If a child is choking and cannot cough, cry, or breathe, you need to act immediately. The technique depends on the child’s age: babies under 1 year get back blows and chest thrusts, while children over 1 year get back blows followed by abdominal thrusts. Every second matters, so knowing these steps before an emergency happens is what saves lives.
Partial vs. Complete Blockage
Before you intervene physically, figure out what you’re dealing with. A child who is coughing forcefully, making noise, or crying has a partial blockage. In this case, encourage them to keep coughing. A strong cough is more effective at clearing an airway than anything you can do from the outside. Do not slap their back or perform thrusts while they can still cough, because you risk shifting the object into a worse position.
A complete blockage looks different. The child cannot cry, talk, breathe, or cough. They may clutch at their throat, turn red or blue, or make high-pitched squeaking sounds as they try to pull air past the object. Silence is the most alarming sign. If you see this, have someone call 911 and begin rescue steps right away. If you’re alone, perform two minutes of rescue efforts before pausing to call.
For Babies Under 1 Year Old
The infant technique uses alternating back blows and chest thrusts in sets of five. Do not use abdominal thrusts on a baby, as their organs are too fragile.
Start by sitting down and placing the baby face-down along your forearm, using your thigh for support. Keep the baby’s head lower than their body. Using the heel of your free hand, deliver 5 firm back blows between the shoulder blades. Each blow should be a distinct, deliberate strike, not a pat.
If the object hasn’t come out, turn the baby face-up on your forearm, still resting on your thigh, still keeping the head lower than the chest. Place two fingers on the center of the breastbone, just below the nipple line. Give 5 chest thrusts, pressing down about 1½ inches deep. These should be sharp and quick, like you’re trying to pop the object upward.
Continue alternating 5 back blows and 5 chest thrusts until the object comes out, the baby starts breathing or crying, or the baby becomes unconscious.
For Children Over 1 Year Old
The 2025 American Heart Association guidelines updated the protocol for children over 1 year. The recommended sequence now starts with 5 back blows, followed by 5 abdominal thrusts, repeating as necessary. This matches the infant approach for consistency and reflects evidence that back blows help dislodge objects effectively.
Back Blows
Stand or kneel behind the child (kneel if they’re small). Lean them forward slightly and deliver 5 firm back blows between the shoulder blades with the heel of your hand.
Abdominal Thrusts
Wrap your arms around the child’s midsection from behind. Make a fist with one hand and place the thumb side just below the ribcage, about two inches above the belly button. Clasp your other hand around the fist. Thrust sharply inward and upward 5 times. For children under 5 or weighing less than 45 pounds, kneel to get to their level and use gentler force than you would for an older child or adult.
Keep cycling: 5 back blows, then 5 abdominal thrusts. Stop when the object is expelled or the child can breathe and cough again.
If the Child Loses Consciousness
A child who goes limp and stops responding needs a different approach. Lower them carefully onto their back on a firm, flat surface. If no one has called 911 yet, do it now.
Begin CPR with chest compressions. Push down about 2 inches on the center of the chest, 30 compressions, fast and hard with no pausing. The compressions themselves can help dislodge the object by changing pressure in the chest.
After 30 compressions, open the child’s mouth and look inside. If you can see the object and it’s loose, remove it. If you can’t see it, do not sweep your finger blindly around the throat. Blind finger sweeps can push the object deeper or injure the soft tissue at the back of the throat. Case reports in emergency medicine journals have documented pharyngeal trauma from this exact mistake.
After checking the mouth, tilt the head back to open the airway and give 2 rescue breaths. If the chest doesn’t rise, reposition and try again. If it still won’t rise, the airway is still blocked. Go back to 30 chest compressions, check the mouth, attempt 2 breaths, and repeat. Continue this cycle until the child starts breathing, the object comes out, or emergency responders arrive.
What to Do After the Object Comes Out
Even after a successful rescue, the child should be evaluated by a doctor. Abdominal thrusts can bruise internal organs, crack ribs in small children, or cause soft tissue damage that isn’t immediately obvious. Chest thrusts carry similar risks for infants.
There’s also the possibility that a small piece of the object broke off and was inhaled into the lungs. This can cause coughing, wheezing, or a rattling sound when breathing in the hours that follow. A persistent cough, difficulty swallowing, drooling, or throat pain after a choking episode are all reasons to head to the emergency room, even if the child seems fine at first.
Common Choking Hazards to Watch For
Most choking incidents in young children involve food. The highest-risk foods share a few traits: they’re round, firm, slippery, or sticky enough to seal off a small airway. Hot dogs, grapes, and cherry tomatoes are the classic culprits because their shape matches a child’s airway almost perfectly. Other dangerous foods include whole nuts and seeds, popcorn, chunks of raw carrot or apple, hard candy, marshmallows, and spoonfuls of peanut butter.
The CDC’s full list of foods to avoid or modify for young children is extensive:
- Fruits and vegetables: whole grapes, uncut cherry tomatoes, raw carrots, whole berries, raisins, melon balls, whole corn kernels
- Proteins: hot dogs, sausages, tough or large chunks of meat, whole nuts, chunks of peanut butter
- Snacks and grains: popcorn, chips, pretzels, crackers with seeds or whole grain kernels, granola bars
- Sticky or chewy items: marshmallows, chewing gum, chewy fruit snacks
You don’t have to ban all of these permanently. Many just need to be prepared differently. Cut grapes and cherry tomatoes lengthwise into quarters. Shred or finely chop meats. Spread nut butters in a thin layer rather than giving a child a glob on a spoon. Cook hard vegetables until they’re soft enough to mash with gentle pressure. These small adjustments eliminate most of the risk while still letting kids eat a wide variety of foods.
Beyond food, small household objects are a constant threat for babies and toddlers. Coins, button batteries, small toy parts, pen caps, and deflated or broken balloon pieces are among the most commonly aspirated non-food items. A general rule: anything that fits through a toilet paper tube can lodge in a young child’s airway.