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How To Treat the Choking Conscious Infant

By

Dorothy Habrat

, DO, Department of Emergency Medicine, University of New Mexico School of Medicine

Last full review/revision Aug 2019
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Topic Resources

Choking in an infant is usually caused by a small object the baby has placed in its mouth (eg, food, toy, button, coin, or balloon). If the airway obstruction is severe, then back blows followed by chest thrusts are administered to dislodge the object.

Indications

  • Severe upper airway obstruction in an infant (under age 1 year), caused by choking on a foreign object.

Signs of severe airway obstruction in an infant include

  • Cyanosis

  • Retractions

  • Inability to cry or make much sound

  • Weak, ineffective coughing

  • Stridor

Do not interfere if the infant can cry and make significant sounds, cough effectively, or breathe adequately; such infants do not have severe airway obstruction. Furthermore, strong coughs and cries can help push the object out of the airway.

Contraindications

Absolute contraindications:

  • Do not do back blows or chest thrusts if the infant stops breathing for reasons other than an obstructed airway (eg, asthma, infection, swelling, or a blow to the head).

Relative contraindications:

  • None

Complications

  • Rib injury or fracture

  • Internal organ injury

Equipment

  • None

Additional Considerations

  • This rapid first aid procedure is done immediately wherever the infant is choking.

Positioning

  • For back blows, place the infant prone along your forearm, using your thigh or lap for support. Hold the infant’s chest in your hand and the jaw with your fingers. Tilt the infant head-downward, such that the head is lower than the body (see figure Back blows—infant).

  • For chest thrusts, place the infant supine along your forearm, using your thigh or lap for support. Hold the back of the infant's head in your hand. Again, incline the infant such that the head is dependent to the body (see figure Chest thrusts—infant).

Back blows—infant

Back blows—infant

Chest thrusts—infant

Chest thrusts are delivered on the lower half of the sternum, just below the nipple level.

Chest thrusts—infant

Relevant Anatomy

  • The epiglottis usually protects the airway from aspiration of foreign objects. Objects that are aspirated beyond the epiglottis may be stopped by the vocal cords in the larynx and, at this level or below, cause life-threatening airway obstruction.

  • In infants and children, the cricoid cartilage, which lies inferior to the vocal cords, is the narrowest part of the upper airway. Sometimes, objects become trapped between the vocal cords and the cricoid ring, resulting in an obstruction that is particularly difficult to clear.

Step-by-Step Description of Procedure

  • Determine if there is severe airway obstruction, which may endanger the infant’s life. Look for signs of severe airway obstruction, such as the inability to cry audibly, cough effectively, or breathe adequately (eg, stridor, retractions, cyanosis).

  • If the infant has a strong cry or is coughing hard, do not do these procedures. If you have determined that the infant has severe airway obstruction, proceed with the following procedures.

  • Tell someone to call 911 while you begin first aid. If you are alone, shout for help and begin first aid.

  • Hold the infant face-down along your forearm using your thigh or lap for support. Hold the infant’s chest in your hand and open the jaw by pulling the mandible with your fingers. Point the infant’s head downward and lower than the body.

  • Give up to 5 quick, forceful back blows between the infant’s shoulder blades using the palm of your free hand.

  • Check the mouth to see whether the aspirated foreign body is visible; if it can be easily removed, remove it.

  • If the object does not come out of the airway after 5 back blows, turn the infant face-up.

  • Hold the infant face-up along your forearm using your thigh or lap for support. Hold the head in your hand with the head lower than the torso.

  • Place 2 fingers on the middle of the infant’s sternum just below the nipples. Avoid the lower ribs or the tip of the sternum.

  • Give up to 5 quick thrusts, compressing the chest about 1/3 to ½ the depth of the chest—usually about 1.5 to 4 cm (0.5 to 1.5 inches) for each thrust.

  • Continue to deliver 5 back blows followed by 5 chest thrusts until the object is dislodged or the infant becomes unconscious.

  • Do not try to grasp and pull out the object if the infant is conscious.

  • If the infant becomes unresponsive (unconscious), shout for help and begin infant cardiopulmonary resuscitation (CPR). If you are alone, after 1 minute of CPR call 911.

  • If the infant is unconscious and you can see the object blocking the airway, try to remove it with a finger. Try to remove the object only if you can see it.

Aftercare

  • Carefully examine the infant as soon as possible, even after successful removal of the airway obstruction and resumption of normal breathing.

Warnings and Common Errors

  • Do not do back blows or chest thrusts if the choking infant can cry audibly, cough forcefully, or breathe adequately.

  • Do not do back blows or chest thrusts if the infant stops breathing for reasons other than an obstructed airway (eg, asthma, infection, angioedema, head injury). Do give CPR in these cases.

  • Do not do blind finger sweeps on infants.

  • Do not do abdominal thrusts (Heimlich maneuver) on infants.

Tips and Tricks

  • It is important to use gravity as an ally. Keep the infant's head lower than its torso during the procedure.

More Information

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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