Choking: First Aid and Prevention
What should I do if my child begins to choke?
If your child is breathing, encourage him to cough; it helps clear the windpipe. Minor choking usually occurs because a liquid has gotten into the air passage, and coughing can clear it out. Don't offer your child something to drink, though, since fluids may further block the passage of air.
If your child is choking on an object and can't breathe, call 911 immediately. Then begin first aid. Remember: Take the following steps only if your child is unable to make a sound. If your child is coughing, crying, or speaking, do not do CPR.
For infants under one year old
Place your infant facedown over your knees or forearm - actually upside down -- so gravity helps expel the object. With the heel of your hand, deliver five hard blows in rapid succession between the shoulder blades. If that doesn't restore breathing, lay your infant on his back on the floor and use two fingertips to push firmly on his chest just above the lower breast bone; do this five times in rapid succession. The object is to force out the object that's blocking your infant's air passage. Continue giving back blows and chest thrusts until the object is expelled or your child loses consciousness. Try to stay calm. Remind yourself that the rescue squad is on its way.
For children 1 year old and above
If your child can't breathe, perform what's known as the Heimlich manuever. Grasp your child from behind -- just below the lower ribs and above the waist -- and give a sharp upward jerk at a 45-degree angle. The purpose is to force all the air out of the chest so it dislodges the object from his windpipe. Repeat this upward abdominal thrust 10 times, if necessary, in rapid succession. If you don't have the strength to hold your child upright, lay him on his back on the floor. Put the heel of a hand on each side of his abdomen, just below the ribs. Then apply sudden in-and-up thrusts in rapid succession.
What if my child passes out from choking?
If your child has lost consciousness and you see no movement of the chest and abdomen or other signs of breathing, call 911 (if you haven't already) and begin CPR (cardiopulmonary resuscitation) immediately. First look inside your child's mouth to see if there's an object that you could remove with your fingers. Don't feel for an object that's not visible, since you could force it farther into your child's windpipe. If you know how, begin chest compressions. For detailed information, review CPR.
How can I lower my child's risk of choking?
Don't give children younger than four foods or small objects likely to lodge in the windpipe. Troublesome foods include grapes (always cut them in half), nuts of any kind, sunflower seeds, cherries (unless you remove the pits and slice up the fruit), gum, hard candies, popcorn, raw carrots, raw peas, raw celery, watermelon with seeds, and spoonfuls of peanut butter. Hot dogs, sausages, cheese, and grapes also frequently cause choking, so be sure to chop them into pieces before serving. In fact, all foods should be cut into small pieces.
Always supervise mealtime, and make sure babysitters, other caregivers, and older siblings know which foods are off-limits for small children. Also, make it a rule that your toddler must sit down while eating (eating while walking, running, or playing increases the risk of choking) and must never eat while riding in a car seat (you or another driver might not be able to respond quickly if your child chokes).
Small toys can pose a danger, too. For children, rubber balloons are a leading cause of death from choking, so warn your child never to chew on a piece of a rubber balloon or put his mouth on an inflated balloon. Other risky objects include coins, marbles, small batteries, pen or marker caps, and toys that can fit in your child's mouth. Button batteries are a particular hazard since they can cause serious internal damage, so don't let your child play with anything containing such an item.
National Institute of Child Health & Human Development
Robert H. Pantell M.D., James F. Fries M.D., Donald M. Vickery M.D., Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care. Perseus Books Publishing, L.L.C.
American College of Emergency Physicians. What to Do When an Infant is Choking. http://www.acep.org/patients.aspx?id=26146