Choking — Adults, Children & Infants
A completely blocked airway leaves only minutes. The technique differs for adults, small children and babies, and using the wrong one on an infant causes serious injury.
When to call an ambulance immediately
- Clutching at the throat, the universal choking sign
- Unable to speak, cough forcefully, cry or breathe
- Silent or ineffective coughing, or a high-pitched wheeze on breathing in
- Lips and face turning blue or grey
- Sudden collapse while eating
What to do
Work through these in order. If you are alone, put your phone on speaker so the 108 call handler can guide you while your hands stay free.
- 1
First ask: can they cough?
If they are coughing forcefully and can speak, the blockage is partial. Encourage them to keep coughing, because a strong cough shifts an obstruction better than anything you can do. Stay beside them and watch closely.
- 2
If the cough is silent or ineffective, five back blows
Stand to the side and slightly behind. Lean them well forward so the object falls out of the mouth rather than moving deeper. Give five sharp blows between the shoulder blades with the heel of your hand, checking after each one.
- 3
Then five abdominal thrusts
Stand behind them and put both arms around the upper abdomen. Make a fist and place it just above the navel, well below the breastbone. Grasp the fist with your other hand and pull sharply inwards and upwards. Check after each thrust.
- 4
Alternate five and five, and call 108
Keep cycling five back blows and five abdominal thrusts. If you are alone, call 108 on speaker while you continue.
- 5
For a baby under one year, never abdominal thrusts
Lay the infant face down along your forearm with the head lower than the body, supporting the jaw. Give five back blows between the shoulder blades. Then turn them face up and give five chest thrusts using two fingers on the lower half of the breastbone, sharper and slower than CPR compressions. Alternate five and five.
- 6
For a pregnant woman or a very large person
Use chest thrusts instead of abdominal thrusts. Position your fist on the lower half of the breastbone and pull straight backwards.
- 7
If they become unconscious
Lower them carefully to the floor, call 108 if that has not been done, and begin CPR starting with chest compressions. Each time you open the airway to give breaths, look in the mouth and remove any object you can clearly see.
Never do these
Most of these are well-intentioned and widely believed. All of them make the situation worse.
- Never perform a blind finger sweep. It usually pushes the object deeper and can injure the throat. Remove only what you can actually see and reach.
- Never give abdominal thrusts to an infant under one year. It can rupture the liver.
- Never give water to wash it down. Water cannot pass a blocked airway and risks the lungs.
- Never slap the back of someone sitting upright. Lean them forward first, or gravity works against you.
- Never send someone home after successful abdominal thrusts without a medical check, because the thrusts themselves can cause internal injury.
Once the immediate danger has passed
- Anyone who received abdominal thrusts should be examined by a doctor, even if they feel completely fine.
- If a persistent cough, difficulty swallowing or a sensation of something stuck remains, part of the object may still be lodged. Go to an emergency department.
Frequently asked
What are the most common choking hazards for children?
Peanuts and other whole nuts, grapes, hard boiled sweets, popcorn, chunks of raw carrot and apple, and small toy parts or button batteries. Nuts and whole grapes are the classic culprits in Indian paediatric emergency departments.
The object came out. Do we still need hospital?
If they are breathing and speaking normally and received only back blows, usually not. If abdominal thrusts were used, yes, get checked.
Reviewed and written by
Dr. Poonam Sekhon Chahal, MBBS, MEM
Senior Emergency Physician, Manipal Hospital, Patiala · Certified in ACLS, ATLS, PALS and PoCUS