Do you know that according to the National Safety Council, over 5500 choking-related deaths occur in the United States every year? A piece of food, when it “goes down the wrong way,” you might cough a few times, and everything’s fine. The situation is so common that you barely think about it. However, what most people don’t realize is that such an everyday occurrence can turn deadly in seconds. A simple family dinner can become a life-threatening emergency when a 70-year-old grandmother chokes on a food particle.
A grape, a coin, a small toy part, or even improperly cut food can turn a playful moment for a kid into a parent’s worst nightmare. Moreover, one child dies from choking every five days, as per the New York State Health Department. The sobering statistics make choking a significant public health concern that affects people of all ages.
However, most of these deaths are completely preventable with proper choking first aid techniques. So, how do you know what to do and act without hesitation? Read on to find the warning signs and the proper choking first techniques for each group!
What is Choking?
Choking or foreign body airway obstruction takes place when a foreign body fully blocks the air passage from the upper airway to the trachea. It can happen either due to mechanical obstructions like food, coins, or toys, or non-mechanical causes such as swelling from allergic reactions or aspiration of vomit.
When an object obstructs the airway, oxygen does not reach the lungs. This makes the situation life-threatening as brain damage can start within 4 minutes and death can occur in as little as 6 minutes.. Your body’s natural response is to cough, which can sometimes dislodge the object. However, when coughing fails, immediate choking first aid intervention becomes critical for survival.
How to Recognize a Choking Incident?
The National Safety Council reports that choking is the fourth leading cause of unintentional injury death. Therefore, before you learn what to do if someone is choking, you need to learn to recognize the incident quickly in the first place. The clear warning signs are:
- Universal Sign – Hands clutching the throat, as a classic choking gesture (Infants often can’t make this gesture, so you shouldn’t rely on it in that age group).
- Unable to Speak – Cannot make normal sounds or respond verbally
- Weak or No Coughing – The Natural cough reflex fails to work
- High-pitched Breathing Sounds (Stridor) – Indicates partial airway obstruction, which can progress to complete blockage at any moment, leading to respiratory failure.
- Skin Color Changes – Blue or purple around the lips and face
- Panic and Distress – Wide eyes, obvious fear, frantic gestures
- Inability to Breathe Normally – Gasping or struggling for air
Mild vs. Severe Obstruction
- Mild Obstruction: The person can still cough forcefully, speak, or cry. In this case, encourage them to keep coughing and monitor closely.
- Severe Obstruction: The person cannot cough effectively, speak, or breathe. This requires immediate intervention with back blows and abdominal thrusts.
Read More: What To Do When Someone Is Choking On Water?
What to Do When Someone Is Choking?
The Heimlich Maneuver, also known as abdominal thrusts, is your primary choking first aid technique. In this technique, you have to use quick upward thrusts to create pressure that can dislodge the obstruction. World Journal of Emergency Medicine says that the Heimlich maneuver shows a success rate of 86% when performed correctly. However, administering the technique can be modified based on the victim’s age and condition. The success rate can drop low when the techniques are administered incorrectly, which emphasizes the need for proper training. Let’s have a brief look at the differences below:
| Factors | Infants (0-12 months) | Children (1-8 years) | Adults & Children >8 years |
| Anatomical Considerations | Smaller airway, softer cartilage, larger head relative to body | Developing coordination may cause panic more | Fully developed airway structure |
| Communication | Cannot verbally communicate distress | May be able to point or gesture | Can usually indicate choking if conscious |
| Position | Hold face down on your forearm, support your head with your hand | Stand or kneel behind the victim | Stand behind the victim |
| Back Blows | 5 firm blows between the shoulder blades with the heel of the hand | 5 firm blows between the shoulder blades with the heel of the hand | 5 firm blows between the shoulder blades with the heel of the hand |
| Chest/Abdominal Thrusts | Turn the infant face-up, 5 chest thrusts with 2 fingers on the lower breastbone | Arms around waist,hands positioned above the navel, 5 upward thrusts | Arms around waist, hands positioned above the navel, 5 upward thrusts |
| Technique | Alternate back blows and chest thrusts until the object clears or the infant becomes unresponsive | Alternate back blows and abdominal thrusts until the object clears or the child becomes unresponsive | Alternate back blows and abdominal thrusts until the object clears or the victim becomes unresponsive |
| Force | Gentle but firm – Never use abdominal thrusts on infants | Modify the force appropriate for the child’s size | Use full adult-strength thrusts |
Choking First Aid for Adults
When an adult is choking, follow this systematic approach to maximize your chances of success and minimize the risk of injury.
Step 1: Assess the Situation
Quickly determine if the person is truly choking by looking for the universal choking sign – hands clutched to the throat (universal sign of choking). Ask, “Are you choking?” If they cannot speak, cough effectively, or breathe, proceed immediately to intervention. Avoid administering back blows to adults if you are not trained.
Step 2: Position Yourself
Stand directly behind the choking person and wrap your arms around their waist. If the person is significantly taller than you, have them lean forward or sit down so you can reach properly. Ensure you have a stable footing and room to perform the maneuver.
Step 3: Proper Hand Placement
Make a fist with your dominant hand and place it just above the person’s navel, below the breastbone. The fist should be positioned in the soft area between the rib cage and hip bone, avoiding the ribs themselves to prevent injury.
Step 4: Execute the Heimlich Maneuver
Cover your fist with your other hand and deliver quick, upward thrusts into the person’s abdomen. Each thrust should be forceful and directed upward toward the diaphragm, not inward toward the spine. Use your entire body weight behind each thrust, but avoid lifting the person off the ground. For pregnant women or significantly obese individuals, use chest thrusts instead of abdominal thrusts. Place your hands on the lower breastbone and push firmly inward with the same quick, forceful motion.
Step 5: Continue Until Successful
Keep performing abdominal thrusts until the object is expelled, the person can breathe and speak normally, or the person becomes unconscious. If they become unconscious, begin CPR immediately and call 911.
Choking First Aid for Children
Children require modified techniques that account for their smaller size and developing anatomy. Follow these steps and use less force while maintaining effectiveness.
Step 1: Size Assessment and Positioning
For children over 8 years old, use adult techniques with reduced force. For smaller children (1-8 years), kneel behind them or have them stand on a chair so you can reach the proper position without bending awkwardly. Always make sure the chair is in a stable position to avoid any accidental falls.
Step 2: Gentle but Effective Hand Placement
Place your fist just above the child’s navel, ensuring proper positioning in the soft area below the breastbone. Your hand placement should be proportional to the child’s size, as smaller children require more precise positioning.
Step 3: Modified Heimlich Technique
Cover your fist with your other hand and deliver upward thrusts with controlled force appropriate for the child’s size. The thrusts should be quick and sharp but gentler than those used for adults, using only the force necessary to create adequate pressure.
Step 4: Monitor Response Carefully
Watch the child’s face and breathe closely between thrusts. Children may become distressed or panicked, so offer reassurance while continuing the technique. Stop immediately if the object is expelled or the child becomes unconscious. If they become unresponsive, initiate CPR and call emergency services immediately.
Post-Rescue Care: Don’t Skip This Step
Once the object is removed, comfort the child and check for any remaining pieces in the mouth. Seek medical attention even if the child appears fine, as internal injuries can occur from the rescue attempts.
For very small children, you may need to support them against your thigh while performing the maneuver. Always use proportional force, enough to create pressure but not so much as to cause injury to developing organs.
Choking First Aid for Infants
Infants require completely different techniques due to their fragile anatomy. Never use the Heimlich maneuver on babies under one year old. Similarly, abdominal thrusts are avoided in infants due to the excess external pressure, which can cause organ injury. Here are the proper choking first aid steps for infants:
Step 1: Check for Obstruction
There will be no crying, coughing, or breathing sounds. The child will have weak or absent respiratory effort. You may also notice stridors (high-pitched noise) with partial blockage.
Step 2: Support the Infant Properly
Hold the infant face down along your forearm, supporting their head and neck with your hand. The infant’s head should be lower than their body to allow gravity to assist in dislodging the object.
Step 3: Deliver Back Blows
Using the heel of your free hand, give five sharp, distinct back blows between the infant’s shoulder blades. Each blow should be firm enough to create pressure but controlled to avoid injury.
Step 4: Turn and Position for Chest Thrusts
If back blows are unsuccessful, carefully turn the infant over while continuing to support the head and neck. Place the infant face-up on your forearm or thigh, keeping the head lower than the body.
Step 5: Perform Chest Thrusts
Using two fingers, deliver five chest thrusts on the lower breastbone, just below the nipple line. Push straight down about 1.5 inches with each thrust, allowing complete chest recoil between compressions. In fact, chest compressions should be performed at a depth of approximately one-third of the chest diameter. It automatically adapts to the infant’s size and prevents excessive force that could damage their delicate ribcage and internal organs.
Step 6: Check and Repeat
Look in the infant’s mouth for visible objects that can be safely removed with your finger. If the object is not visible, repeat the cycle of five back blows and five chest thrusts until the object is expelled or the infant becomes unconscious.
How to Self-Rescue When You Are Choking Alone?
When you’re alone and choking, quick self-rescue Heimlich techniques can save your life. Stay calm and act quickly with the following steps,
Step 1: Attempt to Cough
Try to cough forcefully to expel the object naturally. If you can make any sound, continue coughing while moving to a location where you can perform self-rescue techniques or get help. If you’re unable to speak, cough, or make any noise, your airway is likely fully blocked. Move quickly to the next steps.
Step 2: Call for Help if Possible
If you can reach a phone, call 911 immediately. Leave the line open even if you can’t speak, as emergency services can trace the call. Try to press keys repeatedly or hit the speakerphone button to draw attention. If you are near a window or door, bang loudly or make noise to alert neighbors. You can also have a pre-set emergency speed dial on their phone for quick use.
Step 3: Self-Administered Abdominal Thrusts
Make a fist and place it just above your navel. Cover your fist with your other hand and push hard and quickly in an upward motion. Use your entire body weight behind each thrust, pulling upward and inward simultaneously. However, make sure to avoid glass edges or unstable furniture when performing self-thrusts.
Step 4: Use Environmental Aids
If self-administered thrusts aren’t working, position yourself over the back of a chair, the edge of a table, or a railing. The edge should be positioned just above your navel. Press your upper abdomen against the edge and push forcefully to create the same pressure as the Heimlich maneuver.
Step 5: Continue Until Successful
Keep alternating between self-administered thrusts and using fixed objects until the obstruction is cleared. Don’t give up – people have successfully self-rescued after many attempts.
You can also try bending over and giving yourself sharp back blows, or rapidly sitting down and standing up to create pressure changes. If near stairs, you can carefully position yourself to use the stair edge for abdominal thrusts.
Read More: Heimlich Maneuver For Dogs: How To Use If My Dog Is Choking
What to Do After a Choking Incident?
First aid for choking doesn’t end with clearing the object obstructing the victim’s airway. Post-incident care is important for the person’s continued safety and well-being. Here’s what you should do after a choking incident,
Immediate Post-Rescue Care
Even after successful object removal, the person should be evaluated by medical professionals. The Heimlich maneuver can cause internal injuries, and pieces of the object may remain in the airway. Encourage the person to seek medical attention even if they feel fine. Moreover, make sure to keep them under observation for the next 24 hours to assess any delayed complications like pneumonia from aspirated particles.
Know When to Call Emergency Services
You should always call 911 if the person is unconscious, even briefly, as this indicates severe oxygen deprivation. Call immediately if you suspect internal injuries from the rescue attempts or if the person continues to have difficulty breathing after the incident. Emergency services are also necessary if you’re unsure whether all foreign material was removed from the airway or if the person shows any signs of complications following the incident.
Monitor for Complications
Watch carefully for signs of complications in the hours following the incident. Look out for symptoms like a persistent cough that doesn’t resolve, difficulty swallowing, chest pain, or continued breathing difficulties. Pay particular attention to abdominal pain if abdominal thrusts were used during the rescue, as this could indicate internal injury. In rare cases, it could also lead to aspiration pneumonia with visible symptoms as fever, wet cough, and wheezing.
Medical Follow-Up
Medical evaluation after choking incidents can identify potential complications and ensure complete recovery. Doctors may perform imaging studies to check for retained foreign material or assess for internal injuries from the rescue attempts.
How to Reduce the Risk of Choking?
Even though you know how to help someone choking, prevention remains the best strategy for such emergencies. Take a look at some simple precautions that can significantly reduce the risk of choking accidents.
Safe Eating Practices
Encourage slow, careful eating and thorough chewing. Cut food into small pieces, especially for young children and elderly individuals. Avoid talking or laughing while eating, as this can increase the risk of food entering the airway instead of the esophagus.
Home Safety Measures
Keep small objects away from young children and inspect toys regularly for loose or small parts. For elderly family members, ensure proper dental care and consider softer food options if swallowing difficulties exist. If you are feeding your infant, always feed in an upright position in a secure high chair or on your lap. Their head should be slightly tilted forward, and their chin should face toward their chest. Never prop bottles or allow lying-down feeding,
High-Risk Foods to Avoid or Modify
Certain foods pose particular choking risks and should be avoided or modified appropriately. For instance, whole grapes should be cut in half lengthwise, while hard candies should be avoided entirely for young children. Nuts and seeds, popcorn, peanut butter blobs, marshmallows, hot dogs, and large pieces of meat require careful supervision as they can block airways.
Education and Training
Learn proper first aid for choking techniques and keep your skills current. Many organizations offer training courses that can build your confidence and competence. Share this knowledge with family members and colleagues to create a safer environment for everyone.
How to Build Your Confidence to Handle a Choking Emergency?
Confidence in emergencies comes from knowledge, practice, and preparation. Here are some strategies to follow to respond effectively in critical situations,
Regular Skills Practice
Practice first aid techniques regularly with family members or friends. Many community centers and healthcare facilities offer hands-on training sessions with manikins or simulation videos to make the scenario more realistic. The more familiar you become with the techniques, the more naturally you’ll respond in an emergency.
Mental Preparation
Visualize yourself successfully helping someone who is choking. Mental rehearsal can help you remain calm and focused during actual emergencies. Remember that your knowledge and quick action can literally save a life.
Overcoming Psychological Barriers
People worry about breaking ribs, causing internal damage, or “making things worse” with forceful techniques like abdominal thrusts. This fear often leads to hesitant, ineffective attempts or completely prevents you from acting. Proper first aid training addresses this psychological barrier and gives you the confidence to immediately take charge, while directing others to assist you.
Read More: How to Administer Basic First Aid For Workplace Emergencies
What You’ve Been Taught Wrong About Choking First Aid?
Common misconceptions about choking first aid can be dangerous. These myths persist because they seem logical, but they can worsen the situation or cause additional harm. Here are some practices to avoid handling choking incidents.
The Finger Sweep Fallacy
The instinct to reach into someone’s mouth and sweep out the object is natural, but dangerous. Blind finger sweeps can push the obstruction deeper into the airway, making it harder to remove. Only attempt finger sweeps if you can clearly see the object and safely grasp it.
The Water Drinking Myth
Many people believe giving water to a choking person will help wash down the obstruction. This is completely false and dangerous. Water can cause the person to aspirate fluid into their lungs, creating additional complications. Never give anything to drink to someone who is choking.
Choking First Aid: Recognize and React to Save A Life
Choking emergencies demand immediate, confident action. With proper knowledge of choking first aid methods, you can overcome the psychological barriers and potentially save a life. Learn the warning signs, age-appropriate techniques, and prepare yourself mentally for emergency response. Also, make sure to focus on prevention strategies to prevent the occurrence of choking in the first place. Cut food appropriately, eat slowly, and remove small objects from reach. But when emergencies strike, your confident action with first aid guidelines saves lives. So, enroll in a certified online first aid course to practice these techniques with interactive simulations and expert guidance, anywhere at your convenience.
