For the Heimlich maneuver, you place the thumb side of your fist about two inches above the person’s belly button and just below their ribcage. This spot sits right over the upper abdomen, where inward and upward pressure can push the diaphragm up and force a burst of air through the windpipe to dislodge whatever is stuck.
Exact Hand Position on a Conscious Adult
Stand behind the choking person and wrap both arms around their midsection. Make a fist with your dominant hand and place the thumb side against their abdomen, centered between the belly button and the bottom of the ribcage. Your fist should sit roughly two inches above the navel. Wrap your other hand around the fist to lock it in place.
From this position, thrust sharply inward and upward in one motion. The 2025 American Heart Association guidelines recommend performing cycles of 5 back blows followed by 5 abdominal thrusts, alternating between the two until the object comes out or the person becomes unresponsive. Back blows are delivered with the heel of your hand between the shoulder blades while the person leans forward.
Placement matters because you’re trying to compress the space just below the lungs. The sudden pressure travels through the diaphragm and into the chest cavity, creating a rush of air that mimics a forceful cough. Research published in Thorax confirmed that abdominal thrusts produce a sharp spike in both abdominal and chest pressure, which is what pushes the stuck object out. Placing your fist too low (near the belly button) wastes force on the intestines. Placing it too high risks hitting the bony tip of the breastbone, which can fracture and cause internal damage.
Placement for Pregnant or Larger Individuals
If the person is pregnant or you physically cannot reach your arms around their abdomen, switch to chest thrusts. Place your hands at the base of the breastbone, just above the point where the lowest ribs meet in the center. Press hard into the chest with a quick thrust, using the same inward motion you would for abdominal thrusts. This generates similar pressure in the chest cavity through a different route. Repeat until the blockage clears.
Hand Position on Yourself
You can perform the Heimlich maneuver on yourself using the same landmark. Make a fist with one hand and place the thumb side below your ribcage and above your navel. Grab that fist with your other hand and drive it forcefully inward and upward.
A faster and often more effective option is to use furniture. Lean your upper abdomen over the back of a sturdy chair, a table edge, or a railing, and thrust your body weight downward against it. A small study found that chair-assisted thrusts generated greater pressure than the standard self-administered technique. Since most choking happens while eating, a chair is usually within reach.
What to Do for Infants Under One Year
Abdominal thrusts are not used on infants. For a baby under 12 months, hold them facedown along your forearm with their head lower than their chest. Deliver up to 5 firm slaps between the shoulder blades using the heel of your hand. Then flip the infant face-up and give up to 5 chest thrusts using just two fingers pressed on the center of the breastbone. Alternate between back slaps and chest thrusts until the object comes out.
If the Person Loses Consciousness
When a choking victim goes limp and stops responding, lower them onto their back on a firm, flat surface. At this point, the approach shifts to CPR. Perform 30 chest compressions (pushing about 2 inches deep at a rate of 100 to 120 per minute), then open the mouth and look for the object. If you can see it and it’s loose, remove it. Follow compressions with 2 rescue breaths if you’re trained to do so, then repeat the cycle. The chest compressions themselves can generate enough force to push a lodged object free.
Why Medical Follow-Up Matters
Even when the Heimlich maneuver works perfectly, the force involved can injure internal organs. Documented complications include stomach rupture, torn blood vessels near the heart, diaphragm tears, and damage to the esophagus. These injuries aren’t always immediately obvious. Anyone who receives abdominal thrusts should be evaluated by a medical professional afterward, even if they feel fine and are breathing normally. The evaluation is quick and typically involves checking for tenderness, internal bleeding, or air trapped in places it shouldn’t be.