Choking Emergencies

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 can occur.
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.

Home Care

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 necessary.
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 help arrives.


  • 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 arrives.
  • 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.

Lowell General Hospital, 295 Varnum Avenue, Lowell, Massachusetts 01854, Main Telephone: (978) 937-6000
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