Choking occurs when a foreign object obstructs your airway and prevents oxygen from reaching your lungs. In fact, choking affects around 5,000 Americans each year, making it the leading cause of unintentional injury death. If you notice someone choking, call 911 immediately. But brain damage can occur within minutes without oxygen, even before emergency responders arrive. Therefore, you must act immediately while help is on the way.
The Heimlich maneuver is a series of abdominal thrusts designed to force air from the lungs and dislodge the obstruction. However, the technique varies based on the person’s age and even for pets. You need to know these variations because choking emergencies don’t wait for paramedics to arrive.
Keep on scrolling to find out how to do the Heimlich Maneuver on different populations!
What Is the Heimlich Maneuver?
The Heimlich maneuver is an emergency abdominal thrust technique that removes airway obstructions in choking victims. You perform rapid, upward thrusts below the ribcage with the purpose of creating force against the lungs. This force consequently pushes the air from the lungs through the trachea and out to expel the obstruction. The American Heart Association (AHA) recognizes the Heimlich maneuver as the standard first aid response for conscious choking victims who are adults or children over one year of age.
When Should You Perform the Heimlich Maneuver?
You should only attempt the Heimlich maneuver when the individual presents universal choking signs, and he or she is not able to breathe at all. Act instantly if you notice any of the following symptoms:
- Inability to speak or produce sounds
- silent coughing or not coughing at all
- Clutching throat with both hands (universal choking sign)
- Turning blue or purple
- Unable to breathe or gasping
- Unconsciousness
Note: If the victim has a strong cough and is able to speak, do not attempt the maneuver. The presence of a strong cough implies partial blockage of the airway, which might be cleared by the victim himself.
How to Perform the Heimlich Maneuver?
The way to perform the Heimlich maneuver depends on the age and physical condition of the victim. You will need to adapt your technique for adults, children, and yourself. Here are step-by-step protocols to follow in each case:
On Adults
Step 1: Position Yourself Correctly
Stand directly behind the choking person. Wrap your arms around their waist. Position yourself with one foot forward for good balance. Lean the person slightly forward.
Step 2: Clench Your Fist and Position It
Form a fist with one hand. With the thumb side against the person’s abdomen, place your fist at or slightly above the navel, below the ribcage. Do not place your hands on the ribcage or the sternum. Grasp the fist with your other hand.
Step 3: Quick Upward Thrusts
Pull your fist inward and upward with quick, forceful thrusts. Use enough force to lift the person slightly off the ground. Repeat thrusts until the object is dislodged. Each thrust should be a separate and distinct motion, not continuous pressure. If the person becomes unconscious, call 911 and begin CPR immediately.
On Children (Above One Year)
Step 1: Adjust Your Position
Kneel behind the child at their height level. For small children, this may involve supporting them on your lap. Gently but firmly wrap your arms around the child’s waist.
Step 2: Make a Small Fist
Make a fist, sized appropriately to the child’s smaller body size. Place it just above the navel and below the breastbone. Use less force than you would for adults. Grasp your fist with your other hand securely.
Step 3: Give Gentle Upward Thrusts
Perform quick, upward thrusts with controlled force suitable for children. Keep in mind that abdominal thrusts are only for children over age. Continue until the object comes out or help arrives. Watch for signs of distress or loss of consciousness. For conscious choking infants under one year old, the first-aid protocol combines up to five back blows followed by up to five chest thrusts.
On Yourself
Step 1: Make a Fist on Your Abdomen
Place your fist above your navel and below your ribcage. Grasp your fist with your other hand firmly. Lean towards a sturdy surface like the back of a chair or countertop.
Step 2: Do Self-Thrusts
Make quick, upward abdominal thrusts using your fist. Continue until the blockage is relieved or help arrives. You can also bend over a hard surface and press your upper abdomen against it.
Step 3: Use Furniture if Necessary
If abdominal thrusts do not work, lean over a chair back or on the edge of a countertop and push sharply into it with your abdomen. Repeat this until the object is fully dislodged.
In case you cannot breathe, cough, or make noise, call 911 immediately if possible and seek help if someone is around.
| Victim Type | Hand Position | Force Level | Key Difference |
| Adults | Above navel, below ribcage | Firm, controlled, and upward | Stand behind, use maximum appropriate pressure |
| Children (1+ years) | Above navel, below breastbone | Moderate force, gentler thrusts | Kneel or sit, reduce pressure significantly |
| Self | Above navel, below ribcage | Strong, quick thrusts | Use the furniture edge if hand thrusts fail |
When Should You NOT Perform the Heimlich Maneuver?
The Heimlich maneuver can be damaging in certain situations and to specific populations. Be aware of these exceptions and apply appropriate adaptations.
Infants (less than one year)
You should never use abdominal thrusts on infants under 12 months. Their internal organs are too delicate and vulnerable to injury.
What to Do Instead:
- Position the infant face down on your forearm
- Support their head and jaw with your hand (avoid pressure on the throat)
- Give five firm back blows with the heel of your hand between the shoulder blades
- Turn the infant face-up on your other forearm, keeping the head lower than the chest.
- Perform five chest thrusts using two fingers on the breastbone, just below the nipple line.
- Alternate back blows and chest thrusts until the object clears
- Call 911 immediately if the infant becomes unconscious
On Pregnant Women (Third Trimester)
Abdominal thrusts pose risks to both mother and baby during advanced pregnancy. The uterus occupies the abdominal space where you normally apply pressure.
What to Do Instead:
- Stand behind the pregnant woman.
- Place your arms around her under the armpits and across the chest.
- Put your fist on the lower half of the sternum.
- Perform firm chest thrusts rather than abdominal thrusts
- Continue until the obstruction clears or assistance is provided
- Avoid putting pressure on the abdomen altogether
On Unconscious Persons
A choking victim who becomes unconscious cannot benefit from the Heimlich maneuver, and the technique is inappropriate for such a person. Unconscious victims require other life-saving maneuvers.
What to Do Instead:
- Ensure the area is safe and free from hazards.
- Lower the person gently back onto the floor on their back
- Immediately call 911, or delegate someone to call
- Initiate CPR – start with 30 chest compressions
- Check the mouth for visible objects before giving breaths
- Remove objects only if clearly visible and accessible.
- Continue the cycles of CPR until help arrives or the person reacts.
- Never do blind finger sweeps in the mouth.
On Individuals with Severe Obesity
You cannot effectively reach around the abdomen of extremely obese individuals, and chest thrusts may be required.
What to Do Instead:
- Stand behind the person
- Put your arms under their armpits
- Place your fist on the lower half of the breastbone
- Make rapid, backward thrusts against the chest
- Continue until the blockage is cleared
How to Perform the Heimlich Maneuver on Pets?
Your pets can choke on toys, bones, or food just like humans. According to veterinary emergency data, choking ranks among the top life-threatening pet emergencies.
You might notice one of the following signs if your pet is choking:
- Pawing desperately at the mouth.
- Making repeated gagging or retching noises
- Foaming at the mouth or excessive drooling
- Blue or pale gums indicate loss of oxygen.
- Laboured breathing or gasping for air
- Distress, panic or frantic behaviour
- Unconsciousness, in severe cases
If you witness any of the following signs, take action to do the Heimlich maneuver immediately:
- Step 1: Safety First-Look in the Mouth: Gently restrain the animal, open the mouth carefully, and remove only objects that are visible and within easy reach.
- Step 2: Position Your Hands Properly: For larger dogs, stand behind them and wrap your arms around their abdomen; for smaller pets, hold them against your chest with their back towards you, then place a fist in the soft area just below the ribcage.
- Step 3-Abdominal Thrusts: Give five quick, firm upward thrusts using force appropriate to your pet’s size. Check the mouth after each set to see if the object has dislodged.
- Step 4: Immediate Veterinary Care: Take your pet to an emergency veterinary clinic immediately, calling ahead so the veterinary clinic may prepare for your arrival. Even if the object clears, professional examination is important to check for internal injuries.
When to Stop the Heimlich Maneuver
If you continue to perform abdominal thrusts even after they are no longer needed, it might cause injury. Stop performing the Heimlich maneuver in the following situations:
- The object dislodges, and the person is able to breathe, speak, or cough forcefully.
- The client coughs productively independently and air exchange is enhanced
- The victim becomes unconscious or unresponsive – switch to CPR immediately
- You see the obstructing object come out of the person’s mouth.
- Able to phonate (speak clearly) or cry (in children), showing that the airway is open
- Emergency medical personnel arrive and take over care
- You are too fatigued to continue and others, equally well trained, must relieve you
- The color of a person returns to normal, and breathing stabilizes.
- You have executed abdominal thrusts unsuccessfully for several minutes and the person becomes unconscious.
When To Get Medical Care After the Heimlich Maneuvre?
After the Heimlich maneuver has been stopped, continue to monitor the person closely. Even after the obstruction has been cleared, complications can develop. After the Heimlich maneuver, seek immediate medical care in the following conditions:
- Severe or worsening abdominal pain
- Difficulty breathing even after removing the obstruction
- Coughing up blood or blood in vomit
- Rapid heartbeat or dizziness, suggesting internal bleeding
- Chest pain, which worsens with respiration
- Visible abdominal distension or rigidity
- Any concern about persistent airway obstruction
What are the Risks of the Heimlich Maneuver?
The Heimlich maneuver saves lives but is not without potential complications. The force exerted to dislodge an airway obstruction is strong enough to cause internal injuries. However, this risk of injury is acceptable to save someone who can not breathe because of an obstruction:
Here are common risks and the right ways to deal with them:
Broken or Fractured Ribs
Abdominal thrusts can also lead to rib fractures, especially among the elderly or those with chronic osteoporosis.
Solution: Firm but controlled application of force and a medical checkup post-procedure for any fractures.
Internal Organ Damage
Abdominal thrusts can bruise or injure the liver, spleen, or lining of the stomach.
Solution: Correctly position the fist above the navel and below the rib cage to avoid the impact on internal organs.
Abdominal Bruising and Soreness
Most patients have some tenderness and bruising at the thrust site for several days.
Solution: Use ice on the swelling to reduce it, and watch for increasing pain as a sign of deeper injury.
Xiphoid Process Injury
If the hands are placed too high, the small cartilage at the bottom of the breastbone can break.
Solution: Keep your fist well below the rib cage and above the navel to avoid this delicate area.
Vomiting and Aspiration of Gastric Contents
Abdominal pressure can induce vomiting, which also creates added choking hazards.
Solution: After successful intervention, move the victim forward or to the side to prevent inhaling vomit.
Injury to the Pregnant Woman’s Uterus
Abdominal thrusts during pregnancy can injure the fetus or traumatize the uterus.
Solution: Always use chest thrusts instead of abdominal thrusts on a pregnant woman in her second or third trimester.
Learn the Heimlich Maneuver to Stay Prepared and Save Lives!
When someone is choking, every second counts, and knowing the Heimlich maneuver can make all the difference between life and death. This lifesaver technique is so simple yet so effective when done right. But knowing what to do is not enough in an emergency. Your hands must know what to do when your brain panics. Certification training will provide you with the confidence and muscle memory to take immediate action.
Sign up now for our online first aid course and be confident to take immediate action in the event of a choking emergency. Our flexible, convenient training allows you to learn at your own pace from anywhere!
FAQs
1. Is the Heimlich maneuver appropriate for an unconscious and unresponsive patient?
No, never give abdominal thrusts to an unconscious person. Instead, carefully lower them to the ground and start CPR with 30 chest compressions; look into their mouth for visible objects before giving rescue breaths, removing anything you see, then continue CPR until help arrives.
2. What should you do if a choking victim becomes unconscious?
When someone collapses unconscious, stop the Heimlich maneuver. Gently lower them to the floor and call 911 if you have not already. Start CPR with chest compressions, checking the mouth for visible blockages before each series of rescue breaths.
3. How do I remove phlegm from the throat of a baby?
Never attempt to use the Heimlich maneuver to remove phlegm. Keep your baby upright while feeding and use a bulb syringe after feeding to help clear the nasal passages. If your baby is having trouble breathing or seems distressed while breathing, call your pediatrician immediately.
4. In what way is CPR different for an unresponsive adult victim of choking?
For an unconscious choking victim: begin CPR having chest compressions without first checking the pulse. Before attempting rescue breaths, open the airway by looking into the mouth for any objects that can be easily removed. Never attempt blind finger sweeps, which can push objects farther into the airway.
