The five and five method is a first aid technique for choking that alternates five back blows with five abdominal thrusts (also called the Heimlich maneuver). You repeat this cycle until the object is dislodged or the person becomes unconscious. It’s the approach recommended by the American Red Cross for conscious choking adults and children over age one.
How the Five and Five Method Works
The technique has two phases, performed back to back:
- Five back blows: Stand to the side and slightly behind the choking person. Support their chest with one hand and lean them forward. Deliver five firm blows between the shoulder blades using the heel of your other hand.
- Five abdominal thrusts: Stand behind the person and wrap your arms around their waist. Place a fist slightly above the navel, grab it with your other hand, and pull sharply inward and upward five times.
If the object doesn’t come out, go back to five back blows and repeat the cycle. Keep alternating until the airway clears or the person loses consciousness. If they go unconscious, lower them to the ground and begin CPR.
Why Two Different Techniques
Back blows and abdominal thrusts clear the airway through different pressure mechanisms, which is why alternating them improves your odds. Back blows create a vibration and downward force behind the obstruction that can loosen it. Abdominal thrusts compress the diaphragm upward, forcing a burst of air from the lungs that pushes the object out from below, similar to an artificial cough.
Research published in the journal Thorax measured the pressures generated by each technique. Abdominal thrusts produced about 64 cm of water pressure in the chest, significantly more than back blows at around 7 cm. For comparison, a natural cough generates roughly 179 cm of water pressure. Neither technique alone matches the force of a cough, which is why cycling between them gives the best chance of creating enough pressure from different angles to pop the object free.
Modifications for Infants
The five and five method is used on infants (under one year), but with critical differences. Abdominal thrusts are never performed on infants because of the risk of liver injury. Instead, you alternate five back blows with five chest thrusts.
For the back blows, hold the infant face-down along your forearm, supported on your thigh. Keep the head lower than the body. Use the palm of your hand to deliver five quick blows between the shoulder blades. Then flip the infant face-up, still keeping the head lower than the torso. Place two fingers on the center of the breastbone, just below the nipple line, and give five quick chest compressions, pressing down about half to one and a half inches per thrust.
Modifications for Pregnant People and Larger Bodies
If the choking person is pregnant or has a larger body that makes it difficult to reach around the abdomen, move your thrusts higher. Instead of placing your fist above the navel, position it on the breastbone (the center of the chest). The inward thrust motion is the same, just applied to the chest rather than the abdomen. This avoids pressure on the uterus or struggling to get adequate force around a larger midsection.
If You’re Alone and Choking
You can’t deliver back blows to yourself, so this becomes a modified version. Call 911 immediately if you can. Then place your fist just above your navel, grab it with your other hand, and bend over a hard surface like a countertop or the back of a chair. Shove your fist inward and upward repeatedly. The edge of the surface helps generate extra force against your abdomen, mimicking what another person’s hands would do.
What to Watch for Afterward
Even after the object comes out and breathing returns to normal, a medical evaluation is still important. Both the choking itself and the force of the rescue technique can cause internal complications. Abdominal thrusts can bruise organs, and fragments of food or small objects sometimes enter the lungs rather than being fully expelled.
In the days after a choking episode, pay attention to any cough that won’t go away, fever, difficulty swallowing or speaking, shortness of breath, or wheezing. These can signal that part of the object reached the lungs or that the throat sustained an injury during the event. Any of those symptoms warrants prompt medical attention.