The sudden inability of an infant under one year old to breathe, cry, or cough is a medical emergency, as a complete airway obstruction prevents oxygen from reaching the lungs and can lead to severe complications quickly. Intervention must be applied swiftly to create an artificial cough that can dislodge the foreign body blocking the airway.
Initial Assessment and Preparation
The immediate priority is confirming a complete or severe airway obstruction. If the infant cannot make noise, has a silent cough, or is unable to cry, this indicates a severe blockage requiring intervention. If the infant is still coughing forcefully or making loud sounds, they should be allowed to try and clear the obstruction naturally.
If the obstruction is severe, ensure professional help is on the way. If another person is present, direct them to call the local emergency number while the rescuer begins physical intervention. If the rescuer is alone, they should begin clearing the airway first before calling the emergency number. Physical intervention should not be delayed.
Infant Positioning for Airway Clearance
To maximize the effectiveness of clearing maneuvers, the infant’s head must be positioned lower than the chest. This uses gravity to assist in expelling the object once it is loosened. The rescuer should sit or kneel, resting their forearm on their thigh for a stable base of support.
For the initial maneuver, the infant is placed face-down (prone) along the rescuer’s forearm. The rescuer must cradle the infant’s jaw and head, ensuring the neck is supported and aligned. The infant’s body should rest along the forearm, with the head pointing down lower than the torso.
The head-low position must be maintained when transitioning. To transition, the rescuer sandwiches the infant between their two forearms, supporting the head and neck, then flips the infant face-up (supine) onto the other thigh or forearm. Throughout this rotation, the head must remain lower than the chest to utilize gravity.
Executing the 5-and-5 Technique
The mechanical action used is the 5-and-5 technique, which alternates between back blows and chest thrusts. This sequence generates a rapid increase in pressure within the airway to force the object out. The five back blows are delivered first, using the heel of the hand.
These blows must be firm and targeted directly between the infant’s shoulder blades. Each blow should be a distinct attempt to dislodge the object, not a series of gentle taps. After five back blows, the infant is turned to the face-up position, maintaining the head-low angle.
Five chest thrusts are then administered using two fingers placed on the lower half of the breastbone, just below the nipple line. The thrusts should be quick, downward compressions approximately one and a half inches deep, similar to the depth used in infant cardiopulmonary resuscitation (CPR). The rescuer repeats the cycle of five back blows and five chest thrusts until the object is expelled or the infant becomes unresponsive.
Post-Intervention Actions and Follow-Up Care
Once the foreign object is cleared and the infant begins to cry, cough, or breathe normally, intervention should cease. The rescuer must check the infant’s mouth for the expelled object, removing it only if it is clearly visible and easily accessible. A blind finger sweep should be avoided, as it risks pushing the object further into the airway.
If the infant loses consciousness at any point during the 5-and-5 technique, the rescuer must immediately stop the back blows and chest thrusts. The infant should be gently lowered onto a firm, flat surface, and the rescuer must begin infant CPR. If the emergency call has not been made, it is now the priority, or the rescuer should continue CPR while waiting for emergency services.
Even if the obstruction is successfully cleared and the infant appears fine afterward, medical professionals must evaluate the infant. The force of the back blows and chest thrusts may cause internal injury, and a thorough medical examination is required to rule out complications.