Choking is one of the few emergencies where a bystander with no equipment routinely saves a life, and where the window is measured in minutes. It is also one where the correct action differs sharply by age, and where doing the adult thing to a baby causes serious internal injury.
First, is it actually choking
If they are coughing effectively, let them cough. A forceful cough moves more air than any thrust you can deliver, and back blows or thrusts on someone who is coughing well can dislodge the object into a worse position. Stay with them, encourage the coughing, and be ready.
Severe obstruction is usually silent. That is the thing to internalise. Someone who is properly choking cannot make noise, because noise requires moving air. They may clutch their throat, look panicked, go red then grey or blue. A quiet person at a table who has gone very still and wide-eyed is the picture.
Adults and children over one
Back blows:
- Stand to the side and slightly behind them.
- Lean them well forwards, supporting the chest with one hand. This matters: it means the object comes out rather than travelling further down.
- Strike firmly between the shoulder blades with the heel of your hand.
- Up to five times, checking after each.
Abdominal thrusts:
- Stand behind them, arms around their waist.
- Make a fist and place it between the navel and the bottom of the breastbone.
- Grasp your fist with the other hand.
- Pull sharply inwards and upwards.
- Up to five times, checking after each.
Shout for help early, and if anyone else is present get them to ring 999 while you work. If you are alone, do the first cycles first, then ring.
For a child, kneel or sit so you are at their level, and use less force, scaled to their size.
Babies under one
Back blows:
- Sit or kneel, and lay the baby face down along your forearm or thigh.
- Head lower than the bottom, so gravity helps.
- Support the head and jaw with your hand, being careful not to compress the soft tissues of the throat.
- Give up to five firm blows between the shoulder blades with the heel of your hand.
Chest thrusts:
- Turn the baby over so they are face up, still with the head lower than the body, supported along your forearm.
- Place two fingers on the breastbone, in the middle of the chest, roughly a finger's width below the nipple line.
- Push sharply downwards, about a third of the depth of the chest, up to five times.
- Chest thrusts are slower and sharper than chest compressions in CPR.
Check the mouth after each cycle. Remove anything you can clearly see and reach with one finger. Never sweep a finger blindly round the mouth: you will push it further in.
If they go unresponsive
Afterwards
- Anyone who received abdominal thrusts should be checked by a clinician, even if they seem completely fine. Thrusts can cause internal injury that is not immediately apparent.
- Anyone who was unresponsive, or who had a prolonged obstruction, needs assessment.
- Watch for a persistent cough, difficulty swallowing, drooling, or a sensation of something still there. Part of the object may remain, or the airway may be swollen.
- A baby or child who choked should always be seen afterwards.
Prevention, which matters more
Nearly all of this is avoidable, and in a household running on stored, dried and preserved food the risk profile changes.
For young children:
- Cut round food lengthways. Grapes, cherry tomatoes, sausages and carrot batons quartered lengthways, never left in discs. A disc is exactly the shape of a small airway.
- No whole nuts under five.
- Sit down to eat. No running, walking or playing with food in the mouth.
- Supervise eating, especially with a sibling who might share unsuitable food.
- Hard sweets, popcorn, marshmallows and chunks of apple are all common causes.
- Keep small objects off the floor: batteries, magnets, beads, coins.
Relevant to a long emergency specifically:
- Dried and preserved foods are choking hazards in a way fresh food is not. Jerky, dried fruit, hard biscuit, pemmican and dried beans are all dense, chewy or hard. Cut them small for children and soak or stew them where you can.
- Eating in poor light, in a hurry, or while distracted raises the risk, and all three describe an emergency.
- Anyone eating lying down or half-upright, which happens when people are unwell or cold, is at higher risk. Sit them up.