One second your child is laughing and playing; the next, they’re gasping for breath. Choking is every parent’s nightmare, and for good reason: It’s the fourth leading cause of accidental death in children under the age of 5. And sadly, it can happen in an instant.
If you’re prepared, you can ensure your child stays safe and healthy should they ever have a choking incident. And with some common-sense precautions, you can minimize their risk of ever choking in the first place. Here’s everything you need to know.
How to tell if your child is choking
Look for these signs to spot a choking infant or child:
- Trouble breathing
- Weak, ineffective coughing
- Gasping, wheezing or making high-pitched sounds
- Inability to cry
- Bluish skin color (in people with darker skin, look at their lips, nails and around the eyes)
- Unconsciousness
Sometimes a child might be gagging or coughing but can still breathe or talk. This means that her airway isn’t totally blocked.
In these cases, experts say it’s best to do nothing. It might be tempting to pat her on the back or try to remove the object from her mouth or throat, but that could move the object further down her windpipe and cause her to actually start choking. Watch her carefully until she’s able to dislodge the object on her own, or until she starts exhibiting the above-mentioned choking signs.
What to do if a baby or toddler is choking
If a choking incident happens in a public place, know that automatic external defibrillators (AEDs) can be found in many public spaces. How to use them is explained during a formal CPR course, and you must make sure the one available can be used on an infant or child.
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- If you are alone, shout for help and call 911 if you have a cell phone with you, then immediately perform age-appropriate emergency first aid (back blows or abdominal thrusts). If you must perform CPR and are alone and do not have a cell phone, do not move away from the child to call for help until you have done 2 minutes of CPR.
- If two or more rescuers are available, one should start emergency first aid while the other calls 911 right away and attempts to locate an AED.
How to help an infant (under 1) who is choking
If your baby (under 1 years of age) is choking, follow these steps to safely help her breathe again:
- Lay your baby face down along your arm. Sit or kneel and rest your arm on your lap or thigh for support. Hold baby’s chest in your hand and her jaw in your fingers, pointing her head downwards below her body. Be careful not to cover her mouth.
- Use your other hand to give up to five forceful blows between her shoulder blades.
- If the object doesn’t come out, turn her face up onto your lap. Support her head in your hand.
- Put two fingers on the middle of her breastbone (right under her nipples).
- Thrust your fingers down quickly up to five times.
- Alternate between five back blows and five chest thrusts until the object is dislodged or help arrives.
- If your baby loses consciousness and help has not arrived, start infant CPR.
How to perform infant CPR
Every parent should be trained in infant and child CPR in case of emergencies. During a choking incident, people trained in infant CPR should perform it if a baby has lost consciousness or is unresponsive. You can sign up for a CPR class through the American Heart Association, American Red Cross or your local hospital.
This step-by-step is not a replacement for proper training. Instead, think of it as a refresher to review every few months to ensure that if you need to do CPR, you remember exactly how to do it.
- Check to see if your baby is responsive. Call her name or tap the soles of her feet. (Do not shake a baby). If she responds, don’t start CPR. If she doesn’t respond, carefully look in her mouth to check for an object. If you see an object and can safely take it out with a sweep of your finger, do so and start CPR. If you don't see an object, start CPR.
- Carefully place the baby on her back, being careful not to twist her head or neck.
- Perform chest compressions. Place two fingers on the breastbone, just below her nipples. Put your other hand on her forehead to keep her head tilted back. Press down with your fingers on the baby’s behest to compress about one third to one half the depth of her chest. Do this 30 times in rapid succession with no pauses.
- Open her airway by lifting her chin up with one hand and tilting down her forehead with the other hand.
- Double-check her breathing. Put your ear next to her mouth and nose to feel and listen for breathing. See if her chest rises and falls.
- If she’s not breathing, give her two rescue breaths. Cover her mouth and nose with your mouth and keep her chin lifted and head tilted up. Give her two short, gentle breaths lasting one second each.
- Repeat chest compressions and rescue breathing until the baby is breathing again or help has arrived.
How to help a toddler or older child (1 and up) who is choking
If your child is older than 1 year, these are the steps to follow to safely help them breathe again:
- Ask your child, “Are you choking?” If she can speak, do not perform first aid. If she cannot speak or is struggling to breathe, proceed with abdominal thrusts (the Heimlich maneuver).
- Stand behind your child and wrap your arms around her waist.
- Make a fist with one hand and place it just below the child’s chest above her navel. The thumb side of your fist should be facing her body.
- Grab your fist with your other hand.
- Press your fists into her stomach and thrust upwards. Repeat until the lodged object comes out of her mouth.
- If your child passes out:
- Lower her to the floor and place her on her back. Open her mouth, keeping your thumb on her tongue and fingers holding her lower jaw. (This helps open her airway.)
- Look in her mouth to try and spot what’s blocking her airway. If you can see it, try sweeping your finger in her mouth to remove it. Don’t force it, as that could move it further down her throat.
- If breathing does not resume, tilt your child’s head back and lift her chin. Place your mouth over hers. Pinch her nose shut and perform two rescue breaths — two slow breaths that last for one-and-a-half to two seconds.
- If your child doesn’t resume breathing, return to abdominal thrusts, modified for their position on the floor: Kneel at their feet and place the heel of one hand in the middle of their stomach between their belly button and rib cage. Place your other hand on top. Press upwards into the abdomen in six to 10 rapid inward and upward thrusts.
- Repeat the steps above until the child starts breathing or help arrives.
What to do after a choking incident in a baby or toddler
After your little one has had a choking episode, you should take her to the ER right away to ensure she’s fully recovered. Choking can damage the vocal cords or parts of the lodged object can enter the lung, which can lead to infection or other issues.
Certain sharp objects can also potentially perforate the airway, or might otherwise damage your child’s insides. In more severe cases, prolonged loss of oxygen caused by choking can cause brain damage.
Remember that the best way to prepare for choking emergencies is to take a first aid and CPR course. You can sign up for classes through the American Heart Association, American Red Cross or your local hospital.
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