Chest thrusts are a choking rescue technique used when standard abdominal thrusts (the Heimlich maneuver) aren’t safe or practical. They work the same way, using sharp bursts of pressure to force air up through the windpipe and push out whatever is stuck. You’ll use chest thrusts in three main situations: when someone who is choking is pregnant, when they’re too large for you to wrap your arms around their midsection, or when the person choking is an infant under one year old.
When to Use Chest Thrusts Instead of Abdominal Thrusts
For most choking adults and children past puberty, abdominal thrusts are the standard technique. Chest thrusts become the right choice when abdominal thrusts could cause harm or simply won’t work. The American Red Cross identifies three scenarios: the person is obviously pregnant, the person is too large for you to reach around their abdomen, or the person is in a wheelchair and you can’t get enough leverage for effective abdominal thrusts.
For infants younger than about one year old, abdominal thrusts are never used. The 2025 American Heart Association guidelines recommend repeated cycles of 5 back blows alternating with 5 chest thrusts for infants with severe choking. Children from age one through puberty follow a different protocol using back blows and abdominal thrusts, not chest thrusts.
Chest Thrusts on a Pregnant or Large Adult
Stand directly behind the person and wrap your arms around their chest, under the armpits. Make a fist with one hand and place it on the middle of the breastbone, right between the nipples. Wrap your other hand around the fist.
Pull sharply backward with both arms, delivering a firm inward thrust into the chest. The motion is straight back, not upward like an abdominal thrust. You want a significant, abrupt force. Timid pushes won’t generate enough air pressure to dislodge the object. Give 5 chest thrusts in a row, then check whether the object has come out. If the person is still choking, repeat the cycle.
If the person becomes unconscious at any point, lower them to the ground carefully, call 911 (if not already done), and begin CPR.
Chest Thrusts on an Infant
The infant technique looks completely different from the adult version. Start with back blows: hold the baby face-down along your forearm, supporting the head and jaw with your hand, and keep the infant’s head lower than the body. Using the heel of your free hand, deliver 5 firm blows between the shoulder blades.
If the object doesn’t come out, flip the infant face-up on your forearm, still keeping the head lower than the body. Place 2 fingers on the center of the chest, just below the nipple line. Push down quickly and firmly, compressing the chest about one-third to one-half its depth. For most infants, that’s roughly half an inch to an inch and a half. Give 5 quick thrusts.
Continue alternating between 5 back blows and 5 chest thrusts until the object comes out, the infant starts crying or coughing forcefully, or the infant becomes unresponsive. If the baby loses consciousness, stop the back blow and chest thrust cycle and begin infant CPR.
How Much Force to Use
This is where many people hesitate, and hesitation is the biggest mistake in a choking emergency. The MSD Manual states directly that “significant, abrupt force is appropriate for these maneuvers.” A gentle squeeze will not create enough air pressure behind the obstruction to move it. Each thrust should be a distinct, sharp burst of effort, not a slow push.
That said, you do need to match your force to the person’s size and fragility. An infant’s chest compresses with two fingertips. An adult needs the full force of both arms pulling backward. The goal is a sudden spike in chest pressure that mimics a powerful cough, which is ultimately what dislodges the object.
People in Wheelchairs
If someone in a wheelchair is choking, try abdominal thrusts first by kneeling behind the chair. If you can’t get enough leverage or can’t reach around their abdomen effectively, switch to chest thrusts using the same technique described for adults: arms wrapped around the chest, fist centered on the breastbone, firm backward thrusts. The wheelchair back may limit your positioning, so you may need to angle yourself to the side or lock the wheels to keep the chair stable.
After the Object Comes Out
Even after a successful rescue, chest thrusts can cause bruising to the chest wall or, in rare cases, rib fractures. This is especially true for infants and elderly adults. If the person had a prolonged choking episode, there’s also a risk that small fragments entered the lungs. Any persistent coughing, chest pain, difficulty swallowing, or breathing trouble after the incident warrants a trip to the emergency room, even if the person feels mostly fine in the moment.