Chest thrusts are a choking rescue technique where you press sharply on a person’s breastbone to force air up through the airway and push out a stuck object. They work on the same principle as the Heimlich maneuver (abdominal thrusts) but target the chest instead of the stomach, making them the go-to method for infants, pregnant women, and anyone whose abdomen you can’t easily compress.
How Chest Thrusts Work
When you push hard and fast against someone’s breastbone, you spike the pressure inside their chest cavity. That sudden burst of pressure drives air upward through the windpipe, mimicking a powerful cough and pushing the lodged object out. It’s essentially an artificial cough created from the outside.
Research comparing the two techniques found that chest thrusts can generate substantial airway pressure. In one study using cadavers, chest thrusts produced an average airway pressure of 40.8 cm H₂O compared to 26.4 cm H₂O for abdominal thrusts. Mid-chest thrusts performed on a seated person generated even higher pressures, around 46.2 cm H₂O. So while the Heimlich maneuver is the more widely known technique, chest thrusts are not a weaker alternative. They create enough force to dislodge most foreign objects.
When to Use Chest Thrusts Instead of the Heimlich
Standard abdominal thrusts work well for most choking adults and children, but certain situations make the abdomen off-limits:
- Pregnant women: Pushing on the abdomen risks harm to the baby. Place your hands on the breastbone instead.
- People with obesity: If you can’t wrap your arms around the person’s midsection to deliver effective abdominal thrusts, chest thrusts are the recommended alternative.
- Infants under one year: Abdominal thrusts are never recommended for babies. Their small, fragile abdominal organs are too easily damaged. Chest thrusts paired with back blows are the standard approach.
For adults and older children who don’t fall into these categories, abdominal thrusts remain the first-line technique. But knowing chest thrusts gives you a backup for any situation where the abdomen isn’t accessible.
Chest Thrusts on Adults
Stand behind the choking person and wrap your arms around their chest, under the armpits. Place the thumb side of one fist against the center of the breastbone, just above where the lowest ribs meet. Wrap your other hand around the fist. Pull sharply inward, pressing hard into the chest with a quick thrust. Each thrust should be a distinct, forceful compression, not a squeeze.
Repeat until the object comes out or the person can breathe and cough on their own. If they become unresponsive, lower them to the ground and begin CPR. The chest compressions used in CPR serve double duty: they keep blood circulating and can also help dislodge the object.
Chest Thrusts on Infants
The technique for babies looks quite different. Current American Heart Association guidelines recommend alternating cycles of 5 back blows and 5 chest thrusts for infants with a severe airway blockage.
Start by laying the baby face-down along your forearm, supporting the head and jaw with your hand, and deliver 5 firm back blows between the shoulder blades using the heel of your free hand. Then flip the baby face-up on your forearm. Using two fingers placed on the center of the chest (just below the nipple line), push down firmly 5 times. Each thrust should compress the chest about 1.5 inches, enough to generate real pressure without being reckless.
Keep alternating between 5 back blows and 5 chest thrusts until the object comes out, the baby starts crying or coughing forcefully, or the baby becomes unresponsive. If the baby goes limp and stops responding, begin infant CPR immediately and call 911 if you haven’t already.
Why the Sequence Matters for Children
For children over age one, the 2025 AHA guidelines updated the choking protocol. The recommended sequence now starts with 5 back blows followed by 5 abdominal thrusts (not chest thrusts), repeated in cycles. This brings the approach for children closer to what’s already used for infants, creating a more consistent pattern that’s easier to remember in a crisis. Chest thrusts still apply to children in the same situations they apply to adults: when abdominal thrusts aren’t feasible due to body size or other factors.
What to Watch for Afterward
Once the object is out and the person is breathing normally, the emergency isn’t necessarily over. Forceful chest thrusts can bruise the breastbone or surrounding tissue, and in rare cases, crack a rib. The person may feel chest soreness for a few days, which is normal. However, sharp pain with breathing, difficulty swallowing, or a feeling that something is still stuck in the throat all warrant a medical evaluation. Small fragments of food or objects can remain lodged deeper in the airway without causing obvious choking but still need to be removed.
With infants especially, it’s worth having a doctor check the baby even if the object came out cleanly. Babies can’t tell you about pain or lingering discomfort, and a quick exam can rule out any injury from the rescue itself.