Step 1: Assess the situation quickly.
If a child is suddenly unable to cry, cough, or speak, something is probably blocking her airway, and you’ll need to help her get it out. She may make odd noises or no sound at all while opening her mouth. Her skin may turn bright red or blue.
If she’s coughing or gagging, it means her airway is only partially blocked. If that’s the case, encourage her to cough. Coughing is the most effective way to dislodge a blockage.
If the child isn’t able to cough up the object, ask someone to call 911 or the local emergency number as you begin back blows and abdominal thrusts (see step 2, below).
If you’re alone with the child, give two minutes of care, then call 911.
On the other hand, if you suspect that the child’s airway is closed because her throat has swollen shut, call 911 immediately. She may be having anallergic reaction – to food or to an insect bite, for example – or she may have an illness, such as croup.
Also call 911 right away if the child is at high risk for heart problems.
Step 2: Try to dislodge the object with back blows and abdominal thrusts.
First do back blows
If a child is conscious but can’t cough, talk, or breathe, or is beginning to turn blue, stand or kneel slightly behind him. Provide support by placing one arm diagonally across his chest and lean him forward.
Firmly strike the child between the shoulder blades with the heel of your other hand. Each back blow should be a separate and distinct attempt to dislodge the obstruction.
Give five of these back blows.
Then do abdominal thrusts
Stand or kneel behind the child and wrap your arms around his waist.
Locate his belly button with one or two fingers. Make a fist with the other hand and place the thumb side against the middle of the child’s abdomen, just above the navel and well below the lower tip of his breastbone.
Grab your fist with your other hand and give five quick, upward thrusts into the abdomen. Each abdominal thrust should be a separate and distinct attempt to dislodge the obstruction.
Repeat back blows and abdominal thrusts
Continue alternating five back blows and five abdominal thrusts until the object is forced out or the child starts to cough forcefully. If he’s coughing, encourage him to cough up the object.
If the child becomes unconscious
If a child who is choking on something becomes unconscious, you’ll need to do what’s called modified CPR. Here’s how to do modified CPR on a child:
Place the child on his back on a firm, flat surface. Kneel beside his upper chest. Place the heel of one hand on his sternum (breastbone), at the center of his chest. Place your other hand directly on top of the first hand. Try to keep your fingers off the chest by interlacing them or holding them upward.
Perform 30 compressions by pushing the child’s sternum down about 2 inches. Allow the chest to return to its normal position before starting the next compression.