Choking first aid: back blows and the Heimlich maneuver for adults, children and babies

Choking on a foreign object, usually food, can happen to anyone at any time: a child with a candy, an older person with a piece of meat, an adult laughing while eating. The brain survives only a few minutes without oxygen, and an ambulance usually takes longer to arrive. What you do in the first minute matters.

This guide follows European Resuscitation Council guidelines. It doesn’t replace a first aid course, where you practice on a manikin.

How to recognize choking

Partial blockage: the person is coughing, can speak and is breathing, even if with difficulty. Encourage them to cough. Don’t hit their back or give them water. Stay with them.

Complete blockage: the person can’t cough, speak or breathe. They often clutch their throat. Their face turns red, then bluish. Act immediately.

Adults and children over one

1. Ask: “Are you choking?” If they nod and can’t speak, act.
2. 5 back blows:
   • stand to the side and slightly behind them;
   • support their chest with one hand and lean them forward;
   • give 5 firm blows between the shoulder blades with the heel of your other hand;
   • check after each blow whether the object has come out.
3. 5 abdominal thrusts (Heimlich maneuver):
   • stand behind them and put your arms around their waist;
   • make a fist and place it between the navel and the bottom of the breastbone;
   • grasp the fist with your other hand;
   • pull sharply inward and upward, up to 5 times.
4. Alternate 5 back blows and 5 abdominal thrusts until the object comes out or the person becomes unresponsive.
5. Call the emergency number, or have someone call, as early as possible.

For children, use the same technique but adjust the force to their size. Kneel to get to their height.

Pregnant women and larger people

Instead of abdominal thrusts, give chest thrusts: fist on the lower half of the breastbone, pull sharply inward.

Babies under one

1. 5 back blows:
   • lay the baby face down along your forearm, head lower than the body, supporting the jaw with your fingers;
   • rest your forearm on your thigh;
   • give 5 firm blows between the shoulder blades with the heel of your hand.
2. 5 chest thrusts:
   • turn the baby face up on your other forearm, head lower;
   • press firmly with two fingers in the center of the chest, just below the nipple line, 5 times.
3. Alternate until the object comes out or the baby becomes unresponsive.
4. Never give abdominal thrusts to a baby.
5. Don’t sweep the mouth with your fingers unless you can clearly see the object and remove it easily.

If they become unresponsive

1. Lower them carefully onto their back on a firm surface.
2. Call the emergency number and put the phone on speaker.
3. Start CPR: 30 chest compressions, then 2 breaths.
4. Before giving breaths, look in the mouth: if you see the object, remove it.

Prevention

• Cut food for young children into small pieces; quarter grapes and cherry tomatoes.
• Don’t give nuts, hard candy or popcorn to children under 4–5.
• Keep small toys, button batteries and magnets away from children.
• Children eat sitting at the table, not running around.