Choking First Aid (Child, Age 1 Year and Up)

Choking happens when an object gets stuck in the throat or airway. This can block the flow of air and cut off oxygen to the brain. Young children may choke if they swallow breast milk or formula too quickly or if they have too much mucus.

Any object small enough to go into your child's airway can block it. This includes small food pieces like nuts, grapes, beans, popcorn, hotdogs, or food that hasn't been chewed well. Household objects like buttons, marbles, small batteries like those used in watches, coins, latex balloons, and beads are also common choking hazards. Small toy parts can also cause your child to choke.

If your child is choking, give first aid right away. This will clear the airway so your child can breathe.

These are signs of choking:

• Violent coughing
• A high-pitched sound when breathing in
• Not being able to cough, breathe, cry, or speak
• Face turning pale and bluish
• Clutching at the throat

The steps to take when a child is choking will vary. The instructions for each situation are below.

If a child has trouble breathing but can talk and has a strong cough:

1. Do NOT put your finger into the child's mouth to remove the object. Your finger could push the object deeper into the child's throat.
2. Call 911. This is because the airway can become fully blocked.
3. Encourage the child to cough until the object comes out. Don't do abdominal thrusts. The child's cough is better than abdominal thrusts.
4. Watch the child closely to make sure the object comes out and doesn't shift to fully block the throat.

If a child has trouble breathing but can't talk or make sounds and is conscious:

1. Do NOT put your finger into the child's mouth to remove the object. Your finger could push the object deeper into the child's throat.
2. Tell someone nearby to call 911.
3. Stand or kneel next to the child and put one arm across their chest for support. Then have them bend at the waist so they are looking at the floor.
4. Using the heel of your hand, give 5 firm and quick back blows between the child's shoulder blades.
5. If they are still choking, stand or kneel behind the child and wrap your arms around their waist. If they are standing, place one of your legs between their legs so you can support them if they faint.
6. Make a fist with one hand. Place the thumb-side of your fist into the child's belly just above the belly button (navel). Then grab that fist with your free hand.
7. Use fast, short motions to thrust inward and upward. Do this 5 times. Don't lift the child off the floor while doing this.
8. Continue with 5 back blows and 5 abdominal thrusts until the object comes out, the child can cough and breathe, the child becomes unconscious, or help arrives.

If a child stops breathing or becomes unconscious:

1. Shout for help and call 911.
2. Lay the child down on their back on a hard, flat surface such as a table, floor, or the ground.
3. Start CPR. Use the heel of your hand to push down on the lower part of the child's breastbone, just below the nipple line. Press down to at least 1/3 depth of the child's chest, or about 2 inches. You can use two hands if you need to. Do this 30 times really fast. This should take about 20 seconds. This is a rate of at least 100 to 120 compressions per minute. After each compression, allow the chest to return to its normal position.
4. Look in the child's mouth for the object before you give 2 rescue breaths. Gently lift the child's chin up with one hand and tilt the head back. Place your mouth over their mouth, pinch the nose shut, and puff 2 breaths into the child's mouth. Each breath should last 1 second. Watch to see if the child's chest rises.
5. If the chest does not rise, give 30 chest compressions. Look in the child's mouth for an object. Remove the object, being careful not to push it back into the throat. If you can't see an object, don't put your finger in the child's mouth.
6. If the child does not start breathing, continue cycles of 30 chest compressions followed by 2 quick breaths. Do this until breathing starts, help arrives, you become too exhausted to continue, or the scene becomes unsafe.

• Watch your child during meals. Children should sit down to eat. They should cut food into small, bite-sized pieces.
• Teach your child to take small bites and to chew and swallow food before talking and laughing. Make sure that children sit down while they are eating.
• Teach your child to not put pencils, crayons, or erasers in their mouth.
• Teach children to not run with gum, food, or other objects in their mouth.
• Be aware of older children's actions. Many choking incidents are caused when an older child gives a dangerous toy or food to a younger child.
• Check each room in the house every day for small objects like buttons, coins, and toy parts.
• Try to find the cause of the choking and avoid future problems.
• For younger children, choose large, sturdy toys that don't have sharp edges. Safe toys are those that won't fit into a toilet tissue roll.
• For younger children, avoid toys with small, removable parts. Check toys often for loose or broken parts.
• For younger children, remove drawstrings from clothing. Avoid tying balloons, long strings, or ribbons near the crib.

Follow up with your child's doctor as advised.

Anyone caring for children should learn child CPR and abdominal thrusts. Ask your child's doctor about classes in your area.

Call 911 if:

• Your child has continued choking or trouble breathing.
• Your child has wheezing or any abnormal breathing noises after a choking incident. An airway that is partially blocked can become completely blocked.
• Your child's skin, lips, and nails look blue or pale (dusky).
• Your child is lightheaded, disoriented, or unresponsive.