Choking (in Children)

Choking is a serious threat to people of all ages. Whenever something gets stuck in the throat -- a piece of food, a child's toy, or blood from an injury -- it can block a person's air supply. After four to six minutes without air, the brain begins to die. If someone is choking, quick action can save a life.

How can you tell if someone is choking?

A choking victim will often put both hands on his throat as he struggles to breathe. He won't be able to talk. Don't wait to offer help. After a minute or two, his lips and nails will turn blue, and he may lose consciousness. If someone is not responding to CPR and is unconscious, there's a good chance the windpipe may be blocked. Check to see if something is blocking his airway. If you see anything, try to remove it with your fingers. Don't try to do this if the person is conscious.

What is the Heimlich maneuver?

The Heimlich maneuver is a technique used to dislodge an object blocking someone's airway. It works by sending a blast of air upward through the windpipe. The American Red Cross advises alternating five back blows with five abdominal thrusts when performing the Heimlich maneuver.

The Heimlich maneuver involves four basic steps for victims over 1 year old:

• 1. Stand behind the victim and wrap your arms around his waist.
• 2. Place a fist between the victim's ribcage and navel.
• 3. Grab one fist with the other hand and quickly thrust upward.
• 4. Repeat until the object comes out.

If you're choking and no one is around to help, you can perform a modified Heimlich maneuver on yourself. Put your fist on your upper abdomen, grab the fist with your other hand, and thrust upward until the object dislodges. You can also perform the thrusts by pressing your upper abdomen against the back of a chair, a table, or another fixed object.

After you've dislodged the object, get medical help immediately.

What should I do if a choking victim is unconscious?

Lay the victim on her back and straddle her around her waist. Put the heel of one hand on her upper abdomen, put your other hand on top of the first hand, and give several quick upward thrusts until the object is expelled. If she doesn't respond, try CPR immediately.

How can I help a choking infant?

Using your lap or thigh for support, lay the infant face down across your forearm, resting his head in your hand. The infant should be angled downward, with the head lower than the body. With the heel of your other hand, deliver up to five sharp blows between the shoulder blades. If this fails to dislodge the object, turn the infant over, once again supporting him on your thigh or lap, holding his head in your hand. Place the forefinger and middle finger of your free hand halfway between -- and just below -- the infant's nipples. Thrust straight down up to five times, compressing the chest about an inch.

Repeat this cycle of five back blows and five chest thrusts until the object is dislodged. If it never comes free, and the infant becomes unresponsive, stops breathing, or turns blue, shout for help, administer infant CPR (if you are trained to do so), and call 911. Never reach into the infant's mouth to pull out an object unless you can see it, and never do so when the child is conscious.

Are there any risks to the Heimlich maneuver?

You can crack a rib or cause other damage during the Heimlich maneuver, especially if you use improper technique. When performing the maneuver, try not to put too much pressure on the victim's ribs. If you do the Heimlich correctly, you should have your arms just below the breastbone, so there's no reason to crack ribs. Don't be afraid to use sufficient force to dislodge the item once you are sure that your hands and arms are positioned properly. And, of course, do not use the Heimlich unless you're sure a person is actually choking and can't breathe.

How can I prevent choking?

The best way to prevent choking is to make sure your children eat slowly and thoroughly chew their food. Cut kids' food into small pieces.

According to the Centers for Disease Control and Prevention, 60 percent of children taken to the emergency room for nonfatal choking incidents are choking on food. Some of the common culprits are whole grapes, nuts, popcorn, and hot dogs. Keep young children away from common choking hazards such as coins, marbles, popped balloons, and small toys.

Further Resources

For visual guides to performing the Heimlich maneuver on infants, children, and adults, check out Harvard Medical School's illustrated primers:

Infants: http://www.health.harvard.edu/fhg/firstaid/heimlichInf.shtml
Children: http://www.health.harvard.edu/fhg/firstaid/heimlichChild.shtml
Adults: http://www.health.harvard.edu/fhg/firstaid/heimlichAd.shtml

References

The Heimlich Institute. How to do the Heimlich Maneuver.

University of Virginia Health System. Choking and the Heimlich Maneuver.

National Institutes of Health. Medical Encyclopedia: Choking.

National Institutes of Health, MedlinePlus, "Choking -- adult or child over 1 year" http://www.nlm.nih.gov/medlineplus/ency/article/00...

National Institutes of Health, MedlinePlus, "Choking - infant under one year" http://www.nlm.nih.gov/medlineplus/ency/article/00...

National Institutes of Health. MedlinePlus. Heimlich Maneuver. http://www.nlm.nih.gov/medlineplus/ency/article/00...

National Institutes of Health. MedlinePlus. Heimlich Maneuver Illustrations (Infant)
http://www.nlm.nih.gov/medlineplus/ency/imagepages...
http://www.nlm.nih.gov/medlineplus/ency/imagepages...
http://www.nlm.nih.gov/medlineplus/ency/presentati...

Harvard Medical School Family Health Guide. Choking. http://www.health.harvard.edu/fhg/firstaid/choking...

Harvard Medical School Family Health Guide. Heimlich Maneuver.
http://www.health.harvard.edu/fhg/firstaid/heimlic... (adult)
http://www.health.harvard.edu/fhg/firstaid/heimlic... (child)
http://www.health.harvard.edu/fhg/firstaid/heimlic... (infant)

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Choking Episodes Among Children. http://www.cdc.gov/ncipc/duip/spotlite/choking.htm

American Academy of Pediatrics. Choking Prevention. http://www.medem.com/medlb/article_detaillb.cfm?ar...

American Academy of Pediatrics. Choking: Common Dangers Among Children. http://www.medem.com/medlb/article_detaillb.cfm?ar...

Merck Manual, Second Home Edition. Choking. http://www.merck.com/mmhe/sec24/ch299/ch299d.html

American Red Cross. Conscious Choking. http://www.redcross.org/flash/brr/English-html/con...

American Red Cross. Choking Emergencies. http://american.redcross.org/site/PageNavigator/Sa...

Mayo Clinic. Choking: First Aid. http://www.mayoclinic.com/health/first-aid-choking...
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