First Aid Tips: Choking

 Based on a module by Fred Mednick from the Connexions website’s Health Education Course

Introduction by Dr. Don Rose, Writer, Life Alert

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Periodically reviewing the best way to deal with someone who is choking is always recommended. This article provides an overview that lets you do such a review. Whether you can do the Heimlich, or haven’t the slightest idea how to handle it, this article provides essential and useful information.  --Don Rose

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The Basics

If you are working with infants and children, be sure that you keep marbles, beads, thumbtacks, and other small objects out of their reach and prevent them from walking, running, or playing with food or toys in their mouths. If you observe a "conscious" child choking:

  • Ask, "Are you choking?"
  • If the victim can speak, cough, or breathe, DO NOT INTERFERE.
  • WebMD.com says “It is best not to do anything if the person is coughing forcefully and not turning a bluish color.”
  • If the victim CANNOT speak, cough, or breathe, give abdominal thrusts below the diaphragm (the Heimlich maneuver) until the foreign body is expelled or the victim becomes unconscious. (Note that, in cases of extreme obesity or late pregnancy, one can give chest thrusts.)

The Heimlich Maneuver for Choking Victims

A choking victim who can't speak or breathe needs help immediately. According to WebMD.com, “[s]omeone who cannot answer by speaking and can only nod the head has a complete airway obstruction and needs emergency help. The treatment for a choking person who begins to turn blue or stops breathing varies with the person's age. In adults and children older than 1 year, the Heimlich maneuver should be attempted.”

For cases in which a choking victim cannot speak or breathe, follow these steps:

  • From behind, wrap your arms around the victim's waist.
  • Make a fist and place the thumb side of your fist against the victim's upper abdomen, below the ribcage and above the navel.
  • Grasp your fist with your other hand and press into their upper abdomen with a quick upward thrust. Do not squeeze the ribcage; confine the force of the thrust to your hands.
  • Repeat until object is expelled.

The Heimlich, according to WebMD, “is an abdominal thrust that creates an artificial cough. It may be forceful enough to clear the airway. The quick, upward thrust of the Heimlich maneuver forces the diaphragm upward very quickly, making the chest cavity smaller. This has the effect of rapidly compressing the lungs and forcing air out. The rush of air out will force out whatever is causing the person to choke.”

When a victim is unconscious, or a rescuer cannot reach around the victim, try the following steps:

  • Place the victim on his or her back. Facing the victim, kneel astride the victim's hips. With one of your hands on top of the other, place the heel of your bottom hand on the upper abdomen below the rib cage and above the navel. Use your body weight to press into the victim's upper abdomen with a quick upward thrust. Repeat until object is expelled. If the victim has not recovered, proceed with CPR.
  • The victim should see a physician immediately after rescue.
  • Don't slap the victim's back. (This could make matters worse.)

The Heimlich Maneuver for Choking Infants

An infant or child can choke on food or toys that are small enough to enter the windpipe. If a child has swallowed something but can breathe and is able to cough or speak, it is best not to interfere because he or she will likely cough it out.

If a child cannot breathe, cough or speak, take immediate action. Call 911 for help, and then start treatment. The method of treatment varies with the child's age. Follow these steps to help a choking infant less than 1 year old:

  • Place the baby's face down on your lap with the head lower than the body.
  • With the heel of your hand, hit your baby high between the shoulder blades four times.
  • If the object does not come out, turn your baby over and compress (push on) the chest over the breast bone four times.
  • If your child is still not breathing, open the mouth to see if you can remove the object with your finger.
  • Try mouth-to-mouth breathing, and keep repeating this whole process until help arrives.
  • For an older, larger child (older than 1 year), use the Heimlich maneuver to try and remove a foreign object:
  • Put the child on his back on the floor or a table.
  • Place the heel of one hand between his belly button and the breast bone in the middle of his abdomen. Put your other hand on top of the first hand and press inward and upward six to 10 times in rapid succession.
  • Check the child's mouth quickly for the object, and try to remove it if it is visible.
  • Try mouth-to-mouth breathing and then repeat the Heimlich maneuver. Keep trying until help arrives.
  • The Heimlich maneuver can be done on a very large child in the standing or sitting position (from behind).

If the victim becomes unconscious:

  • Position victim on back, arms by side.
  • Call out "Help!", or if others respond, call 911.
  • Perform tongue-jaw lift and finger sweep to try to remove the foreign body.
  • Open airway (head-tilt/chin-lift), and attempt rescue breathing.
  • If unsuccessful, give 6-10 sub-diaphragm abdominal thrusts (the Heimlich maneuver).
  • Repeat sequence: perform finger sweep, open the airway, attempt rescue breathing, perform abdominal thrusts -- until successful.
  • After obstruction is removed, begin the ABC's of CPR if necessary.
  • BE PERSISTENT. Continue uninterrupted until obstruction is relieved or advanced life support is available. When successful, have the victim examined by a physician as soon as possible.

Final Thoughts

If you are choking yourself, use the above steps as an action guide, and try to get someone to assist you. Do not hesitate to ask people nearby for help, if needed; staying alive trumps modesty and shyness. (Never underestimate the ability of others to help; a recent story revealed that a dog owner was saved from choking by the owner’s pooch, who pounded on its owner’s chest until the piece of food was dislodged. Good dog!)

For choking victims who are home and need to contact paramedics for attention, dial 911 if you can. If you are not near a phone, cannot get to a phone or cannot punch in the numbers, you can still get immediate help if you are a member of Life Alert; simply press your pendant to get in touch with live dispatchers within seconds. They can send help to you, which will arrive in a matter of minutes. Life Alert members who are not home while choking (or while facing other emergencies) can also use a special one-button 911 cellphone (an optional Life Alert feature). If you don’t currently have Life Alert, see below for links to information on this lifesaving service.


The article above is covered by a Creative Commons Attribution 2.0 License. The information provided is, to the best of our knowledge, reliable and accurate. However, while Life Alert always strives to provide true, precise and consistent information, we cannot guarantee 100 percent accuracy. Readers are encouraged to review the original article, and use any resource links provided to gather more information before drawing conclusions and making decisions.

Dr. Don Rose writes books, papers and articles on computers, the Internet, AI, science and technology, and issues related to seniors.

For more information about Life Alert and its many services for seniors and younger adults nationwide, please visit the following websites:

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