If someone is choking and cannot speak, cough, or breathe, you need to act immediately. A completely blocked airway can cause brain damage in as few as four minutes. The steps differ depending on whether the person is an adult, a child, or an infant, but the core principle is the same: use forceful pressure to push air out of the lungs and dislodge whatever is stuck.
How to Tell if Someone Is Actually Choking
The universal distress signal for choking is grabbing the throat with one or both hands. But not every choking episode requires intervention. If the person is coughing forcefully and can still speak, their airway is only partially blocked. A strong cough can dislodge the object on its own, and stepping in with thrusts at this point can actually make things worse. Let them cough.
You need to act when the person cannot cough effectively, cannot speak or make sound, cannot breathe or is making high-pitched wheezing noises, or is turning blue around the lips and face. A partial blockage can become a complete one quickly, so stay close and watch for these signs even if the person seems to be managing at first.
The 5-and-5 Method for Adults and Children
Current guidelines from the American Heart Association recommend alternating between back blows and abdominal thrusts in repeated cycles of five. This applies to adults and children over age one. Start by calling 911 or having someone nearby do it, then begin immediately.
Back Blows
Stand to the side and slightly behind the person. Place one arm across their chest for support and lean them forward at the waist. Using the heel of your other hand, deliver 5 firm blows between their shoulder blades. Each blow should be a distinct, forceful strike, not a pat.
Abdominal Thrusts
If back blows don’t clear the object, move behind the person and wrap your arms around their waist. Make a fist with one hand and place it thumb side in just above their navel. Grab that fist with your other hand. Pull sharply inward and upward in a quick J-shaped motion, as if you’re trying to lift them off the ground. Each thrust should be a separate, deliberate movement.
Alternate between 5 back blows and 5 abdominal thrusts until the object comes out, the person can breathe and cough on their own, or they lose consciousness.
What to Do for Infants Under 1 Year
Never use abdominal thrusts on an infant. Their organs are too fragile. Instead, use a combination of back blows and chest thrusts.
Sit or kneel and lay the infant face-down along your forearm, using your thigh for support. Cradle their head in your hand and keep their head lower than their body. With the heel of your free hand, give 5 firm back blows between the shoulder blades.
Then turn the infant face-up, still keeping their head lower than their chest. Place two fingers on the center of their breastbone, just below the nipple line. Give 5 quick chest thrusts, pressing down about 1½ inches deep. Continue alternating 5 back blows and 5 chest thrusts until the infant can cough or cry, or becomes unresponsive.
If the Person Becomes Unconscious
Lower the person carefully to the ground and call 911 if you haven’t already. Begin CPR with chest compressions, pressing about 2 inches deep on the center of the chest. Each time you open the airway to give rescue breaths, look inside the mouth. If you can see the object and it’s loose, remove it.
Do not reach into the throat blindly to feel for an object. This is one of the most dangerous mistakes a rescuer can make. Research has documented cases where a blind finger sweep pushed objects deeper into the airway, turning a treatable blockage into a fatal one. In one case, a 5-centimeter piece of pencil was pushed into an infant’s airway by a sweeping finger. Only remove an object you can clearly see.
How to Save Yourself if You’re Alone
If you’re choking and no one is around, you can perform abdominal thrusts on yourself. Make a fist and place it just above your navel, then grab it with your other hand and thrust inward and upward. You can also lean your upper abdomen over the edge of a sturdy chair, countertop, or railing and use your body weight to thrust against it. Gravity helps generate the force your own arms may struggle to produce when you’re panicking and losing air.
Pregnant or Large-Bodied Individuals
If you can’t reach around the person’s abdomen, or if they’re in late pregnancy, use chest thrusts instead. Stand behind them, wrap your arms around their chest, and place your fist on the center of the breastbone (not the lower tip). Pull straight back with quick, firm thrusts. The mechanics are similar to abdominal thrusts but target the chest cavity instead.
After the Object Is Dislodged
Even after a successful rescue, the person should be evaluated by a medical professional. Abdominal thrusts can cause broken ribs and, less commonly, tears in the lining of the stomach or esophagus. These injuries aren’t always obvious right away. Internal bruising or small perforations may not produce symptoms for hours. There’s also a risk that small fragments of the object remain lodged in the airway, which can cause breathing problems or infection later. If the person needed multiple rounds of thrusts, or if a child or infant was involved, a medical evaluation is especially important.