Back blows are firm strikes delivered between the shoulder blades to dislodge an object stuck in someone’s airway. They are the recommended first response to choking, delivered in sets of five, and the technique differs significantly depending on whether the person choking is an adult, a child, or an infant. Here’s exactly how to do it.
When To Use Back Blows
Back blows are appropriate when someone has a blocked airway and can no longer cough effectively. You’ll recognize this by a weak or silent cough, inability to speak or cry, high-pitched or no breathing sounds, and skin that may be turning blue. If the person is still coughing forcefully, encourage them to keep coughing. That’s more effective than any external intervention. Back blows are for the moment when coughing alone isn’t working.
International resuscitation guidelines from ILCOR recommend using back blows as the first technique for choking, before moving to abdominal thrusts if the back blows don’t work.
How Back Blows Work
Each strike between the shoulder blades sends a sharp wave of pressure through the chest cavity. This creates a burst of air behind the lodged object, similar to an artificial cough. Gravity helps too. Because you lean the person forward (or hold an infant face-down), the dislodged object can fall out of the mouth rather than sliding deeper into the airway. The combination of force, air pressure, and positioning is what makes back blows effective.
Back Blows for Adults and Children Over 1 Year
Stand to the side and slightly behind the choking person. Place one arm across their chest to brace and support their upper body. Then bend them forward at the waist so their head and chest are facing the ground. This forward lean is critical. Without it, you risk pushing the object further down.
Using the heel of your other hand (the fleshy base of your palm, not your fist), strike firmly between the shoulder blades. Deliver five separate, distinct blows. Each one should be a deliberate strike, not a pat. You’re aiming for enough force to generate that burst of pressure in the chest. Check after each blow to see whether the object has come out. If the person starts coughing, breathing, or talking, stop.
If all five back blows fail to clear the airway, switch to abdominal thrusts (the Heimlich maneuver) and alternate between five back blows and five abdominal thrusts until the object comes out or help arrives.
Back Blows for Infants Under 1 Year
The technique for infants requires much more careful positioning because of their small, fragile bodies. You can sit, kneel, or stand for this.
Place the infant face-down along your forearm, using your thigh to brace and support that arm. Cradle the infant’s head in your hand, with your fingers supporting the jaw on either side. Their head must be lower than their chest at all times. This downward angle lets gravity work in your favor.
With the heel of your free hand, deliver five firm back blows between the infant’s shoulder blades. Use noticeably less force than you would for an adult, but the blows still need to be deliberate. Gentle taps won’t generate enough pressure.
If the five back blows don’t clear the object, turn the infant face-up on your forearm (still keeping the head lower than the chest) and deliver five chest thrusts using two fingers pressed on the breastbone, just below the nipple line. Alternate between five back blows and five chest thrusts. Do not use abdominal thrusts on an infant, as their internal organs are too vulnerable.
Common Mistakes To Avoid
- Not leaning the person forward enough. If the person is upright or leaning back, a dislodged object can slide deeper into the airway instead of falling out.
- Striking too high or too low. Aim directly between the shoulder blades. Hitting the lower back or the neck reduces effectiveness and risks injury.
- Using your fist. The heel of your open palm distributes force across a wider area and is more effective at creating airway pressure than a punch.
- Being too gentle. Timid pats won’t generate enough pressure to move a stuck object. Each blow should be sharp and forceful.
- Holding an infant face-up for back blows. The infant must be face-down with head lower than chest. Turning them face-up is only for the chest thrust phase.
If the Person Loses Consciousness
When a choking person becomes unresponsive, the situation changes immediately. Lower them to the ground on their back and call emergency services if you haven’t already. Begin CPR, starting with chest compressions. Each time you open the airway to give a breath, look in the mouth for the object. If you can see it, remove it. If you can’t see it, do not sweep your fingers blindly through the mouth, as this can push the object deeper.
What To Do After the Object Comes Out
Even after a successful rescue, anyone who has choked should get a medical evaluation. The force of back blows and abdominal thrusts can cause internal bruising, and small fragments of the object may remain in the airway without causing obvious symptoms right away.
In the days following a choking episode, watch for a persistent cough, fever, difficulty swallowing or speaking, shortness of breath, or wheezing. Any of these can signal that part of the object is still lodged in the airway or that tissue was damaged during the episode, and they require prompt medical attention.