Choking Episode

Choking occurs when liquids, food or other solid objects get past the throat and into the airway. This will sometimes cause sputtering and spasms of coughing. Usually liquids will be coughed up in a few seconds. Liquids are the most common cause of choking in infants. Solids can be a much bigger problem. Foods most likely to get caught in the airway include gum, hard candy, seeds, fruit pits, popcorn, grapes, raw vegetables and meats (especially hot dogs). Balloons, small objects and foods (especially hot dogs, round candies, nuts and grapes) are the most common causes of choking in children. If the airway is completely blocked, breathing will stop. Emergency treatment is needed immediately.

Most of the time coughing will clear the airway of liquids and small objects. However, some liquids cause damage to the airway. Not all solids will be cleared with coughing. If solid bits of food drop into smaller airways, it can cause problems with breathing (including pneumonia) days later. Watch for signs of breathing difficulty or fever and call your caregiver or get help at a hospital emergency department right away if you have any concerns.

If the choking victim is still breathing and has a forceful cough, strong cry or is able to speak or make some sounds, do not interfere. Allow him/her to clear the airway with coughing. Stay with him/her and watch closely for signs of severe airway blockage.

Signs of a severe airway blockage include:

  • The cough becomes weak, ineffective or silent.

  • Soft or high-pitched sounds while breathing.

  • Inability to cry, speak or make sounds.

Immediate action is needed if the choking victim has signs of a severe airway blockage.

With severe airway blockage, prepare to do 1 of the following:

  • For a conscious adult or child over the age of 1 year:

  • Stand or kneel behind the choking victim and wrap your arms around the victim's waist. Have the victim lean forward slightly and tilt the head down.

  • Make a fist with 1 hand. Place the thumb of the fist slightly above the victim's belly button and below the breastbone.

  • Grasp the fist with the other hand.

  • Do repeated, quick upward abdominal thrusts with your hands to try to force the object out of the airway. Do this until the object comes out or the victim becomes unresponsive.

  • For a conscious pregnant woman or an obese adult:

  • Stand behind the choking victim and wrap your arms around the victim's chest.

  • Make a fist with 1 hand. Place the thumb of the fist on the middle of the victim's breastbone.

  • Grasp the fist with the other hand.

  • Do repeated, quick inward (backward) chest thrusts with your hands to try to force the object out of the airway. Do this until the object comes out or the victim becomes unresponsive.

  • For a conscious infant under the age of 1 year:

  • Place the choking infant face down on your arm. Hold the infant's chest with that hand and support the jaw with your fingers. Place the infant's head lower than his/her body. Use your thigh to support the infant.

  • Give up to 5 quick, forceful back blows (slaps) between the shoulder blades with the heel of your other hand.

  • If the object does not come out after the back blows, turn the infant face up on your forearm. Support the infant's head with that hand. Use your thighs to support the infant.

  • Place 2 or 3 fingers of your other hand just below a line between the nipples. Give up to 5 chest thrusts down, depressing 1/3 to 1/2 the depth of the chest.

  • Continue the 5 back blows and 5 chest thrusts until the object pops out or the child becomes unresponsive.

  • DO NOT do abdominal thrusts as they can cause internal injury to an infant.

Do not give the victim anything to drink until the airway is clear.

A complete blockage will cause the choking victim to pass out. If this happens, call emergency services (911 in the U.S.) immediately and start CPR.

It is always good to be trained to know how to perform the Heimlich maneuver and CPR. All children and adults who have had a serious choking episode should have a medical evaluation and appropriate follow-up immediately after breathing is back to normal.