Choking (Children over one year of age)
Choking happens when an object wedges itself in the trachea (windpipe) and breathing becomes very difficult or impossible.
What is it? (Overview)
Just about anything a young child can put in his hand is likely to end up in his mouth. That means that parents who learn first aid and CPR can save many children from choking. Of the nearly 3,000 people in the United States who die every year from choking, most of them are children. You can find a class on first aid and CPR through your local Red Cross office or hospital.
How do I know my child is choking? (Symptoms and Diagnosis)
A child who is choking will often clutch his hands to his throat. He may also have a look of panic or fear on his face or a change in skin color. If you’re not sure your child is choking, ask if he can talk.
If your child is unconscious:
- Look for stomach or chest movement.
- Listen for coughing or any kind of breath noise.
- Feel for air against your cheek.
What should I do? (Emergency Treatment)
If your child is able to cough strongly, talk, or cry, then there is little or no blockage. Call a health-care
professional for further help.
If the child is conscious but cannot breathe, first try rescue breathing. Tilt the child’s head back and pinch his
nose closed with your thumb and forefinger. Take a deep breath. Place your mouth over the child’s mouth and
exhale. Repeat again. If his chest rises, continue giving breaths until the child can breathe on his own.
If you don’t see his chest rise, try abdominal thrusts
(fig. 1).
Stand behind him with your arms around his middle. Place a fist just above his navel. Cover your fist with your other hand.
Give a quick upward thrust. If someone is with you, ask that person to call 911. If you are alone and rescue breathing is
unsuccessful after one minute, call 911.
If the child is unconscious, lay him on his back. Sometimes the tongue can block breathing when an unconscious victim
is lying down. You can lift the tongue out of the throat by grasping the lower jaw and pulling forward. With your first
two fingers, sweep inside the mouth to remove any debris. Don’t perform a finger sweep in children under 8 years
old unless you can see the object. Check again for breathing by looking for a rise and fall in the child’s chest,
by placing your check next to his mouth to feel for air, and by listening for any breathing sounds.
If your child is still not breathing, kneel astride his legs or straddle his hips. With splayed fingers, place one hand
over the other on his stomach just above the navel, but below the breastbone. Give up to five quick upward thrusts.
After each set of five thrusts, press the forehead back with the palm of one hand and lift the chin forward. Try rescue
breathing. Continue this cycle of thrusts, jaw lift, and breaths until you notice the child breathing. If you are alone
in this situation, your first priority should be to get the child breathing again. If the child isn’t breathing
after one minute, call 911 for help.
Non-emergency treatment (Treatment)
In a situation when your child has swallowed an object like a coin or small toy that you cannot remove but the child
can still breathe, your health-care professional may extract the item using a bronchoscope, a long tube that goes into
the airway. Anesthesia may be used or a sedative given to help the child relax during the procedure. If the item is not
removed, it can cause a chronic cough and repeated infections.
How dangerous is it? (Outlook)
It only takes a few minutes for a child to die from choking. In fact, brain damage can happen in just four minutes.
Without air, your child can die in four to eight minutes.
How can I prevent it? (Prevention)
Children commonly choke on food or small toys. The American Academy of Pediatrics (AAP) suggests that you cut food into
small pieces for children under age 4 and have children sit down while they eat. You should be especially watchful when
a child is eating the following foods, which are common choking hazards:
- Hot dogs.
- Nuts.
- Whole grapes.
- Popcorn.
- Hard or sticky candy.
- Raw carrots.
- Chunks of peanut butter.
- Chunks of meat or cheese.
- Coins.
- Marbles.
- Caps of pens or markers.
- Button-type batteries.
- Small toys that can fit inside the mouth.
Frequently asked questions (FAQ)