To help a choking adult, stand behind them, place your fist just above their navel, and deliver quick upward and inward thrusts until the object comes out. The latest 2025 American Heart Association guidelines recommend alternating 5 back blows with 5 abdominal thrusts in repeated cycles. Here’s exactly how to do it, including modifications for infants, pregnant individuals, yourself, and what to do if someone loses consciousness.
How to Tell if Someone Needs Help
Not every choking episode requires intervention. If someone is coughing forcefully, their airway is only partially blocked, and coughing is the most effective way to clear it. Let them cough. The time to act is when the airway is completely blocked.
Signs of a complete airway obstruction:
- Can’t speak, cry, cough, or breathe
- Grasps their throat (the universal choking sign)
- Skin turns blue or dusky
- Becomes severely anxious or agitated
- Loses consciousness
If you see any of these, act immediately. Have someone call 911 while you begin.
The Full Technique for Adults
The current recommended approach cycles between two techniques: back blows and abdominal thrusts. You repeat sets of 5 and 5 until the object is expelled or the person becomes unresponsive.
Back Blows
Stand to the side and slightly behind the person. Place one arm across their chest for support and lean them forward at the waist so their upper body is angled toward the ground. Using the heel of your other hand, deliver 5 firm blows between the shoulder blades. Each blow should be a distinct, forceful strike, not a pat. The forward lean uses gravity to help move the object toward the mouth.
Abdominal Thrusts
Stand directly behind the person and wrap your arms around their waist. Make a fist with one hand and place it thumb side in, just above their navel. Grasp that fist with your other hand. Press into their abdomen with a quick upward and inward thrust, as if you’re trying to lift them off the ground. Each thrust should be a separate, deliberate motion. Deliver 5 thrusts, then switch back to 5 back blows.
Keep alternating between 5 back blows and 5 abdominal thrusts. Don’t stop until the object comes out, the person can breathe and cough on their own, or they lose consciousness.
How to Do It on Yourself
Choking while alone is terrifying, but you can perform abdominal thrusts on yourself. Make a fist and place it just above your navel. Grab your fist with your other hand and shove inward and upward in a sharp thrust. Repeat until the object dislodges.
If your own thrusts aren’t generating enough force, lean over the back of a chair, a table edge, or a railing. Position the edge against your upper abdomen, just below the ribcage, and thrust your body weight forward and down against it. Gravity and the hard surface create more pressure than your hands alone. Repeat as many times as needed.
Modifications for Pregnant or Larger Individuals
Standard abdominal thrusts aren’t safe during pregnancy and may not be effective on someone whose abdomen you can’t reach around. For pregnant individuals or people with obesity, place your hands higher. Instead of positioning your fist above the navel, place it on the center of the breastbone. The motion is the same: quick inward thrusts. You’re compressing the chest rather than the abdomen, which still forces air up through the airway.
Helping a Choking Infant
For babies under one year old, you never use standard abdominal thrusts. Their small bodies require a different approach that alternates back slaps and chest thrusts.
Sit down and hold the baby face-down along your forearm, supporting their head and jaw with your hand. Rest your forearm on your thigh so the baby’s head is lower than their chest. With the heel of your free hand, deliver 5 firm back slaps between the shoulder blades.
Then flip the baby face-up on your other forearm, still keeping the head lower than the chest. Place two fingers on the center of the breastbone, just below the nipple line, and give 5 quick chest thrusts. Each thrust should compress the chest about 1.5 inches. Alternate between 5 back slaps and 5 chest thrusts until the object comes out or the baby becomes unresponsive.
If the Person Loses Consciousness
Sometimes the object won’t come out before the person passes out. If that happens, lower them carefully to the ground on their back. Call 911 if someone hasn’t already. Begin CPR immediately, starting with chest compressions. Before each attempt to give rescue breaths, open the mouth and look for the object. If you can see it, sweep it out with a finger. If you can’t see it, don’t blindly sweep, as you risk pushing it deeper. Continue CPR until emergency responders arrive.
Chest compressions during CPR can sometimes dislodge the object on their own, since they generate significant pressure in the airway.
What to Watch for Afterward
Even after the object is successfully cleared, abdominal thrusts can cause internal injuries. A review of reported complications found abdominal injuries in nearly half of cases, with stomach rupture being the most common. Damage to the aorta and pancreas has also been documented, particularly when the technique is applied with excessive force or incorrect hand placement.
After receiving abdominal thrusts, watch for abdominal pain, chest discomfort, bruising, nausea, vomiting (especially with blood), or difficulty swallowing in the hours and days that follow. Any of these symptoms warrants a medical evaluation. Even if the person feels fine, it’s worth getting checked out, since some injuries don’t produce obvious symptoms right away. This is especially true for children and older adults, whose tissues are more vulnerable to compression injuries.