Choking can kill in minutes, and it often happens at the dinner table or while a child is playing. Knowing two simple techniques could save someone you love.
A toddler grabs a grape, gasps and goes silent. In that moment, the adult who knows five back blows and five thrusts is the difference between a scare and a tragedy.
Is it mild or severe?
| Mild choking | Severe choking |
|---|---|
| Can cough loudly, speak, cry or breathe | Cannot cough effectively, speak, cry or breathe |
| Encourage them to keep coughing | Act immediately |
| Stay with them and watch | Call for help and start back blows |
Adults and children over 1 year
- Give up to 5 back blows. Stand to the side and slightly behind. Support their chest with one hand and lean them forward. Give sharp blows between the shoulder blades with the heel of your hand. Check after each blow.
- Give up to 5 abdominal thrusts. Stand behind them, put your arms around their waist, place a fist between the belly button and the bottom of the breastbone, grasp it with your other hand and pull sharply inwards and upwards.
- Repeat 5 back blows and 5 abdominal thrusts. Call your emergency number if the object has not come out after the first cycle.
- If they become unresponsive, lower them to the ground, call for an ambulance and start CPR.
Some organisations, such as the American Heart Association, teach abdominal thrusts alone for adults. Both approaches aim to create enough pressure to push the object out; follow the method you were taught.
Babies under 1 year
Never use abdominal thrusts on a baby. They can damage the internal organs.
- Lay the baby face down along your thigh or forearm, with the head lower than the body, supporting the head and jaw.
- Give up to 5 back blows between the shoulder blades.
- If that fails, turn the baby onto their back and give up to 5 chest thrusts: two fingers in the middle of the chest, just below the nipple line, pressing down sharply.
- Repeat, and call for an ambulance if the object is not cleared.
- If the baby becomes unresponsive, start baby CPR.
After choking
Anyone who has had abdominal thrusts or chest thrusts should be checked by a health professional, as they can cause internal injury. Also seek help if a cough, wheeze or difficulty swallowing continues, as part of the object may still be in the airway.
Preventing choking in children
- Cut grapes, cherry tomatoes and sausages lengthways into quarters
- Keep small objects, button batteries and magnets out of reach
- Make children sit down to eat
- Never leave babies alone with a bottle propped up
“But won’t back blows push the object further down?”
No. Back blows, done with the person leaning forward or the baby head-down, use gravity and pressure to move the object up and out. They are recommended by resuscitation councils worldwide.
Your next step: practise the hand positions on a pillow or teddy right now, then send this guide to every parent and grandparent you know.
Related: How to do CPR
Sources: Resuscitation Council UK, choking guidance (2021); American Heart Association; St John Ambulance and Red Cross first aid guidance. Take a practical first aid course to practise these skills.
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