When giving back blows to an infant, you position the baby face-down along your forearm with their head lower than their chest, then deliver 5 firm strikes between the shoulder blades using the heel of your hand. This technique is used when an infant under 1 year old has a severe airway obstruction and cannot cough, cry, or breathe effectively on their own.
When Back Blows Are Needed
Back blows are only appropriate when an infant is truly choking, meaning the airway is severely blocked. The signs include bluish skin color, an inability to cry or make much sound, weak or ineffective coughing, and soft or high-pitched sounds while breathing in. You may also see the ribs and chest pulling inward as the baby struggles to get air.
If the infant is coughing forcefully, crying loudly, or breathing well enough on their own, do not intervene with back blows. A strong cough is the body’s own clearing mechanism and is more effective than anything you can do from the outside. Back blows are reserved for the moment when that natural response fails.
How to Position the Infant
Sit, kneel, or stand. Rest your forearm on your thigh for stability. Place the infant face-down along your forearm so their stomach rests against it. Cradle their head in your hand, with your fingers supporting the jaw on either side. The critical detail: the infant’s head must be lower than their body. Gravity works with you in this position, helping the object move toward the mouth rather than deeper into the airway.
Place your other forearm along the infant’s front, supporting the jaw with your thumb and forefinger, then turn them into the face-down position. Your thigh acts as a platform so you’re not relying on arm strength alone to hold a slippery, panicking baby steady.
Delivering the Back Blows
Use the heel of your free hand, the firm fleshy part just above your wrist. Deliver 5 quick, firm strikes right between the infant’s shoulder blades. Each blow should be deliberate and forceful enough to create pressure behind the lodged object. These are not gentle pats. The goal is to generate enough force to pop the object loose from the airway.
That said, back blows can cause pain and potentially injure internal structures, so they should only be used in a genuine emergency when you are certain the infant is choking. This is not something to practice at full force on a real baby. If you want hands-on experience, take an infant CPR class that uses a training mannequin.
What Comes After: Chest Thrusts
If the object doesn’t come out after 5 back blows, you immediately flip the infant face-up on your forearm (still keeping the head lower than the body) and give 5 chest thrusts. Place two fingers on the center of the breastbone, just below the nipple line. Press down about one-third to one-half the depth of the chest, roughly half an inch to an inch and a half per thrust. Avoid pressing on the lowest part of the breastbone or on the ribs.
The 2025 American Heart Association guidelines confirm this sequence: 5 back blows alternating with 5 chest thrusts, repeated in cycles until the object comes out or the infant loses consciousness. Abdominal thrusts (the Heimlich maneuver) are not recommended for infants under 1 year because of the risk of damaging their internal organs.
What Not to Do
Never stick your finger into an infant’s mouth to sweep for an object you can’t see. A study published in the Journal of Emergency Medicine documented cases where blind finger sweeps in infants pushed foreign bodies deeper into the airway, turning a partial blockage into a complete one. The researchers concluded that blind finger sweeps in crying infants are not only dangerous but potentially fatal. Only remove an object from the mouth if you can clearly see it.
If the Infant Loses Consciousness
If the baby stops responding, goes limp, stops breathing, or turns blue during the back blow and chest thrust cycles, the situation has escalated. Have someone call 911 immediately. Place the infant on a firm, flat surface and begin infant CPR. Before each set of rescue breaths, look inside the mouth for the object. If you can see it, remove it. If you can’t, do not sweep blindly.
If you are alone, perform 2 minutes of CPR before stepping away to call 911. You can carry the infant with you to make the call. Continue CPR, checking the mouth before each breath attempt, until emergency responders arrive or the infant begins breathing on their own.
After the Object Comes Out
Even after a successful rescue, the infant should be evaluated by a medical professional. Back blows and chest thrusts can bruise tissue or crack small ribs, and fragments of the object may remain in the airway without causing obvious symptoms right away. Persistent coughing, wheezing, or difficulty feeding in the hours after a choking episode can signal that something is still lodged or that the airway was injured during the event.