(See also Overview of Respiratory Arrest Overview of Respiratory Arrest Respiratory arrest and cardiac arrest are distinct, but inevitably if untreated, one leads to the other. (See also Respiratory Failure, Dyspnea, and Hypoxia.) Interruption of pulmonary gas exchange... read more and Airway Establishment and Control Airway Establishment and Control Airway management consists of Clearing the upper airway Maintaining an open air passage with a mechanical device Sometimes assisting respirations (See also Overview of Respiratory Arrest.) read more .)
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
Inability to cry or make much sound
Weak, ineffective coughing
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.
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).
Rib injury or fracture
Internal organ injury
This rapid first aid procedure is done immediately wherever the infant is choking.
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.
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 Step-by-Step Description of Procedure 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... read more ).
Chest thrusts are delivered on the lower half of the sternum, just below the nipple level.
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 Cardiopulmonary Resuscitation (CPR) in Adults Cardiopulmonary resuscitation (CPR) is an organized, sequential response to cardiac arrest, including Recognition of absent breathing and circulation Basic life support with chest compressions... read more (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.
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.
The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
American Heart Association: Basic Life Support (BLS) Provider Manual. Dallas, American Heart Association, 2016.