What to Do if a Child Is Choking: Step-by-Step First Aid

A choking emergency gives you about ninety seconds before brain injury becomes a real risk. There isn't time to look up what to do. The technique has to be in your head before it happens.

This is the first aid sequence for babies and children. It is worth reading now and worth taking a hands-on course as soon as you can — practising on a manikin is what makes the actions stick when adrenaline takes over.

Healthbooq gives parents step-by-step emergency reference cards alongside everyday safety guidance.

First, Decide: Effective Cough or Not?

The single most important decision in a choking emergency is whether the airway is partly or completely blocked.

Effective cough. The child is coughing forcefully, crying, or making noise. Air is moving. Stay close, stay calm, encourage them to keep coughing — their own cough is more powerful than anything you can do externally. Do not slap their back, do not put fingers in their mouth, do not pick them up upside down. All of those risk turning a partial obstruction into a complete one.

Ineffective cough. The child cannot make sound, can't cry, is silent or only weakly wheezing, may go red then blue, eyes wide, hands at the throat in older toddlers. This is a complete or near-complete obstruction. Act now.

If you have any doubt and a second adult is present, get them to dial 999 (or 911) immediately while you start first aid. If you're alone, the order is: shout for help, start back blows, and after the first cycle, dial 999 on speaker while continuing.

Babies Under One Year

Do not use abdominal thrusts on a baby — their abdominal organs sit higher than in older children and can be injured.

Five back blows.

1. Sit down or kneel. Lay the baby face-down along your forearm with their head lower than their bottom. Support the jaw with your fingers — do not press on the soft throat tissues.
2. Use the heel of your other hand to deliver five firm blows between the shoulder blades. The force should be enough to make the chest jolt — gentler than for an adult, but firm. Light pats won't shift anything.
3. After the fifth blow, check the mouth. Only sweep out an object you can clearly see. A blind sweep can push a hidden object further down.

If the obstruction is still there, five chest thrusts.

1. Turn the baby face-up along your other forearm, head still lower than the body.
2. Place two fingers (index and middle) on the lower half of the breastbone, just below an imaginary line between the nipples.
3. Press sharply downward — about a third of the depth of the chest, roughly 4 cm — five times. These are slower and more deliberate than CPR compressions.
4. Check the mouth again.

Keep alternating: five back blows, check, five chest thrusts, check. After three full cycles with no result, if you haven't already, dial 999. Continue while you wait.

Children One Year and Older

For toddlers and older children, you swap chest thrusts for abdominal thrusts (the Heimlich manoeuvre).

Five back blows.

1. Lean the child forwards. With smaller children you can lay them across your lap, head down. With taller children, support their chest with one hand while they bend at the waist.
2. Five firm blows between the shoulder blades with the heel of your hand. After the fifth, check the mouth.

Five abdominal thrusts.

1. Stand or kneel behind the child so your eye level is roughly at theirs.
2. Wrap both arms around their waist. Make a fist with one hand, thumb side in, and place it just above the belly button and well below the ribcage.
3. Cover the fist with your other hand and pull sharply inward and upward — like trying to lift the child off the ground with that one motion.
4. Five thrusts. Check the mouth between each set.

Use less force than you would on an adult. Abdominal thrusts can bruise or injure internal organs even when done correctly, which is why every child who has had them needs to be checked over afterwards, regardless of how well they seem.

Alternate back blows and abdominal thrusts. Call 999 if you haven't already.

If the Child Goes Unresponsive

If the child becomes limp at any stage, the situation has shifted from choking to cardiac-arrest territory. Lay them flat on a firm surface, call 999 immediately if it hasn't been done, and start CPR.

Open the airway: tilt the head back gently with one hand on the forehead, lift the chin with two fingers. Look in the mouth — remove only an object you can clearly see.

Five rescue breaths. Pinch the nose closed (for a child) or seal your mouth over both nose and mouth (for a baby). Blow gently for one second per breath, just enough to see the chest rise.

Then 30 chest compressions, followed by 2 rescue breaths. Repeat.

• Baby: two fingers on the lower breastbone, compress about 4 cm.
• Child: heel of one hand (or two hands for older children) on the lower breastbone, compress about 5 cm.
• Rate: 100–120 compressions per minute. The rhythm of "Stayin' Alive" is roughly correct.

The compressions themselves can sometimes shift an obstruction by raising chest pressure. Check the mouth between cycles for any object that has come up.

Continue until the child responds, until paramedics arrive and take over, or you physically cannot continue.

Mistakes to Avoid

• Blind finger sweeps. Pushing your finger into a baby's mouth without seeing the object is more likely to push it deeper than to remove it.
• Holding the child upside down by the ankles. A real risk of dropping them; not part of any current first aid protocol.
• Hitting the back of a child who is coughing well. Only intervene when the cough is ineffective or absent.
• Abdominal thrusts on a baby. Use chest thrusts for under-1s.
• Stopping after the object comes out. Watch for signs of distress, and get the child medically checked, especially if thrusts were used.

After a Choking Event

Even if you cleared the obstruction at home and your child seems totally fine, get them seen by a doctor when:

• Abdominal thrusts or chest thrusts were used (risk of internal bruising).
• Coughing or wheezing continues afterwards (a fragment may have gone into a lung).
• Their voice is hoarse or breathing sounds different from normal.
• The object hasn't been accounted for — it may still be partly stuck.

Aspiration pneumonia, where small bits of food or liquid go into the lungs and cause inflammation, can develop over the following 24–48 hours. A new cough, fever, or breathing change after a choking incident is a reason to be seen the same day.

Take a Course

Reading about back blows is useful. Practising them on a manikin under instruction, with your hands on the chest, is in a different league. The British Red Cross, St John Ambulance, and the Resuscitation Council UK all run short paediatric first aid courses — most are two to four hours, often free or under £40. Refresh every two years; guidelines change and skills decay.

If grandparents, babysitters, or childminders look after your child regularly, every adult in that loop should ideally have done a course. The technique only saves lives when it's available the moment it's needed.

If a child can cough, cry, or breathe — encourage coughing and don't intervene. If they can't, the response is back blows and chest thrusts for under-1s; back blows and abdominal thrusts for over-1s. Call 999 (UK) or 911 (US) the moment a complete obstruction is suspected. After any successful intervention with thrusts, the child needs to be checked by a doctor — internal injury is uncommon but possible.