What to do with a child under one who is choking

Choking in babies under one year old

A baby who is choking will be distressed and may be unable to cry, cough or breathe.

• Lie the baby face down along your forearm or thigh, with their head low. Support their head.
• Give up to five firm slaps to the baby’s back between the shoulder blades with the heel of your hand. (The heel is between the palm of your hand and your wrist.)
• Stop after each slap to check if the blockage has cleared. Look inside the baby’s mouth and remove any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage. You may push it further in.
• If the airway is still blocked, give up to five chest thrusts (see below).
• Stop after each thrust to check if the blockage has cleared.

If the baby’s airway is still blocked after three cycles of back slaps and chest thrusts, you should:.

• dial 999 (or 112) for an ambulance immediately. Do not leave the baby. Take him or her with you to the phone 
• continue with the cycles of back slaps and chest thrusts until help arrives

Chest thrusts for babies under one year old

In babies under one year old, chest thrusts are used in an emergency to clear a blockage from their airway. Important: do not use abdominal thrusts with babies under one year old.

• Lie the baby along your forearm on their back, with their head low. Support their back and head.
• Give up to five chest thrusts. Using two fingers, push inwards and upwards (towards the head) against the baby’s breastbone, one finger's breadth below the nipple line.
• Check if the blockage has cleared after each thrust, by looking inside the baby’s mouth and removing any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage as you may push it further in. 

Complications

Once the baby’s airway is cleared, some of the material that caused the blockage can sometimes remain and cause complications later. If the baby still has a persistent cough or difficulty swallowing, they need to see a health professional urgently. You should take the baby to A&E, an NHS Walk-in Centre or your GP if it’s during GP hours.

Mild choking in adults and children over one year old

If the airway is only partly blocked, the person will usually be able to speak, cry, cough or breathe. In situations like this, an adult or child over one year old will usually be able to clear the blockage themselves.

To help with mild choking in an adult or child over one year old:

• Encourage the person to keep coughing to try and clear the blockage.
• Remove any obvious blockage from their mouth, using your first two fingers and thumb to grasp the object.

Be ready to help in case their airway becomes fully blocked or the choking becomes severe. 

Severe choking in adults and children over one year old

Where choking is severe, the person will not be able to speak, cry, cough or breathe. Without help, they will eventually become unconscious.

To help an adult or child over one year old who is choking severely:

• Stand slightly behind the person to one side. If you’re right-handed, stand to the left. If you’re left-handed, stand to the right.
• Support their chest with one hand. Lean the person forward so that the object blocking their airway will come out of their mouth, rather than going further down.
• Give up to five sharp blows between the person’s shoulder blades with the heel of your hand. (The heel is between the palm of your hand and your wrist.)
• Stop after each blow to check if the blockage has cleared.
• If not, give up to five abdominal thrusts (see below).
• Stop after each thrust to check if the blockage has cleared.

If the person’s airway is still blocked after three cycles of back blows and abdominal thrusts, you should send for help:

• If someone else is with you, send them to dial 999 (or 112) for an ambulance immediately.
• If you are alone, dial 999 (or 112) for an ambulance immediately, then return to help the person.
• Continue with the cycles of back blows and abdominal thrusts until help arrives.

If you have any doubt that the person is breathing normally and you have been trained to do so, you should begin external chest compressions and rescue breaths. Together these are called cardio-pulmonary resuscitation (CPR).

Important: procedures such as CPR can cause injury. You should not attempt CPR unless you have been trained. See Further information below to find out about learning first aid skills.

Abdominal thrusts: adults and children over one year old only

Abdominal thrusts are an emergency technique for clearing a blockage from the airway of an adult or child over one year old who is choking. They are also known as the Heimlich manoeuvre.

Important: Do not use abdominal thrusts with babies under one year old, pregnant women or people who are obese.

1. Stand behind the person who is choking.
2. Place your arms around their waist and bend them well forward.
3. Clench your fist and place it right above the person's navel (belly button).
4. Place your other hand on top, then thrust both hands backwards into their stomach with a hard, upward movement.
5. Repeat this until the object stuck in their throat comes out of their mouth.

Complications

Once the person’s airway is cleared, parts of the material that caused the choking can sometimes remain and can cause complications later. If the person still has a persistent cough, difficulty swallowing, or feels as though something is still stuck in their throat, they need to see a health professional urgently. You should take the person to A&E, an NHS Walk-in centre or their GP if it’s during GP hours.

Abdominal thrusts can cause serious injuries. Where this potentially life-saving treatment has been necessary, a health professional such as your GP or a doctor in A&E should always examine the person afterwards.