Airway obstruction in an infant constitutes an emergency requiring immediate intervention. The infant’s small, pliable airway can be quickly blocked by foreign objects, leading to rapid loss of consciousness. Recognizing signs of a severe blockage—such as the inability to cry, cough, or make any sound—demands an instant, sequenced response.
The accepted protocol for a conscious infant involves the five-and-five sequence: five back blows followed by five chest thrusts. This sequence aims to generate a forceful artificial cough to dislodge the obstruction.
Initial Response and Positioning
When an infant shows signs of a fully obstructed airway, immediately activate emergency medical services (EMS). If another person is present, instruct them to call 911 while you begin care. If you are alone, deliver approximately two minutes of care before pausing to call EMS yourself.
Before beginning maneuvers, position the infant to maximize the effectiveness of the blows and thrusts. Cradle the infant face-down along your forearm, using your thigh for support if needed. Firmly support the infant’s head and neck with your hand, ensuring the head remains lower than the chest. This downward angle allows gravity to assist in clearing the airway once the object is loosened.
Administering Back Blows
Once the infant is positioned face-down, begin the sequence with up to five firm, distinct back blows. Deliver the blows using the heel of your hand to the middle of the infant’s back, between the shoulder blades.
Use enough force to potentially dislodge the foreign body, but avoid causing injury. After each blow, check the infant’s mouth; if the object is visible and easily reachable, remove it. If the obstruction remains, transition the infant smoothly to the face-up position for chest thrusts.
To transition, place your free hand along the infant’s back, supporting the head and neck, and sandwich the infant between your forearms. Carefully turn the infant face-up, keeping the head lower than the chest throughout the movement. Constant support for the head and neck is necessary due to the infant’s underdeveloped musculature.
The Correct Chest Thrust Technique
Chest thrusts are compressions designed to create a rapid pressure change within the chest cavity. With the infant face-up on your forearm and the head lower than the chest, identify the correct location for the thrusts. The spot is on the lower half of the breastbone, one finger-width below the imaginary line connecting the infant’s nipples.
Use only two fingers—typically the index and middle fingers—to administer up to five quick, forceful downward thrusts. This localizes the force and minimizes the risk of injury. Each thrust should be sharp and distinct, aiming to compress the chest by approximately 1.5 inches, or about one-third the total depth of the chest.
Allow the chest to recoil fully between each thrust, which helps ensure maximum pressure is generated. Repeat the cycle of five back blows and five chest thrusts until the foreign object is expelled or the infant’s condition changes. This repetition sustains the pressure needed to push the obstruction from the airway.
When to Transition to CPR
Continue the five-and-five sequence until the infant coughs, cries, or breathes normally, indicating the obstruction is cleared, or until the infant becomes unresponsive. If the infant loses consciousness and becomes limp, the choking protocol must cease immediately.
Carefully lower the infant to a firm, flat surface and immediately begin cardiopulmonary resuscitation (CPR), starting with chest compressions. Before initiating rescue breaths, quickly check the infant’s mouth for the foreign object. If the object is clearly visible, carefully remove it; however, a blind finger sweep is not recommended as it may push the obstruction deeper into the airway.
Seek professional medical evaluation even if the obstruction is successfully cleared. A medical assessment is required to ensure no injuries occurred during the maneuvers and that the infant’s breathing and heart function are stable.