First Aid for Choking

Choking occurs when an object lodges in the throat or windpipe, blocking airflow and posing a life-threatening emergency.

Signs and Symptoms

• Clutching the throat and inability to speak or cough
• Strained or noisy breathing (squeaks)
• Weak cough or ineffective attempts to clear the airway
• Skin, lips, or nails turning blue or gray (cyanosis)
• Panic, confusion, or loss of consciousness

These signs demand immediate intervention to restore the airway.

First Aid for Conscious Adult and Child (Over 1 Year)

Follow these steps in order until the obstruction is cleared or the victim becomes unresponsive:

1. Encourage the victim to cough forcefully if they can.
2. Deliver up to five back blows between the shoulder blades with the heel of your hand, supporting and leaning the person forward (kneel behind children).
3. If back blows fail, perform up to five abdominal thrusts: place a clenched fist above the navel, grasp it with your other hand, and give sharp inward–upward thrusts.
4. Alternate five back blows and five abdominal thrusts as needed.
5. If another rescuer is present, have them call emergency services immediately; if alone, call for help after completing the first sequence.

Repeat this cycle until the object is expelled or the person becomes unresponsive.

First Aid for Infants (Under 1 Year)

1. Sit and support the infant face-down on your forearm, head lower than the body, and rest your forearm on your thigh. Give up to five back blows between the shoulder blades with the heel of your hand.
2. If the airway remains blocked, turn the infant face-up, supporting the head. Use two fingers to deliver up to five chest thrusts in the center of the chest just below the nipple line.
3. Alternate back blows and chest thrusts until the obstruction clears or the infant becomes unresponsive.
4. Call emergency services as soon as possible if help has not yet been summoned.

First Aid for Unresponsive Victims

If the person becomes unresponsive, lower them gently to a firm surface, call emergency services if not already done, and begin CPR starting with chest compressions. Before each rescue breath, open the mouth and remove any visible obstruction.

Continue CPR until professional help arrives or the victim shows signs of life.

Adults usually choke due to a piece of food, and choking happens in children owing to them swallowing smaller objects. Since choking prohibits oxygen from getting supplied to the brain, it can be life-threatening, which is why first aid should be provided immediately to save a person’s life.

In order to understand choking, it’s important to understand the mechanism behind it:

• When we breathe in oxygen, it travels to the rest of the human body after entering the bloodstream. This oxygen is used as a source to create energy from the food we consume.
• As we exhale, we breathe out nitrogen, carbon dioxide, and oxygen.
• When we choke, it’s due to a blocked airway which doesn’t allow oxygen to get into the lungs, thereby affecting the brain. First aid for choking needs to be provided at this point so as to prevent brain death.

Special Techniques

• Self-Administered Thrusts: If you’re alone and choking, call EMS then perform abdominal thrusts on yourself by pressing your fist inward and upward against a hard surface (e.g., the back of a chair).
• Pregnant or Obese Individuals: Give chest thrusts instead of abdominal thrusts—place your hands at the base of the breastbone and push sharply backward and upward to dislodge the blockage.
• Infants Under 1 Year: Follow infant-specific guidelines (five back blows followed by five chest thrusts), as detailed in paediatric first-aid resources

Do’s and Don’ts

Prevention

You can prevent choking in adults with these safety measures:

• Cut food into small pieces.
• Chew food slowly and thoroughly, especially if wearing dentures.
• Don’t laugh and talk while chewing and swallowing.
• Don’t drink lots of alcohol before and during meals.

You can prevent choking in children with these safety measures:

• Keep marbles, beads, thumbtacks, latex balloons, coins, and other small toys and objects out of reach, particularly in children younger than 4 years old.
• Prevent children from walking, running, or playing when they have food and toys in their mouth.
• Don’t feed children younger than age 4 foods that can easily get lodged in the throat. This includes hot dogs, nuts, chunks of meat or cheese, grapes, hard or sticky candy, popcorn, chunks of peanut butter, or raw carrots.
• Supervise mealtimes with young children.
• Prevent older siblings from giving a dangerous food or toy to a young child.

REFERENCES

1. American Red Cross Training Services. Choking. In: First Aid/CPR/AED Participant’s Manual. The American Red Cross; 2021. https://www.redcross.org/store/first-aid-cpr-aed-participants-manual/754100.html.
2. Tintinalli JE, et al., eds. Resuscitation of children. In: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw Hill; 2020. https://accessmedicine.mhmedical.com
3. Joh Hopkins, Choking: First Aid and Prevention, https://www.hopkinsmedicine.org/health/wellness-and-prevention/choking-first-aid
4. John Furst, First Aid For Choking, Updated December 14, 2023, https://www.firstaidforfree.com/first-aid-for-choking/

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