When giving chest thrusts to an infant, you place two fingers on the center of the chest, just below the nipple line, and push down about 1.5 inches (roughly one-third to one-half the depth of the chest). Chest thrusts are part of a specific sequence used to clear a severe airway obstruction in babies under one year old. They always follow back blows and are delivered in sets of five.
When Chest Thrusts Are Needed
Chest thrusts are only for severe choking, meaning the infant’s airway is completely or nearly completely blocked. The signs are distinct: the baby cannot cry or can only make faint sounds, has a weak or silent cough, and may show blue or darkened color around the lips, skin, or nails. You might also notice the baby straining to breathe with visible pulling between or below the ribs, but no air actually moving.
If the infant is coughing forcefully, crying loudly, or breathing adequately, do not perform back blows or chest thrusts. A strong cough is the body’s own clearing mechanism and is more effective than any first aid technique. Intervening during a partial obstruction can actually make things worse by shifting the object into a more dangerous position.
The Back Blows and Chest Thrusts Sequence
The American Heart Association and American Academy of Pediatrics recommend repeating cycles of 5 back blows alternating with 5 chest thrusts until the object comes out or the infant loses consciousness. Here is the full sequence:
- Position for back blows: Hold the infant face-down along your forearm, supporting the head and jaw with your hand. Keep the baby’s head lower than the body so gravity helps move the object outward. Rest your forearm on your thigh for stability.
- Deliver 5 back blows: Using the heel of your free hand, give 5 firm strikes between the shoulder blades. Each blow should be a distinct, forceful hit, not a pat.
- Flip for chest thrusts: Sandwich the infant between your forearms and turn the baby face-up, still keeping the head lower than the body. Support the back of the head with your hand.
- Deliver 5 chest thrusts: Place two fingers on the center of the chest, just below the nipple line, and push straight down. Then repeat the cycle from the beginning.
Continue alternating between 5 back blows and 5 chest thrusts. Check the mouth briefly between cycles. If you can see the object, remove it. Never do a blind finger sweep in an infant’s mouth, as this can push the object deeper.
Correct Finger Placement and Depth
The landmark for chest thrusts is the breastbone, at the center of the chest, just below an imaginary line drawn between the nipples. Place the pads of two fingers (typically your index and middle finger) on this spot. Your fingers should be pointing toward the baby’s head, not angled to either side.
Push straight down to a depth of about 1.5 inches, which is roughly one-third to one-half the front-to-back depth of the infant’s chest. Each thrust should be a sharp, deliberate compression followed by a full release. Let the chest return completely to its normal position between thrusts. The goal is to create a burst of pressure behind the lodged object, essentially producing an artificial cough. Thrusts that are too shallow won’t generate enough force, so press with purpose.
Why No Abdominal Thrusts for Infants
The Heimlich maneuver, used on older children and adults, is not recommended for infants. Babies’ abdominal organs are proportionally larger and more vulnerable to injury. Abdominal thrusts carry a real risk of damaging the liver, spleen, or stomach in a child this small. Chest thrusts create similar airway pressure without that risk, which is why they replace abdominal thrusts for anyone under one year of age.
Once a child is approximately one year old or older, guidelines shift to back blows alternating with abdominal thrusts instead.
If the Infant Loses Consciousness
If the baby becomes limp and unresponsive during the sequence, stop the back blows and chest thrusts immediately. Place the infant on a firm, flat surface and begin infant CPR. If you haven’t already called 911 or your local emergency number, do so now. Before starting rescue breaths, open the mouth and look for the object. If it’s visible, remove it. Then begin cycles of 30 chest compressions and 2 rescue breaths.
The chest compressions used in infant CPR are performed in nearly the same location and depth as choking chest thrusts, but at a steady rate of 100 to 120 compressions per minute. Continue until emergency responders arrive or the infant starts breathing again.
After the Object Is Removed
Even if you successfully clear the blockage and the baby seems perfectly fine, the infant still needs a medical evaluation. Choking can cause small injuries to the throat or airway that aren’t visible from the outside. The chest thrusts and back blows themselves, while necessary, can also occasionally cause bruising or other complications. Your pediatrician or emergency department will check for any residual fragments in the airway and confirm there’s no internal injury. Always follow up, regardless of how well the baby appears to recover.