Choking

What happens during choking#

Air reaches the lungs through the trachea (windpipe). Choking happens when a foreign object — such as a hard lump of food, a marble or a set of false teeth — enters the trachea instead of the esophagus (food pipe).

If the object is at the entrance to the trachea (the epiglottis), a strong cough will usually push it out. If the object has passed the epiglottis, coughing may at least stop it from going further down. Sometimes an inhaled object blocks the airway completely. Choking can be a life-threatening emergency, because the brain can survive only a few minutes without oxygen.

Applied correctly and immediately, first aid can save a choking person’s life. The steps differ for adults and children.

Always call for help in an emergency#

Always call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) in an emergency. The information here is not a substitute for first aid training, and everyone should learn basic first aid skills.

Recognizing choking#

A person with a partly blocked airway can still breathe, speak or cough. Symptoms may include:

• Panicked and distressed behavior
• Inability to talk in full sentences or at full volume
• Coughing, wheezing or gagging
• Unusual breathing sounds, such as wheezing or whistling, or no sound at all
• Clutching at the throat
• A red face and watery eyes

If the airway is completely blocked and the person cannot breathe, speak or cough at all, they may make vigorous efforts to breathe, then turn pale and then blue from lack of oxygen (cyanosis) before collapsing into unconsciousness.

First aid for a conscious adult or child#

To begin with, reassure the person and encourage them to keep breathing and coughing. If coughing does not clear the blockage:

• Bend the person well forward and give up to 5 back blows with the heel of your hand between their shoulder blades, checking after each blow to see whether the blockage has cleared.
• If 5 back blows do not work, give up to 5 chest thrusts: place one hand in the middle of their back for support and the heel of the other hand on the lower part of their breastbone, checking after each thrust.
• Continue alternating 5 back blows with 5 chest thrusts until the blockage clears or help arrives.

For an adult or child, ask the person to lean over with their hands on their knees, or to sit in a chair leaning forward. Use less force on a child than on an adult.

If the person becomes blue, limp or unconscious, start CPR and immediately call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance. Stay on the phone.

First aid for a conscious infant#

Place the infant with their head downwards along your forearm, supporting the head and shoulders in your hand, and hold the mouth open with your fingers. Use less force than you would for a child.

• Give up to 5 sharp blows to the back between the shoulder blades with the heel of one hand, checking after each blow. The aim is to remove the obstruction, not to deliver all 5 blows.
• If the blockage comes loose, turn the infant onto their side and remove any visible object with your fingers. Do not sweep blindly inside the mouth with a finger.
• If 5 back blows do not work, lay the infant on their back on a firm surface. Place 2 fingers on the lower half of the sternum (the CPR compression position), support the head with your other hand, and give up to 5 chest thrusts, checking after each one.
• If the blockage has not cleared after 5 thrusts, continue alternating 5 back blows with 5 chest thrusts until medical help arrives.

If the person becomes unconscious#

If at any point the person becomes unconscious, call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) , remove any visible obstruction from the mouth, and begin cardiopulmonary resuscitation (CPR).

A basic CPR sequence is:

• Place the person on their back on the floor (place a baby on a firm surface, such as a table).
• Tilt the head gently back, pinch the nostrils closed, cover their mouth with yours to make a seal, and blow firmly. (For a baby, do not tilt the head back; instead, cover both the nose and mouth with your mouth and blow in gentle puffs.)
• Place the heel of one hand on the lower half of the breastbone, place the other hand on top and interlock your fingers, keeping your fingers up so only the heel of your hand presses on the chest. For a baby, use two fingers only.
• Press down firmly and smoothly, compressing to about one third of the chest depth, 30 times, then give 2 breaths.
• Repeat at a rhythm of about five cycles in two minutes.

Continue CPR until ambulance crews take over, the person recovers, or you are no longer able to continue.

If you are choking on your own#

• Try to stay calm and attract someone’s attention for help.
• Attempt forceful coughing: breathe out, then take a deep breath in and cough. This may eject the object.
• Lean as far forward as you can, holding onto something firmly anchored if possible.
• Make sure you are leaning well forward before anyone slaps you on the back. This reduces the chance of the object slipping further down the trachea.

Children and choking#

Infants and children under 5 explore their world by touching and feeling, and often by putting things in their mouths. Their airways are small and easily blocked.

In a young child, the struggle to breathe may not last long. If frantic activity suddenly stops, this can signal a serious or life-threatening situation rather than a sign that the blockage has cleared. Watch for other signs such as the child’s responsiveness, a pale face, or cold, clammy skin — these can mean the child is in shock.

When a child is choking:

• Immediately check whether they can still breathe, cough or cry. If they can, they may be able to dislodge the object by coughing. Stay with them and watch whether their breathing improves.
• If breathing does not become easier within a few minutes, call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) .
• If, after the coughing settles, there is any continued noisy breathing or coughing, take the child to a doctor, as the object may have lodged in the airway and may need to be removed in hospital with a special instrument.

Preventing choking in children#

Small children can choke on food and on small items such as buttons or beads. The molars (back teeth) are used to grind and mash food, and children do not begin getting them until around 12 to 18 months of age. It can take a further two years or more before all the molars are through and the child chews well. Until then they are vulnerable to choking on hard foods such as raw carrot, chunks of apple, hard candy, popcorn or peanuts.

Safer food#

• Cook, grate or avoid hard foods.
• Cut meat into small, manageable pieces, and remove tough skins from sausages.
• Cut long foods lengthwise to make them narrower.
• Supervise your child while they eat, and explain the importance of eating quietly while sitting down. Do not try to feed a child who is laughing or crying.

Choking hazards around the home#

• Treat any object smaller than a ping-pong ball — such as coins, buttons, marbles or beads — as a possible choking hazard, and keep these out of reach.
• Polystyrene beads, found in beanbags and some stuffed toys, are easily inhaled.
• Check toys regularly for wear and tear, and remove or secure any potential hazard immediately.
• Buy toys from reputable manufacturers and choose toys that meet recognized safety standards. A label such as “Not suitable for children under three years” warns that small parts may be a choking hazard — it does not refer to skill level.
• Keep balloons away from small children, as a bitten balloon may burst and send fragments down the throat.
• Warn older children in the household not to leave small or dangerous items near young children. Peanuts are a well-known hazard.

Emergency treatment for young children is not always the same as for adults, which is why all parents should consider taking a course in pediatric (child) first aid.

Key points#

• Choking happens when a foreign object enters the trachea and can be a life-threatening emergency.
• For a conscious adult or child, alternate up to 5 back blows with up to 5 chest thrusts until the blockage clears or help arrives.
• For an infant, use back blows and two-finger chest thrusts, and never sweep blindly inside the mouth.
• If the person becomes unconscious, call for an ambulance, remove any visible obstruction, and start CPR.
• Young children are especially at risk; supervise eating, prepare food safely, and keep small objects out of reach.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).