Choking First Aid: How to Save a Life When Someone Can't Breathe

What Are the Signs That Someone Is Choking?

The signs of choking include sudden inability to speak or cough, difficulty breathing, wheezing or high-pitched sounds, hands clutching the throat (universal choking sign), and blue lips or skin. In complete airway obstruction, the person cannot make any sound and will lose consciousness within minutes without intervention.

Recognizing choking quickly is essential because every second counts when someone's airway is blocked. Choking occurs when food, small objects, or other foreign bodies become lodged in the throat or windpipe, blocking the flow of air to the lungs. The severity of symptoms depends on whether the obstruction is partial or complete, and understanding these differences helps you respond appropriately.

In a partial (mild) obstruction, some air can still pass through. The person may be able to cough, make sounds, or speak weakly. Their breathing may be noisy or wheezy. In this situation, the body's natural cough reflex is often effective at clearing the obstruction, so you should encourage forceful coughing while staying ready to assist if the situation worsens.

In a complete (severe) obstruction, no air can pass at all. This is a life-threatening emergency. The person will be unable to speak, cough effectively, or breathe. They may make silent attempts to cough or gasp. Their face may turn red initially, then blue (cyanosis) as oxygen levels drop. Many people instinctively clutch their throat with both hands - this is known as the universal choking sign. Without immediate intervention, the person will lose consciousness within approximately 2-3 minutes and can suffer permanent brain damage or death within 4-6 minutes.

Common Signs of Choking in Adults and Children

• Sudden onset of difficulty: The person was eating or had something in their mouth immediately before symptoms began
• Inability to speak: They cannot answer when you ask "Are you choking?"
• Weak or absent cough: Attempts to cough produce little or no sound or airflow
• High-pitched or wheezing sounds: Indicates partial obstruction with turbulent airflow
• Universal choking sign: Both hands clutching the throat
• Panic and agitation: The person appears distressed and may grab at you
• Cyanosis: Blue discoloration of lips, face, or fingernails
• Loss of consciousness: In severe cases, occurs within minutes

Signs of Choking in Infants

Infants cannot tell you they are choking, so you must recognize the signs visually. Watch for sudden difficulty breathing, inability to cry or make sounds, weak cough, high-pitched sounds when inhaling, and blue skin color. Infants often put objects in their mouths as part of normal development, making them particularly vulnerable to choking on small objects, food pieces, and toys.

When and Where Should I Seek Emergency Help?

Call emergency services immediately if someone cannot breathe, speak, or cough; becomes unconscious; has a battery lodged in the airway; or if you cannot clear the obstruction. Even after successful choking first aid, the person should be examined by a doctor to ensure nothing remains in the airway and to check for any internal injuries.

Understanding when to call for professional help is crucial in a choking emergency. While you should begin first aid immediately for a conscious choking victim, calling emergency services ensures that advanced medical help is on the way if your efforts are unsuccessful or if complications arise.

The decision to call emergency services depends on the severity of the obstruction and the victim's response to first aid. In many cases, especially with complete airway obstruction, you may need to ask someone else to call while you provide assistance. If you are alone with the victim, provide 2 minutes of first aid before calling, as the immediate need is to clear the airway.

When to Call Emergency Services Immediately

• Complete airway obstruction: The person cannot breathe, speak, or cough effectively
• Loss of consciousness: The person becomes unresponsive during choking
• Battery ingestion: Suspected or confirmed - this is a medical emergency due to chemical burns
• Failed first aid attempts: Multiple cycles of back blows and abdominal thrusts have not cleared the object
• Infant choking: Always call after beginning first aid for a choking infant
• Uncertainty: You are unsure whether the airway is fully clear

After successful first aid, a medical evaluation is still recommended. The forceful maneuvers used to clear the airway can sometimes cause internal injuries, including bruising to the abdomen, rib fractures, or damage to internal organs. Additionally, small fragments of the object may remain in the airway and cause complications later. A healthcare provider can perform a thorough examination and, if necessary, imaging studies to ensure complete recovery.

How Do You Help a Choking Adult or Child Over 1 Year?

For a conscious choking adult or child over 1 year, first encourage coughing. If ineffective, give 5 firm back blows between the shoulder blades, then 5 abdominal thrusts (Heimlich maneuver) with your fist positioned above the navel. Alternate between these techniques until the object is expelled or the person becomes unconscious.

The approach to helping a choking adult or older child follows international guidelines established by the International Liaison Committee on Resuscitation (ILCOR), the American Heart Association (AHA), and the European Resuscitation Council (ERC). These organizations recommend a combination of back blows and abdominal thrusts as the most effective first-line treatment for foreign body airway obstruction in conscious individuals over one year of age.

Before intervening physically, assess the situation quickly. Ask the person clearly: "Are you choking?" If they can respond verbally, cough forcefully, or breathe adequately, their obstruction is likely partial. In this case, encourage them to keep coughing while you stay with them and prepare to assist if their condition worsens. Do not interfere with their attempts to clear the object naturally, as forceful coughing is often the most effective way to expel a foreign body.

If the person cannot speak, cannot cough effectively, or shows signs of severe obstruction (blue lips, silent coughing, clutching throat), you must act immediately. The sequence of back blows followed by abdominal thrusts creates different pressure waves in the airway that can dislodge the object from different angles. Research shows that alternating between these techniques is more effective than using either one alone.

Step 1: Deliver 5 Back Blows

Step 2: Perform 5 Abdominal Thrusts (Heimlich Maneuver)

Step 3: Alternate and Repeat

Continue alternating between 5 back blows and 5 abdominal thrusts until one of the following occurs:

• The object is expelled and the person can breathe normally
• The person becomes unconscious (begin CPR - see below)
• Emergency medical services arrive and take over

How Do You Help a Choking Infant Under 1 Year?

For a choking infant under 1 year, never use abdominal thrusts. Instead, hold the infant face-down on your forearm with head lower than body, give 5 back blows between the shoulder blades, then turn face-up and give 5 chest thrusts using two fingers on the breastbone. Alternate until the object is expelled or the infant becomes unconscious.

Choking in infants requires a modified approach because their anatomy differs significantly from older children and adults. An infant's airway is smaller and more flexible, making them more vulnerable to obstruction but also requiring gentler intervention. Abdominal thrusts (Heimlich maneuver) are specifically contraindicated in infants under one year of age because they can cause serious internal injuries to the liver, spleen, and other abdominal organs.

The combination of back blows and chest thrusts recommended for infants works on the same principle as techniques for adults - creating pressure waves that can dislodge the object - but uses a gentler approach appropriate for their size and fragility. The infant should be positioned with the head lower than the body throughout the procedure to allow gravity to assist in expelling the object.

Step 1: Position the Infant for Back Blows

Step 2: Perform Chest Thrusts

Step 3: Repeat Until Successful

Continue alternating between 5 back blows and 5 chest thrusts until the object is expelled, the infant starts crying or breathing normally, or the infant becomes unconscious. If the infant becomes unconscious, immediately call emergency services and begin infant CPR.

What Should You Do If the Person Becomes Unconscious?

If a choking person becomes unconscious, immediately call emergency services and begin CPR. For infants, give 5 rescue breaths first before calling. Before each set of rescue breaths, look in the mouth and remove any visible object. Continue CPR until the person recovers, emergency help arrives, or you are too exhausted to continue.

When a choking victim loses consciousness, the situation becomes more critical but the treatment approach also changes. The muscles of the throat may relax when unconscious, potentially allowing the obstruction to be cleared more easily. Additionally, chest compressions during CPR generate airway pressure that can help dislodge foreign objects, and rescue breaths may force air past partial obstructions.

The transition from choking first aid to CPR should be smooth and immediate. Do not spend time trying to check for a pulse in an unresponsive choking victim - assume they need CPR and begin. The priority is to maintain some circulation and oxygenation while attempting to clear or bypass the obstruction.

CPR Sequence for Unconscious Choking Victim (Adult/Child)

1. Lower the person safely to the ground: Support their head and neck as you lay them on their back on a firm, flat surface.
2. Call emergency services (or have someone call): For adults, call immediately. For children, provide 2 minutes of CPR first if you are alone, then call.
3. Begin chest compressions: Place the heel of your hand on the center of the chest (lower half of breastbone). Give 30 compressions at a rate of 100-120 per minute, pressing down at least 5 cm (2 inches) for adults.
4. Open the airway and check the mouth: Before giving breaths, tilt the head back, lift the chin, and look in the mouth. If you see an object, remove it carefully with your finger. Do not perform blind finger sweeps.
5. Give 2 rescue breaths: Pinch the nose closed, create a seal over the mouth, and give 2 breaths (1 second each). Watch for chest rise. If the chest doesn't rise, reposition and try again.
6. Continue CPR: Repeat cycles of 30 compressions and 2 breaths. Continue until the person recovers, professional help arrives, or you cannot continue.

CPR Sequence for Unconscious Choking Infant

For infants, the approach is slightly different. Begin with 5 rescue breaths before compressions if you witnessed the choking episode, as respiratory causes are more common in pediatric cardiac arrest. Use gentle puffs of air (not full breaths) and two-finger chest compressions.

If at any point the person begins breathing normally, place them in the recovery position (on their side) and monitor closely until emergency services arrive. Even if they appear fully recovered, they need medical evaluation to ensure the airway is completely clear and to check for any injuries from the choking episode or CPR.

Can You Perform Choking First Aid on Yourself?

Yes, you can perform self-administered abdominal thrusts if you are choking alone. Make a fist and position it above your navel, grasp with your other hand, and thrust sharply inward and upward. Alternatively, bend over a firm surface like a chair back and press your abdomen against it forcefully. Call for help immediately when possible.

Choking while alone is a terrifying situation, but it is possible to help yourself using modified techniques. The key is to act quickly while you still have the strength and consciousness to do so. If you cannot clear the obstruction, try to call emergency services or attract attention from others, even if you cannot speak.

The self-Heimlich maneuver follows the same principle as when performed by another person - creating sudden upward pressure on the diaphragm to force air and the obstructing object out of the airway. The challenge is generating enough force without assistance.

Self-Heimlich Maneuver Technique

While performing self-help, try to move toward a phone to call emergency services, or toward an area where others might see or hear you. Even if you cannot speak, emergency dispatchers may be able to send help if you call. If you are in a public place, create noise or motion to attract attention.

How Can Choking Be Prevented?

Prevent choking by cutting food into small pieces, chewing thoroughly, not talking or laughing while eating, supervising children during meals, keeping small objects away from infants and toddlers, and avoiding giving high-risk foods (whole grapes, nuts, hard candies, popcorn) to young children.

While knowing how to respond to choking emergencies is essential, prevention is always preferable. Choking is a leading cause of accidental injury and death, particularly in children under five years and adults over 65 years. Understanding the risk factors and implementing simple safety measures can significantly reduce the likelihood of choking incidents.

The risk of choking varies with age and circumstance. Infants and young children are at high risk because they explore the world by putting objects in their mouths, have small airways, and are still developing their chewing and swallowing skills. Older adults are at increased risk due to dental problems, decreased saliva production, neurological conditions affecting swallowing, and medication side effects.

Prevention Strategies for Children

• Supervise mealtimes: Always watch children while they eat. Ensure they are seated and calm, not running or playing.
• Cut food appropriately: Cut round foods like grapes and hot dogs lengthwise, then into small pieces. Avoid giving whole nuts, hard candies, or popcorn to children under 4.
• Choose age-appropriate toys: Follow age guidelines on toy packaging. Use a choke tube tester (available at many stores) to check if small parts are choking hazards.
• Keep small objects out of reach: Batteries, coins, buttons, and small toy parts are common choking hazards. Store them safely.
• Learn about high-risk foods: Hot dogs, grapes, nuts, raw carrots, apples, marshmallows, and chewing gum are leading causes of food choking in children.

Prevention Strategies for Adults

• Eat slowly and chew thoroughly: Take small bites and chew food completely before swallowing.
• Avoid talking or laughing while eating: Distraction increases choking risk.
• Be careful with alcohol: Intoxication impairs the swallowing reflex and judgment about food size.
• Address dental issues: Ensure dentures fit properly and maintain dental health for effective chewing.
• Be aware of medications: Some medications cause dry mouth or affect swallowing. Discuss concerns with your doctor.

Where Can I Learn First Aid and CPR?

First aid and CPR courses are offered by organizations such as the Red Cross, St John Ambulance, American Heart Association, and local community health centers worldwide. Courses typically include hands-on practice with training mannequins and certification. Regular refresher training is recommended every 2-3 years.

While reading about choking first aid is valuable, hands-on training with feedback from qualified instructors and practice on mannequins provides much better preparation for real emergencies. Studies show that people who have received practical training are more confident and effective when responding to choking and cardiac emergencies.

First aid and CPR courses are widely available through various organizations worldwide. Most courses take only a few hours and provide certification that may be required for certain jobs or volunteer positions. Many employers offer or subsidize training for their workers, and some schools include basic first aid in their curriculum.

Benefits of Formal Training

• Hands-on practice: Practice techniques on mannequins in a safe environment
• Feedback from instructors: Learn correct positioning and force from experienced trainers
• Confidence building: Repetition builds muscle memory and reduces hesitation in emergencies
• Updated techniques: Guidelines are updated periodically; courses teach current best practices
• Certification: Many jobs and activities require proof of first aid training

Consider seeking training from recognized organizations in your country such as the Red Cross/Red Crescent, St John Ambulance, American Heart Association, European Resuscitation Council member organizations, or your local emergency medical services. Many community centers, workplaces, and healthcare facilities also offer courses.