To open a child’s airway, you gently tilt the head back and lift the chin forward, a technique called the head-tilt chin-lift. The exact amount of head tilt depends on the child’s age: infants need only a slight tilt to a neutral or “sniffing” position, while older children need a bit more extension, similar to an adult. Getting this right matters because a child’s airway is smaller and softer than an adult’s, and tilting too far in either direction can actually make the obstruction worse.
Why a Child’s Airway Is Different
Children are not simply small adults when it comes to airway anatomy. A few key differences explain why the technique changes with age. Infants have a proportionally large tongue relative to their mouth, which means the tongue is more likely to fall back and block the airway when a child is unconscious. The voice box sits higher in the neck, right behind the tongue, making it especially vulnerable to compression. And the cartilage rings that hold the windpipe open are soft and pliable, so they can collapse under pressure or when the neck is bent at an extreme angle.
Infants between about 2 and 6 months are also preferential nose breathers, meaning they rely heavily on their nasal passages. Any positioning that pushes the chin toward the chest or cranks the head too far back can pinch off their already narrow airway. The narrowest point in a child’s airway sits just below the vocal cords, at a ring of cartilage called the cricoid. In adults, the narrowest point is higher up. This lower bottleneck is one reason even small amounts of swelling or misalignment cause big problems in young children.
Head-Tilt Chin-Lift for Infants Under 1
For babies, the goal is a neutral to slightly extended head position, sometimes called the “sniffing position.” Imagine the baby looking straight ahead or just barely looking upward. MRI-based research on infants up to 4 months old found that a slightly extended head position gave a greater than 95% probability of a clear airway. By contrast, when the head was hyperextended (tilted too far back), the probability of a clear airway dropped below 20%. That’s a dramatic difference from a small change in angle.
Here’s how to do it: lay the baby on a firm, flat surface on their back. Place one hand on the forehead and use the fingertips of your other hand to lift the bony part of the chin. You want to bring the chin up just enough that the nose points toward the ceiling, not past it. Because infants have a large, rounded back of the head (the occiput), their neck naturally flexes forward when they lie flat. To counteract this, place a thin folded towel or small pad under the shoulders. This brings the head into alignment without you having to force it.
Avoid pressing on the soft tissue under the chin. Pushing into the fleshy area beneath the jaw can compress the airway from the outside, which defeats the purpose. Only lift on the bony ridge of the chin itself.
Head-Tilt Chin-Lift for Children Over 1
For children roughly aged 1 through puberty, the technique is the same in principle but allows slightly more head extension. Place one hand on the forehead and tilt the head back while lifting the chin with your other hand’s fingertips. The tilt can be a bit more pronounced than with an infant because the airway cartilage is firmer and the proportions of the head and neck are closer to an adult’s.
Shoulder padding is still helpful for younger children in this age range, since the back of the head remains relatively large compared to the body until around age 6 or 7. Without that padding, laying a toddler flat can push the chin toward the chest and force the tongue backward, worsening obstruction rather than relieving it. A rolled-up towel under the shoulders solves this quickly.
When to Use the Jaw-Thrust Instead
If there’s any chance the child has a neck or spinal injury, such as after a fall, car accident, or diving incident, you should not tilt the head. Instead, use the jaw-thrust maneuver, which opens the airway without moving the neck.
Position yourself at the top of the child’s head. Place your palms on the sides of the head, near the temples, and hook your fingertips under the angles of the jawbone on both sides. Push the jaw upward and forward until the lower teeth are higher than the upper teeth. This pulls the tongue away from the back of the throat and clears the airway while the neck stays in a neutral position. As with the chin-lift, press only on bone. Any pressure on the soft tissue of the neck can compress the airway.
What to Do After Opening the Airway
Once the airway is open, check for breathing. Look for chest rise, listen for breath sounds, and feel for air against your cheek. You have about 10 seconds to assess whether the child is breathing and whether you can feel a pulse. Research shows that even trained healthcare providers tend to take around 20 seconds for a pulse check, so be deliberate about keeping it brief. If the child is not breathing or only gasping, begin rescue breaths immediately.
Signs that the airway is still partially blocked include a high-pitched whistling sound during breathing (called stridor), visible sucking-in of the skin between the ribs or at the base of the throat, and labored or noisy breathing. If you see these after repositioning, adjust the head tilt slightly. Sometimes just a small change in angle makes the difference.
If the Child Is Choking
Airway obstruction from a foreign object requires a different response than simply opening the airway. The 2025 American Heart Association and American Academy of Pediatrics guidelines updated the approach for both age groups.
For infants under 1 with a severe obstruction (unable to cry, cough, or breathe): sit down and hold the baby facedown along your forearm, resting your forearm on your thigh. Support the head and jaw with your hand, keeping the head lower than the body. Deliver 5 firm back blows between the shoulder blades with the heel of your hand, then flip the baby face-up and give 5 chest thrusts using two fingers in the center of the chest, just below the nipple line. Alternate between 5 back blows and 5 chest thrusts until the object comes out or the baby becomes unresponsive. Do not use abdominal thrusts on an infant.
For children over 1: the updated guidelines now recommend alternating 5 back blows with 5 abdominal thrusts. For abdominal thrusts, kneel behind the child, wrap your arms around their waist, and press inward and upward just above the belly button. Continue alternating until the blockage clears.
Common Mistakes That Block the Airway
The most frequent error is over-tilting an infant’s head. It’s intuitive to think more tilt means more opening, but the opposite is true in babies. Hyperextension kinks the soft trachea the same way bending a garden hose stops water flow. The research is clear: extreme extension and extreme flexion are both dangerous, and the safe zone for infants is a narrow range of slight extension.
Placing a pillow under an infant’s or toddler’s head is another common mistake. The pillow pushes the chin toward the chest, drives the tongue backward, and worsens obstruction. If you need padding, it goes under the shoulders, not the head.
Pressing on soft tissue is the third major error. Whether you’re doing a chin-lift or jaw-thrust, your fingers should only contact bone. The structures of a child’s neck, including the windpipe and voice box, are soft enough to compress under finger pressure, and pressing into the tissue beneath the jaw can push the tongue upward into the airway.