How Do You Help a Choking Child or Infant? First Aid Steps by Age

To help a choking child or infant, first decide whether the airway is blocked enough to stop breathing. A child who can cough forcefully, cry, or speak usually has a partial blockage and should be allowed to keep coughing. A child who cannot breathe, cough, cry, or make sound needs immediate action and a 911 call. This article covers the signs, the steps for infants and for children, and what to do afterward.

How to Tell Mild Choking From Severe Choking in a Child or Infant

The first decision in helping a choking child or infant is whether air is still moving. MedlinePlus (NIH) describes choking as a blocked airway that can keep air from reaching the lungs, and the right response depends on how complete the blockage is. You can read its overview in Choking.

Signs of mild (partial) choking

• The child can cough, and the cough sounds forceful.
• The child can cry, talk, or make noise.
• The child may gag, sputter, or have watery eyes.

In this situation, stay with the child and let them cough. Coughing is the body's own way to push an object out. Do not slap the back, give a belly thrust, or put your fingers in the mouth while the child is moving air well, because this can push the object deeper or turn a partial blockage into a complete one. Watch closely. If the cough becomes weak or silent, treat it as severe choking.

Signs of severe (complete) choking

• The child cannot cough, cry, or speak, or the cough is silent or very weak.
• An infant makes no sound or only a high-pitched, squeaky noise while struggling to breathe.
• The child grabs at the throat, looks panicked, or has clear trouble getting any breath in.
• The lips or skin look blue or gray.
• The child becomes limp or unresponsive.

These signs call for immediate action. If another person is with you, one of you starts first aid while the other calls 911. If you are alone and the child is conscious, start first aid and put your phone on speaker to call 911 at the same time, so the dispatcher can guide you while your hands stay free.

First Aid Steps for a Choking Infant (Under 1 Year)

Infants have small, soft airways and are at risk of injury from adult-style abdominal thrusts, so the approach differs. The steps below follow the commonly taught infant rescue sequence of back blows alternating with chest thrusts. Hands-on first aid courses teach this sequence, and a class is the best way to practice it.

Back blows and chest thrusts

• Sit or kneel and place the infant face down along your forearm, with your forearm resting on your thigh. Support the head and jaw with your hand, keeping the head lower than the chest. Do not press on the soft tissue of the throat.
• With the heel of your other hand, give up to five firm back blows between the shoulder blades.
• If the object has not come out, sandwich the infant between your hands and forearms, turn the infant face up, and keep the head lower than the chest.
• Place two fingers on the center of the breastbone, just below the nipple line, and give up to five quick chest thrusts. Instructors commonly teach pressing the chest down about a third of its depth and letting it return fully.
• Repeat the cycle of back blows and chest thrusts until the object comes out, the infant starts to cough, cry, or breathe, or the infant becomes unresponsive.

Abdominal thrusts (the Heimlich maneuver) are not used for infants in these protocols, in part because of concern about injury to the abdominal organs.

If the infant becomes unresponsive

Lay the infant on a firm, flat surface and start CPR with chest compressions. If someone else is there, have them call 911. If you are alone and have a speakerphone, call 911 on speaker while you begin. If you have no way to call while working, courses generally teach giving about two minutes of CPR before leaving to call. Each time you open the airway to give breaths, look in the mouth. If you can see an object, remove it. If you cannot see it, do not sweep with your finger, because a blind sweep can push the object farther back. Keep going until help arrives or the infant starts to breathe.

First Aid Steps for a Choking Child (Age 1 to Puberty)

For a child older than one year who is choking severely, the commonly taught response is abdominal thrusts, also called the Heimlich maneuver. Some courses teach back blows alternating with abdominal thrusts, and guidance varies between organizations, so follow the method taught in the class you take.

Abdominal thrusts for a conscious child

• Stand or kneel behind the child, depending on their size, and wrap your arms around the waist.
• Make a fist with one hand and place the thumb side just above the belly button and well below the breastbone.
• Grasp the fist with your other hand and give quick, firm thrusts inward and upward.
• Continue until the object comes out, the child can breathe or cough, or the child becomes unresponsive.

Use less force for a small child than for a larger one. Aim to be firm enough to move air but not so forceful that you risk injury. A child who has had abdominal thrusts should be checked by a clinician afterward, even if they seem fine (see below).

If the child becomes unresponsive

Lower the child to the floor and start CPR, beginning with chest compressions. Have someone call 911, or call on speaker if you are alone with a phone. Without a way to call while you work, courses generally teach about two minutes of CPR before leaving to call. Before each set of breaths, look in the mouth and remove an object only if you can see it. Never do a blind finger sweep, because it can push the object deeper. Continue until emergency responders take over or the child starts to breathe.

Choking Versus Other Breathing Problems

Not every scary breathing episode is choking. Croup, asthma, allergic reactions, and infections can also make a child struggle to breathe. Choking is more likely when the trouble starts suddenly while eating, drinking, or playing with a small object, often with no fever or cold beforehand. Hives with swelling of the lips or face, trouble breathing, or wheezing after a food may be anaphylaxis, which needs 911. If your child has a prescribed epinephrine auto-injector and these signs appear, use it as your clinician and the product label direct, then call 911. An auto-injector does not clear a physical blockage, so if the child is choking and cannot breathe or cough, start choking first aid. For breathing worries that are not clearly choking, see our related article When to Worry About a Baby's Breathing.

Why Children Choke and How to Lower the Risk

Young children are at higher risk for several reasons that work together. Their airways are small, they are still learning to chew, they often put objects in their mouths, and they may run, laugh, or talk while eating. Several factors contribute, and no single cause explains every event.

Foods that are often associated with choking

• Whole grapes, hot dog pieces, and other round or tube-shaped foods
• Whole nuts, popcorn, and hard candy
• Raw hard vegetables such as carrot chunks, and large pieces of fruit
• Spoonfuls of peanut butter and other thick, sticky foods
• Chewing gum

Cutting food into small pieces appropriate for the child's age, having the child sit while eating, and supervising meals can lower the risk. Your pediatrician can tell you which food textures suit your child's stage. MedlinePlus has background on feeding in Infant and Newborn Nutrition.

Small objects in the home

Coins, small toy parts, balloon pieces, and household items can block the airway. Keep them out of reach of young children, and check floors and low surfaces. Button batteries and magnets carry additional dangers beyond choking, and they are covered in our related article What Should You Do if a Child Swallows a Battery, Magnet, or Medicine? A suspected button battery swallow is an emergency even if the child looks well and has no symptoms, because serious internal injury can develop before symptoms appear. Do not wait for symptoms or for an X-ray to decide. Swallowing more than one magnet also needs urgent emergency evaluation. Go to the emergency room or call 911, and call Poison Control at 1-800-222-1222 on the way. Bring the battery packaging, the device it came from, or the magnets if you can, so the team can identify what was swallowed. For magnets and other objects, do not give food or drink and do not induce vomiting. For a suspected button battery, some poison center guidance advises a specific household food for certain older children on the way to the hospital, but whether that is appropriate depends on the child and the timing, so ask Poison Control or the 911 dispatcher before giving anything by mouth. Introducing allergenic foods safely is a separate topic, covered in our related article When and How Should Babies First Eat Peanut and Egg?

MedlinePlus lists related topics on Foreign Bodies.

Does Choking First Aid Work? What the Published Evidence Looks Like

It is worth being honest that the research on rescue maneuvers is limited. A narrative review in PubMed Central, Do We Actually Help Choking Children?, examined the quality of the evidence on how well and how safely first aid maneuvers work. It points to gaps in high-quality data, which is common for emergency situations that are hard to study. This does not mean the steps should be skipped. Rescue sequences are taught because a completely blocked airway can become life-threatening quickly, and trained responders generally agree that acting is better than waiting. It does mean that recommendations can differ among organizations and may change as new evidence appears.

Published studies also suggest that many people feel unprepared. Studies of parents, kindergarten teachers, and even medical students have found gaps in knowledge of choking first aid, for example in a study of parents in a tertiary care hospital in Sri Lanka and a multicentre study of medical students. A simulation study on animated images for infant foreign body airway obstruction explored whether visual teaching aids might help people learn the steps. These findings suggest that practicing before an emergency may be valuable.

What to Do After the Object Comes Out

Even when a child seems fine afterward, a clinician should check them if they needed back blows, chest thrusts, abdominal thrusts, or CPR. Thrusts can sometimes cause internal bruising or injury, and a small piece of the object may remain in the airway. Tell the clinician what happened, what the child was choking on, and what you did.

Call the child's clinician or seek care the same day if any of these follow a choking episode:

• A cough that continues or keeps coming back
• Wheezing or noisy breathing
• Fever, which may suggest an infection after something was inhaled
• Mild pain in the belly or chest after thrusts
• Drooling, pain with swallowing, or refusal to eat or drink

Call 911 if breathing becomes difficult, the lips turn blue, the child becomes limp or unresponsive, or a child who had abdominal thrusts develops severe belly pain, repeated vomiting, or a hard, swollen belly.

Preparing Before an Emergency

• Take a hands-on class. Infant and child choking and CPR courses are offered by many hospitals, community centers, and first aid organizations. Practicing on a manikin builds confidence in a way that reading cannot.
• Teach other caregivers. Grandparents, babysitters, and child care staff should know the steps and your address in case they need to call 911.
• Keep the phone nearby at meals. A speakerphone call lets you talk to a dispatcher while using both hands.
• Do not use unproven gadgets in place of training. Airway clearance devices have been studied mostly in adult care settings, such as this evaluation of the DeChoker in adult care homes. Whether they are suitable for children is a question to ask your pediatrician.

MedlinePlus also offers general guidance at First Aid.

When to Seek Medical Care