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Infant choking first aid: what to do step by step

Assigned clinical reviewerSharyn Harrison· CNM, NPDraft · pending clinical reviewUpdated

What does the evidence say about infant choking first aid?

  1. A choking infant who cannot make sound, has a weak or ineffective cough, shows bluish skin color, or is pulling the chest and ribs inward while trying to breathe needs immediate first aid, while one who is coughing hard or crying strongly should be watched rather than interrupted, since a forceful cough can clear the airway on its own. 1
  2. The first step for a conscious choking infant is up to 5 back blows: position the baby face down along your forearm, supported by your thigh, head angled lower than the body, and strike firmly between the shoulder blades with the heel of your hand. 1
  3. If the object has not come out after back blows, turn the infant face up along your thigh and give up to 5 chest thrusts with the heel of one hand on the middle of the breastbone just below the nipple line, then keep alternating 5 back blows with 5 chest thrusts until the object dislodges or the infant stops responding. 1
  4. If a choking infant becomes unresponsive, summon emergency help and begin infant CPR with chest compressions. Look for a visible object before giving breaths and remove it only if seen; do not delay compressions for a prolonged breathing check or perform a blind finger sweep. 2
  5. CPR and choking-response technique both vary by age and body size, which is why the infant-specific version (used under age 1) differs in hand placement and force from the versions written for children past puberty or adults. 3
  6. Infants and toddlers are especially vulnerable to airway obstruction from food and small objects because they explore by mouth and have immature chewing and swallowing skills. Severe obstruction requires immediate first aid and emergency medical help. 4

Frequently asked questions

How can I tell if my baby is really choking or just gagging?

Gagging is a normal, noisy protective reflex where a baby coughs, sputters, or briefly grimaces but is still moving air and often still making sound. True choking looks different: a weak or silent cough, no crying or vocal sound, bluish lips or skin, or visible effort where the chest and ribs pull inward without air moving. If your baby is still coughing forcefully or crying, hold off and watch closely rather than intervening.

Should I start back blows the moment my baby coughs on something?

No. A strong, forceful cough is the airway working to clear itself, and interrupting it can do more harm than good. Back blows and chest thrusts are for a baby who cannot cough effectively, cannot cry or make sound, or is struggling to breathe. Stay close, stay calm, and step in only if the cough turns weak or silent.

How many back blows and chest thrusts should I give?

Give up to 5 firm back blows between the shoulder blades with the baby face down along your forearm, head lower than the body. If the object hasn't come out, turn the baby face up and give up to 5 chest thrusts on the breastbone just below the nipple line. Keep alternating sets of 5 and 5 until the object dislodges or the baby stops responding.

What if I've done several rounds of back blows and chest thrusts and nothing has worked?

Have someone call 911 immediately while you continue cycles of five back blows and five chest thrusts; do not wait for the infant to become unresponsive before seeking help. If the baby stops responding, begin infant CPR with compressions. Check for a visible object before breaths, without a blind finger sweep.

Can I reach into my baby's mouth to pull the object out myself?

Only if you can actually see the object and can remove it without pushing it further in. A blind finger sweep, reaching in without seeing anything, can drive the object deeper into the airway and make things worse. Focus on back blows and chest thrusts instead, which are designed to dislodge the object using pressure rather than a hand in the airway.

What do I do if my baby goes limp or stops responding?

Call 911, or have someone else call while you stay with the baby. Check inside the mouth for a visible object before giving any breaths, and begin infant CPR right away. CPR for an unresponsive choking infant uses a different technique than back blows and chest thrusts for a conscious baby, and it's worth learning both in a hands-on infant CPR and choking course before you need them.

Is the technique different for a two-week-old newborn versus an 11-month-old?

The core technique, back blows then chest thrusts, is the same throughout the under-1-year infant category, since it's built around infant anatomy rather than a specific age within that range. What changes in practice is your own confidence and the force you use: a hands-on class lets you practice the right pressure on a training manikin sized for infants rather than guessing in the moment.

The object came out and my baby seems fine. Do we still need to see a doctor?

Yes. Even after a successful rescue, have your baby evaluated the same day. Part of the object can remain in the airway or be inhaled into a lung without obvious symptoms, and back blows or chest thrusts can occasionally cause injury that's worth a clinician checking. Call your pediatric provider or go to an emergency department to be safe.

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References

  1. Choking - infant under 1 year

    MedlinePlus · https://medlineplus.gov/ency/article/000048.htm

  2. CPR - infant

    MedlinePlus · https://medlineplus.gov/ency/article/000011.htm

  3. CPR

    MedlinePlus · https://medlineplus.gov/ency/article/000010.htm

  4. Choking, StatPearls, NCBI Bookshelf

    StatPearls · https://www.ncbi.nlm.nih.gov/books/NBK499941/

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.