Choking: What to Do?

Choking, also called foreign body airway obstruction, happens when a foreign body lodges in one’s throat, obstructing the air passage into the lungs. It is a life-threatening condition because it cuts off the oxygen supply to the brain.

Choking is the leading cause of injury and death among children, particularly those younger than 4 years of age. The most common cause of choking in adults is food, while children are most likely to choke on food or small objects such as toys or coins.

Choking symptoms

The universal sign for choking is when a person puts his clutched hands on the throat. Other signs and symptoms include the inability to talk, coughing, wheezing, gagging, squeaky sounds when trying to breathe, difficulty in breathing, pale or bluish color of the skin and loss of consciousness.

What to do when an infant is choking?

Infants may have a heightened risk of choking on food and small items because they often put objects in their mouth. Yet, this is a normal part of how infants and children explore the world. The most common objects that can cause choking are beads, marbles, and button batteries.

• If an infant is choking, shout for help or immediately call an ambulance. Ask for the parents’ consent if they are present.
• If you see an object inside an infant’s mouth, try to remove it. If there is no visible obstruction, proceed with five back blows.
• Position the baby face down on your forearm. With your fingers and thumb, hold the baby’s jaw. Position your forearm in a way that the infant’s head is lower than the chest.
• Give the baby five back blows. Make sure the heel of one hand is between the shoulder blades.
• If these are not effective, give chest thrusts. Place two or three fingers in the middle of the chest. Compress the breastbone about 1 ½ inches.
• Continue a set of five back blows and a set of five chest thrusts until the foreign object is forced out, the infant may become unconscious or may cough forcefully, breathe, or cry.
• If the infant becomes unconscious, check the mouth for the obstruction. Then give two rescue breaths. Tilt the head back and lift the chin. Create a complete seal over the baby’s mouth and nose. Blow in air for about 1 second.
• If the chest does not rise, give 30 chest compressions. Push about 1½ inches deep with fast compressions of about 100 per minute.
• If the chest rises, check for breathing. Continue with the cycle until the baby starts breathing again, an AED is available, or a trained responder comes over.

What to do when a child is choking?

Choking in children is an emergency. It can rapidly result in death if it is not treated promptly. Here is what should be done when a child is choking:

• If you see an object inside the child’s mouth, try to remove it. However, do not poke blindly if you don’t see any obstruction.
• If the child is coughing loudly, do not do anything and just encourage the child to continue coughing. This means that the airway is just partially blocked.
• If the coughing is not effective or if the child can’t breathe properly, shout for help or call the emergency hotline.
• If the child is conscious but not coughing, bend the child forward. Give five back blows. The heel of the hand should be between the shoulder blades.
• After each back blow, assess if the obstruction is relieved. Back blows create a strong vibration and pressure in the airway, helping dislodge the obstruction.
• But, if the back blows do not help the choking child, move on to abdominal thrusts, also called Heimlich maneuver. These squeeze the air out of the lungs and may help dislodge the blockage. However, if you are not trained to perform this, it might hurt the child.
• To perform abdominal thrusts, put a fist with the thumb side against the middle of the child’s abdomen. Put the other hand over the fist and give five quick upward abdominal thrusts.
• Continue with five back blows and five abdominal thrusts until the child can forcefully cough out the obstruction, the object comes out or the child becomes unconscious.
• For an unconscious choking child, tilt the head back and lift the chin up. Pinch the nose and make a total seal over the child’s mouth. Give two rescue breaths.
• If the chest does not rise with the rescue breaths, give 30 chest compressions of about 2 inches deep at a speed of 100 compressions per minute.
• Continue with the cycle until a trained responder comes, the patient breathes, or an AED device arrives.

What to do when an adult is choking?

Adults, even the elderly are also prone to choking. Usually, adults choke on food items that get lodged in the throat. Here is the guideline for attending to an adult who is choking.

• If the person is conscious and can cough the obstruction out, let them cough forcibly. If the person stops coughing, gagging or breathing, call the ambulance and provide care.
• If the coughing does not work, help the patient bend forward. By using the heel of your hand, provide five blows in the middle part of the two shoulder blades. This will help dislodge the obstruction in the airway.
• Check the mouth if there is something there. Perform five abdominal thrusts when the patient is still choking. Position yourself behind the patient and use one hand to find the belly button or navel. Put a fist with the thumb side against the middle of the patient’s abdominal area. Put the other hand over the fist and give five upward abdominal thrusts.
• If the patient is still choking, open the patient’s airway and check for breathing. If they’re not breathing start with 30 chest compressions and give two rescue breaths. These will help release the foreign body in the airway.
• Do not stop until the patient is breathing, an AED device arrives for use, or a trained person arrives.

Choking is a medical emergency, but with the right knowledge on basic cardiopulmonary resuscitation (CPR) and first-aid, you can save the lives of individuals who are choking.

Further Reading

• All Choking Content

Written by

Angela Betsaida B. Laguipo

Angela is a nurse by profession and a writer by heart. She graduated with honors (Cum Laude) for her Bachelor of Nursing degree at the University of Baguio, Philippines. She is currently completing her Master's Degree where she specialized in Maternal and Child Nursing and worked as a clinical instructor and educator in the School of Nursing at the University of Baguio.