of the infant’s chest. These thrusts are similar to the compressions used in CPR but are performed with a different purpose. The cycle of five back blows and five chest thrusts is repeated until the object is expelled, the infant can breathe, cough, or cry, or until the infant becomes unresponsive.
What to Do If the Infant Becomes Unresponsive
If the choking maneuvers fail and the infant becomes limp or unconscious, the first aid approach must immediately transition to the full Infant Cardiopulmonary Resuscitation (CPR) protocol. The infant should be gently lowered onto a firm, flat surface to facilitate effective compressions.
CPR begins with chest compressions, following the ratio of 30 compressions to two rescue breaths. The compression technique uses the same two fingers and location as the chest thrusts: the center of the chest, just below the nipple line, to a depth of about 1.5 inches. This action helps to circulate oxygenated blood and maintain pressure.
Before attempting the two rescue breaths, the rescuer must open the infant’s mouth and look for the foreign object. If the object is clearly visible, it should be removed with a finger. A blind finger sweep, where the rescuer attempts to feel for the object without seeing it, should never be performed, as this can push the obstruction further down the airway.
The cycle of 30 compressions and two breaths is continued without interruption until the infant shows signs of recovery or until EMS personnel arrive. If the rescuer is alone and has not yet called for help, they should perform CPR for about two minutes before pausing to call the emergency number.