Choking Prevention and First Aid for Infants and Children

Understanding choking prevention procedures will lessen the chance of serious injury. The information in this brochure can help you to prevent or respond to a choking event. However, it is not a substitute for an approved first aid course or cardiopulmonary resuscitation (CPR) course available in your community.

As a parent, do your part by knowing first aid for a choking child or infant. Parents are encouraged to enroll in Basic Life Support class, offered by the American Red Cross or the American Heart Association to learn choking prevention procedures and CPR for infants and children.

When children begin eating table foods, parents must be very careful. Older infants, and children under age 4, are at greatest risk for choking on food and small objects.

Choking occurs when food or objects enter the airway (trachea). Blocking the airway prevents oxygen from getting to the lungs and to the brain. If the brain goes without oxygen for more than 4 minutes, brain damage or death may occur. Each year approximately 3,900 men, women, and children in the United States die from accidental choking. Many of these deaths can be avoided.

The American Academy of Pediatrics (AAP) and the American Heart Association (AHA) believe that parents often can prevent choking. The AAP and the AHA offer the following choking prevention and first aid information for parents of children and infants.

Dangerous Foods

Do not feed children younger than 4 years old any round, firm foods unless they're chopped completely. These types of foods are common choking dangers. Infants and young children sometimes don't grind or chew their food well, so they sometimes attempt to swallow it whole.

Common Choking Dangers

Inspect your children's toys and identify choking hazards. You can test for choking hazards by seeing if toys fit through an empty toilet paper roll. If they do, they're too small to be played with safely. Children can decorate their "no-choke tester" with pictures, stickers or their names. Toys with choking hazards should be kept away from babies, toddlers and young children.

Data Sources: Canadian Institute for Health Information (CIHI), Centers for Disease Control and Prevention (CDC), Health Canada, National SAFE KIDS Campaign®, Safe Kids Canada

Prevention

• Keep the above foods from children until 4 years of age.
• Insist that children eat while sitting at the table; children should never walk, run, or play with food in their mouths.
• Prepare and cut food for young children and teach them to chew their food well.
• Supervise mealtime for young children. Many choking cases occur when older brothers or sisters offer unsafe foods to a younger child.
• Avoid toys with small parts and keep other small household items out of reach of young children.

First Aid

• Find out if the child can breathe, cry, or speak. See if the child has a strong cough. (A strong cough means there is little or no blockage and a child may dislodge the item if there is blockage).
• DO NOT start first aid if there is a strong cough or if there is little or no blockage. This can turn a partial blockage into a complete blockage. If the child is coughing, crying, or speaking, DO NOT do any of the following, but call your doctor for further advice.
• Begin the following first aid if:

The child cannot breathe at all.

The child's airway is so blocked that there's only a weak cough and a loss of color.

• If you determine there is blockage, shout for help; then begin the first aid techniques below.

1. Place the infant's face and head down on your forearm with the infant's head lower than his or her trunk, supporting the head and neck in your hand. Rest your forearm on your thigh to support the infant. (Picture 1)
2. Give up to five back blows forcefully between the infant's shoulder blades with the heel of your other hand.
3. If the blockage is not relieved, place your free hand on the infant's back, holding his or her head. Turn the infant over while supporting the head and neck with your hand. Position the infant face up on your forearm. Give up to five quick, downward chest thrusts with your middle and ring fingers near the center of the breastbone. (Picture 2)
4. NOTE: If the infant is large, you may want to lay the child over your lap. Firmly support the head, holding it lower than the trunk, and perform steps 1 through 3.
5. Repeat steps 1, 2, and 3 until object is coughed up, or until the infant is able to breathe or becomes unconscious.
6. If the infant becomes unresponsive or is found unresponsive, place the infant face up. Lift jaw and tongue. This is called the jaw lift (Picture 1). It draws the tongue away from the back of the throat and may help clear the airway. If a foreign object is seen, sweep it out with your finger. Never poke the finger straight into the throat. Only try a finger sweep if you can actually see the foreign object. Otherwise, you may cause further blockage.
7. If the infant does not begin to breathe right away, tilt his or her head back and place your mouth over the mouth and nose of the infant. Attempt two slow breaths to see whether the chest will rise, which would indicate that the blockage has been relieved.
8. If the chest does not rise, tilt the head again and repeat the two rescue breaths (Picture 2). If the chest still does not rise, then the blockage still has not been relieved.
9. Give up to five back blows and chest thrusts as in steps 1-3.
10. Repeat steps 5 through 8 until the object is coughed up, or until rescue breathing is successful.
11. After performing these steps for 1 minute, you can break and call for an ambulance. If the child is small, you may want to carry him or her to the phone and continue rescue breathing while calling for help. You should have the phone number for emergency medical services (EMS) by your phone.

For Children Older Than 1 Year Old

Begin the following if the child is choking and is unable to breathe. However, if the child is coughing, crying, or speaking, DO NOT do any of the following, but call your doctor for further advice.

1. Stand behind the child with your arms around the chest, just below the child's armpits.
2. Place your fist with the thumb against the middle of the child's abdomen, just above the navel. Grasp your fist with your other hand.
3. Give up to five quick upward thrusts without touching the bones in the chest.
4. Repeat steps 2 and 3 until the object is coughed up, or until the child is able to breathe or becomes unconscious.
5. Make sure you or someone you know has called for emergency medical services.
6. If the child becomes unresponsive or is found unresponsive, place the child on his or her back.
7. Lift jaw and tongue. This is called the jaw lift. It draws the tongue away from the back of the throat and may help clear the airway.
8. If a foreign object is seen, sweep it out with your finger. Never poke the finger straight into the throat. Only try a finger sweep if you can actually see the foreign object. Otherwise, you may cause further blockage.
9. Tilt the child's head back. Seal your lips tightly around the child's mouth, and pinch the nose shut.
10. Give two slow breaths until the chest gently rises.
11. If the chest does not rise, retilt the head and repeat steps 7 and 8.
12. If air won't go in, kneel beside the child or straddle his or her hips.
13. Put the heel of one hand in the midline between the navel and rib cage. Place the second hand on top of the first. Then press firmly, but gently, into the abdomen with a rapid inward and upward thrust. Repeat this step up to five times.
14. Repeat steps 6 through 11 or until the object is coughed up or rescue breathing is successful.
15. After performing these steps for 1 minute, you can break and call for an ambulance if that has not already been done. You should have the phone number for emergency medical services (EMS) by your phone.