Choking is one of the few true emergencies of childhood--minutes may determine life or
death. Choking is caused when the airway becomes obstructed, resulting in inability to
breathe. A swallowed object is the most common cause of choking.
Choking is easily identified by two key signs: the child frantically tries to breathe, and
the child is not able to cry out or to speak. If choking continues, the child quickly
becomes blue, convulsive, limp, and unconscious. If an object completely blocks the air
passage, you have only a few minutes to reestablish an airway before brain damage or death
Objects that present a particular danger of choking if a child puts them in his or her
mouth are peanuts, tablets, glass eyes of toy animals, hard or hard-coated candies, beads,
popcorn, and tiny toys or small parts from toys. Solid particles of food from the stomach
may choke a child who breathes in while vomiting. A baby who has been vomiting is safest
from choking when
lying on his or her stomach. Choking may also occur in a child who has croup.
However, it is easy to tell choking from croup from other choking by one important
distinction--a child choking on a foreign object cannot speak or cry out, while a child
with croup can do both. Choking caused by croup is treated differently from other choking
(see the article on Croup for treatment of that form of choking).
Signs and Symptoms
Choking on an object is easily identified by two major signs: frantic, unsuccessful
efforts to breathe and inability to talk or cry out.
Seconds count! Scream for help. A second adult on the scene should phone the police or
paramedic squad for help. (Police are usually more quickly available in most communities
than an ambulance, the fire department, or a doctor.)
Give the child one minute to cough up the object. If the child's efforts are unsuccessful,
perform the following maneuvers.
If the child is an infant: Lay the baby face down on your forearm, with your hand
supporting his head. The baby's head should be lower than his chest. Using the heel of
your hand, give four quick blows to the baby's back between the shoulder blades. Then
place your free hand on the back of the
baby's head and, holding him between your forearms, turn him face up, with his head still
lower than his body. Put two fingertips on the baby's chest between the nipples. Press
quickly and fairly hard four times. (You are trying to squeeze the upper abdomen and lower
chest, which will force up the diaphragm so that air is pushed out of the lungs. The rush
of air out of the lungs may pop the object out of the airway.) Repeat the cycle of four
blows and four presses for as long as the baby is still choking. Don't give up.
If the child is a toddler or an older child: Stand behind the child. Reach around the
child, lock your hands together, and place them just below his breastbone. Use a quick
upward motion while pulling his stomach in. (You are trying to squeeze the upper abdomen
and lower chest, which will force up the diaphragm so that air is pushed out of the lungs.
The rush of air out of the lungs may pop the object out of the airway.) Repeat if
Only if these efforts are unsuccessful should you attempt to get the object out with your
fingers or tweezers (there is a danger of pushing the object farther into the airway).
If breathing stops, begin resuscitation once the airway is clear. Continue until trained
- When an object completely blocks the air passage, the child seldom reaches a doctor in
time. However, the object may be only partially blocking the airway, even though you may
not think so. Do not abandon your efforts to help a choking child until medical help
- Never give mouth-to-mouth resuscitation until the obstructing object has been removed.
To do so may force the object farther down the throat.
- A baby who has been vomiting should be placed on his stomach to lessen the chance of
choking on the vomit.
- Prevention of choking is most important. Examine all toys for loose eyes or other small
parts. Keep tablets under lock and key. Do not give peanuts, popcorn, or hard candies to
toddlers, and be sure to clean up after adult parties before children can wander
unattended into a room and find such hazardous treats.