Choking in children and infants: what to do step by step (ERC guidelines)

Choking, that is the obstruction of the airway by a foreign body, is one of the most frightening situations a parent can face. It most often happens with food or small objects, and develops within seconds. Composure and the right moves make the difference.

How do I know a child is choking

There are two cases, and the treatment differs:

• Mild (partial) obstruction: the child can still cough forcefully, cry or speak. The airway is not completely blocked.
• Severe (complete) obstruction: the child cannot cough effectively, makes no sound, is not breathing or starts to turn blue. They often clutch their throat with their hands. Here immediate action is needed.

First priority: call 112

As soon as you recognise severe obstruction, your first move is to activate specialist help: call 112 immediately and put it on speaker (loudspeaker). This keeps your hands free and you start the airway-clearing skills at the same time, while the call handler guides you.

Do not waste time. The call to 112 and the manoeuvres begin together, not one after the other.

Mild obstruction: encourage coughing

If the child is coughing effectively, do not intervene. Coughing is the most powerful mechanism for expelling the object. Encourage them to keep coughing and stay next to them, watching in case the situation worsens into severe obstruction.

Severe obstruction in a child (over 1 year old)

You alternate two manoeuvres, in cycles:

1. 5 back blows: lean the child slightly forward. With the heel of your hand, give 5 firm blows between the shoulder blades.
2. 5 abdominal thrusts (Heimlich manoeuvre): stand behind the child, put your arms around their abdomen, make a fist just above the navel and pull sharply inwards and upwards, 5 times.

Continue the cycles (5 and 5) until the object is expelled or the child loses consciousness.

Severe obstruction in an infant (under 1 year old)

In infants we never do abdominal thrusts (risk of serious damage to the internal organs). Instead:

1. 5 back blows: lay the infant face down along your forearm, with the head lower than the body, supporting the head and neck well. Give 5 blows between the shoulder blades with the heel of your hand.
2. 5 chest thrusts: turn the infant face up, with the head low. With two fingers in the centre of the chest (on the sternum), give 5 thrusts.

Alternate 5 back blows and 5 chest thrusts until the object is expelled or the infant loses consciousness.

If the child or infant loses consciousness

Start Cardiopulmonary Resuscitation (CPR) immediately, beginning with chest compressions. Each time, before giving breaths, look in the mouth and remove the object only if you can see it clearly. Continue until help arrives.

What NOT to do

• Do not put your fingers in the mouth "blindly" to search for the object. You may push it deeper.
• Do not ever do abdominal thrusts on an infant under one year old.
• Do not intervene while the child is coughing effectively. Coughing works better than you can.
• Do not stop to call and then act. Put 112 on speaker and act at the same time.

After the obstruction is cleared

Even if the object is expelled and the child seems fine, they need a medical assessment, especially if abdominal thrusts were performed (they can cause internal injuries) or if there is a persistent cough, difficulty breathing or difficulty swallowing.

Prevention

• Cut young children's food into small pieces.
• Avoid high-risk foods for the very young (nuts, whole grapes, hard sweets, popcorn).
• Keep small objects and toys with small parts away from infants.
• Supervise meal times. Children should eat sitting down, calmly.

Knowledge saves

Reading these steps is the first step. Practising them with your own hands, on a manikin, is what will make you react calmly at the moment that matters. In the Paediatric Basic Life Support (PBLS) seminars of Life Support Hub you train in exactly that.

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This article is informative and does not replace specialised training or medical advice.