The Heimlich maneuver uses quick inward-and-upward thrusts to the abdomen to force air out of the lungs and push a stuck object out of someone’s airway. It has a success rate of roughly 86.5%, and knowing the correct hand placement and technique makes the difference between an effective rescue and a wasted, panicked effort. Here’s exactly how to do it on adults, children, infants, and yourself.
Recognizing When Someone Is Choking
Before you act, you need to know whether the airway is partially or fully blocked. Someone with a partial blockage can still cough forcefully, wheeze, or make high-pitched sounds when breathing. If they’re coughing hard, let them keep coughing. That’s the body’s own clearing mechanism, and it’s more powerful than anything you can do from the outside.
A full blockage looks different. The person can’t speak, can’t cough effectively, and may grab at their throat with both hands (the universal choking sign). Their skin may change color: bluish lips and fingernails on lighter skin, or gray or white lips and gums on darker skin. They may become agitated or confused. This is when you step in.
The Heimlich on an Adult or Older Child
Stand directly behind the person and wrap both arms around their abdomen. Make a fist with one hand, thumb side in, and place it about two inches above their belly button and just below the ribcage. Clasp your other hand tightly around the fist.
Pull sharply inward and upward in one quick motion, as if you’re trying to lift them off their feet. Deliver five thrusts in a row. Each thrust should be a distinct, forceful movement, not a squeeze. The goal is to create a burst of pressure beneath the lungs that shoots air up through the windpipe and pops the object out, like a cork from a bottle.
If the object doesn’t come out after five thrusts, repeat the cycle. Keep going until either the object is dislodged and the person can breathe, or they lose consciousness. If they go unconscious, the protocol changes (covered below).
The “5 and 5” Method
The American Red Cross recommends alternating back blows with abdominal thrusts. In this approach, you start by delivering five firm back blows between the person’s shoulder blades using the heel of your hand while they lean slightly forward. Then switch to five abdominal thrusts using the standard Heimlich technique described above. Alternate between the two until the airway clears.
Both methods are widely taught. The key point is to act decisively and with force. A gentle push won’t generate enough pressure to move a stuck object.
Infants Under One Year
Never use standard abdominal thrusts on an infant. Their small bodies require a different technique combining back blows and chest thrusts.
- Position the baby face down along your forearm, using your thigh or lap for support. Hold the chest in your hand and support the jaw with your fingers. Angle the baby’s head downward, lower than the body.
- Give five back blows between the shoulder blades using the heel of your free hand. Make them quick and forceful.
- Flip the baby face up on your forearm, still supported on your thigh, and keep the head lower than the body.
- Give five chest thrusts by placing the heel of one hand on the center of the breastbone, just below the nipple line, and pressing down firmly.
Alternate five back blows and five chest thrusts until the object comes out or the infant loses consciousness. If the infant becomes unconscious, begin infant CPR immediately and call emergency services if you haven’t already.
Performing It on Yourself
If you’re alone and choking, you can generate enough force to clear your own airway. Make a fist and place the thumb side just below your ribcage, above your navel. Grasp the fist with your other hand and thrust forcefully inward and upward.
A more effective option is to use furniture. Lean your upper abdomen over the back of a sturdy chair, the edge of a countertop, or a railing, and thrust yourself against it. Research has found that thrusting over the back of a chair generates greater pressure than a self-administered fist thrust. Since most choking happens while eating, there’s almost always a chair within reach. Repeat until the object comes free. If you can, call 911 before you start so help is on the way even if you lose consciousness.
Pregnant or Larger-Bodied Victims
For someone who is pregnant or whose abdomen is too large for you to wrap your arms around, move your hand placement up to the chest. Stand behind the person and place your fist against the center of the breastbone, not the abdomen. Wrap your other hand around the fist and deliver firm, sharp backward thrusts. The mechanics are the same: you’re creating a burst of pressure to push air up through the windpipe. You’re just generating it from the chest instead of the belly to avoid compressing the uterus or struggling with positioning.
If the Person Goes Unconscious
Lower them onto their back on a firm surface with their arms at their sides. Call 911 if someone hasn’t already. Check inside the mouth: if you can see the object, reach in with a finger and sweep it out. If you can’t see it, don’t blindly sweep, because you risk pushing it deeper.
Begin chest compressions as you would in CPR. The compressions serve double duty here: they keep blood circulating and they can generate enough pressure to dislodge the object. After each cycle of 30 compressions, tilt the head back, lift the chin, check the mouth again for the object, and attempt two rescue breaths. If the chest doesn’t rise, reposition the head and try again. Continue until the object clears, the person starts breathing, or emergency services arrive.
After the Airway Clears
Even after a successful rescue, the person should be evaluated by a medical professional. The force involved in abdominal thrusts can bruise or fracture ribs, damage abdominal organs, or in rare cases cause internal bleeding or inflammation of the pancreas. One documented case involved a healthy three-year-old who developed pancreatic complications after the maneuver. These injuries aren’t always obvious right away, so a checkup is warranted even if the person feels fine and is breathing normally.
Any object that was partially dislodged but not fully expelled could also have left fragments in the airway, which can cause breathing problems or infection in the following hours or days. If the person develops a persistent cough, difficulty swallowing, or chest pain afterward, those symptoms need prompt attention.