What to do if someone is choking: Responding to adults, babies, and toddlers

Quick response is key during a choking incident.

When air cannot flow into the lungs, serious brain damage occurs quickly. Brain damage is unlikely within the first 4 minutes without air, but brain damage is possible at 4–6 minutes, probable at 6–10 minutes, and severe at 10-plus minutes.

How a choking incident is treated differs by age. It’s important for caregivers of young children and older adults to know what to do if the person in their care chokes. 

Here’s a response guide for choking in babies, toddlers, older adults, adults, and yourself.

A baby’s windpipe is the size of a drinking straw, meaning their tiny airway makes choking a particularly dangerous hazard.

Feeding time must be closely monitored. The baby should sit up while eating, and their food should be cut into small pieces that are no larger than about one centimetre in any direction. Feed the baby small amounts, and don’t rush feeding time. Avoid giving them round, firm foods (like sausages, nuts, and grapes) and white bread products, which can become a gum-like paste that gets stuck in their mouth.

Babies love putting anything and everything in their mouths, from coins to pen caps to pet food to balloons. Baby-proofing the home needs to be done on a constant basis with crawlers. Test the home’s safety by getting a “baby’s-eye view.” Crawl on the floor and pick up any potential choking hazards. Vacuuming regularly will help too.

1. Let the baby cough. Coughing is the most effective way to dislodge something from the airway.
2. Check choking signs. A choking baby may be unable to cough or cry. Typically, a choking baby will open their mouth wide while their skin turns red or blue.
3. Call 000. Ask someone to call 000 immediately. If you are alone with the infant, call 000 after two minutes of treatment.
4. Begin back blows. Place the baby face down on your forearm, with their jaw cradled in your thumb and forefinger, and their head settled lower than their chest. Use the heel of your hand to firmly hit the baby’s back five times between the shoulder blades.
5. Begin chest thrusts. Turn the infant over while still resting your forearm on the front side. Sit down and place the baby’s back on your thigh, with their head still lower than the chest. Put two or three fingers between the baby’s nipples. Thrust by pushing straight down on the chest a few centimetres in a smooth motion, and then allow the chest to return. Repeat five times.
6. Repeat 5-and-5. Repeat five back blows and five chest thrusts. Check the baby’s throat for the choking object after each cycle.
7. Begin CPR. If the baby becomes unconscious and stops breathing, place them on the flat ground.
8. Begin chest compressions. This is similar to chest thrusts, but the baby is kept flat on the ground and your free hand is placed on the forehead. Administer 30 chest compressions with your two or three fingers in the centre of the baby’s nipples, at a rate of two per second.
9. Give two rescue breaths. Open the baby’s airway by placing a hand on the forehead and two fingers on the chin. Make a seal over their mouth and nose with your mouth, inhale a normal-sized breath, then blow into the baby’s mouth for one second, making sure their chest rises.
10. Check airway. If the chest doesn’t rise, the baby’s airway is blocked. Look into the baby’s airway and attempt to dislodge the object.
11. Repeat cycle. Continue with chest compressions and rescue breaths until the baby stops choking or medical personnel arrive.

An average of 12,000 children are treated in emergency departments each year for choking. High-risk toddler-choking foods include lollies, bones, sausages, seeds, nuts, chunks of peanut butter, chunks of raw fruit or vegetables, marshmallows, popcorn, and gum.

Parents still need to diligently babyproof with a toddler (baby gates can help). Most choking deaths for kids ages three and under are caused by toys and child products—not food. A child under age four should not be allowed to play with a toy or an object that can fit through a 3cm. Instruct older siblings to put their toys away, especially small pieces.

1. Let the toddler cough. Let the toddler continue coughing to dislodge the object.
2. Call 000. Ask someone to call 000 immediately. If you are alone with the child, call 000 after two minutes of treatment.
3. Begin back blows. Lay the child over your lap face down, or support them in a forward-leaning position. Give them five firm back blows between the shoulder blades.
4. Begin Heimlich manoeuvre or abdominal thrusts. While standing or kneeling, wrap your arms around their upper abdomen. Clench your fist and place it above the child’s belly button. Grasp your fist with your other hand on top, then pull it inward and upward. Repeat five times.
5. Repeat 5-and-5. Repeat five back blows and five abdominal thrusts. Check their throat for the choking object after each cycle.
6. Begin CPR. If they become unconscious or stop breathing, place them on the flat ground.
7. Begin chest compressions. Place your hands one on top of the other in the middle of the toddler’s chest. Deliver 30 chest compressions, two inches deep, at a rate of 100 compressions per minute. Push down firmly, but not too hard as you could break the child’s rib cage.
8. Give two rescue breaths. Tilt their head to open the airway, plug their nose, and seal your mouth over the top of their mouth. Give two large breaths, delivered at one second each, making sure the chest rises.
9. Repeat cycle. Continue with chest compressions and rescue breaths until they stop choking or medical personnel arrive.

Though choking incidents drop significantly in the adult age category, anyone can still choke. Life-saving response methods for a choking adult should not be ignored.

Adults should be cautious of common choking risks for their age: Attempting to swallow large pieces of unchewed food, eating while laughing or talking, eating too fast, and engaging in physical activity while eating. Adults should also be careful with alcohol consumption before or during meals, as alcohol dulls the swallowing nerves.

1. Determine the severity. Ask, “Are you choking?” before performing any first aid. If the adult is coughing, let them cough to continue to dislodge the choking hazard.
2. Call 000. Ask someone to call 000 immediately. If you are alone with them, call 000 after two minutes of treatment.
3. Begin back blows. Bend the person over at their waist, crossing your less dominant arm over their chest. Use your dominant arm to deliver five powerful back blows between their shoulder blades.
4. Begin Heimlich manoeuvre or abdominal thrusts. Stand up and place your leg between their legs to support them if they faint or pass out. Next, wrap your arms around their upper abdomen. Clench your fist and place it above their belly button. Grasp your fist with your other hand on top, then pull it inward and upward quickly. Repeat five times. If they are pregnant or obese, wrap your arms around their chest instead of their upper abdomen, and put your hands in the middle of their chest.
5. Repeat 5-and-5. Repeat five back blows and five abdominal thrusts. Check their throat for the choking object after each cycle.
6. Begin CPR. If they become unconscious or stop breathing, lay them on the ground on a flat surface.
7. Begin chest compressions. Place your hands one on top of the other in the middle of their chest. Use your body weight and deliver chest compressions 5cm deep at a rate of 100 compressions per minute (try doing it to the beat of "Stayin' Alive" by the Bee Gees)
8. Give two rescue breaths. Tilt their head to open the airway, plug their nose, and seal your mouth over the top of their mouth. Give two large breaths, making sure their chest rises.
9. Repeat cycle. Continue with chest compressions and rescue breaths until they stop choking or medical personnel arrive.

Over half of people who die from choking are adults over the age of 74. This is because normal swallowing function can deteriorate with age. Teeth and throat muscles weaken, saliva production slows, and even diseases like reflux, Alzheimer’s, and Parkinson’s can affect swallowing functions in older adults.

Foods that pose choking risks to older adults include common culprits like hot dogs, hard candy, and white bread. But even water (the thin fluid can cause choking), dry food (crackers, rice cakes), and cake (which can expand in the airway) are foods caregivers and family members need to monitor.

Care professionals also advise older adults to eat slowly and Julienne-cut food, and to avoid drinking fluid while eating or talking.

1. Assess whether or not they’re choking. Sometimes it can be difficult to tell if an older adult who is coughing during a meal is actually choking since coughing is a common reflex of aging. Signs of an older adult choking include being unable to talk or breathe, motioning towards the throat, or skin turning grey or blue. If they are coughing, let them continue to expel the choking hazard. If the person wears dentures, check if they are in the way.
2. Call 000. Ask someone to call 000 immediately. If you are alone with them, call 000 after two minutes of treatment.
3. Begin back blows. Bend them over at their waist, crossing your less dominant arm over their chest. Use your dominant arm to deliver five powerful back blows between their shoulder blades.
4. Begin Heimlich manoeuvre or abdominal thrusts. Stand up and place your leg between their legs to support them if they faint or pass out. Next, wrap your arms around their upper abdomen. Clench your fist and place it above their belly button. Grasp your fist with your other hand on top, then pull it inward and upward quickly. Repeat five times.
5. Repeat 5-and-5. Repeat five back blows and five abdominal thrusts. Check their throat for the choking object after each cycle.
6. Begin CPR. If they become unconscious or stop breathing, lay them on the ground on a flat surface.
7. Begin chest compressions. Place your hands one on top of the other in the middle of the chest. Use your body weight and deliver chest compressions 5cm deep at a rate of 100 compressions per minute.
8. Give two rescue breaths. Tilt their head to open the airway, plug their nose, and seal your mouth over the top of their mouth. Give two large breaths, making sure their chest rises.
9. Repeat cycle. Continue with chest compressions and rescue breaths until they stop choking or medical personnel arrive.

When you’re choking, the rush of adrenaline and fear causes panic. The first instinct is to run to the bathroom. You’re not sure if you may throw up, and you’re likely embarrassed if you’re in a room full of people. If you’re around others, get their attention and make the signs indicating you’re choking: put your hands up to your throat and open your mouth.

If you’re alone, do your best to remain calm. There’s enough oxygen stored in your lungs to stay alive for several minutes without breathing. Do not drink liquid or put your fingers in your throat, as it can cause the object to lodge further in your airway.

1. Cough it up. The cough reflex is most effective for dislodging an object from your airway.
2. Call 000. Call 000 and leave your phone on, even if you can’t talk. The operator will still send paramedics.
3. Begin the self-Heimlich manoeuvre or abdominal thrusts. You can do an abdominal thrust on yourself, the same way you’d perform it on another person. Clench your fist and place it above your belly button, then grasp your fist with your other hand and pull it inward and upward quickly.
4. Repeat. Try to force the object out until medical personnel arrive. You can push your abdomen into the back of a chair or the corner of a table, where you can assert more pressure.

Medical experts recommend visiting a doctor after a choking incident at any age to make sure no damage has been done to the airway or body during the Heimlich and CPR process.

Choking is a terrifying accident, but educating yourself with age-specific choking response guidelines could save the lives of loved ones. The best safety training is to take a class through the Australian Red Cross, which we highly recommend.

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