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Whether your little one guzzles their milk a little too quickly, swallows a rogue Lego piece, or inhales a popcorn kernel during movie night—gagging and choking strikes fear in the hearts of parents everywhere…especially because many don’t know what to do in case of such an emergency. In fact, a 2016 report found that only about 20% of moms surveyed knew CPR and, shockingly, as many as 76% would hesitate to administer choking first aid to their child due to lack of knowledge and courage. Those numbers are quite alarming considering the fact that children under age 4 are most at risk for choking on food and small objects—and accidental choking is the fourth leading cause of unintentional death in little ones under 5.

Worried you wouldn’t know what to do if your child was choking? Here’s a quick guide to help you feel more confident.

Choking Signs in Children

Is it a coughing fit or choking? Sometimes it’s hard to tell, and knowing the difference can save a child’s life. The scary truth is this: If your child is choking and their brain doesn’t receive oxygen for more than four minutes, permanent brain damage and death can result. The following signs of choking signal that you should have someone call 911 immediately while you tend to your child:

  • Can’t talk, cry, or make much sound

  • Weak, ineffective cough

  • Soft or high-pitched sounds on the inhale

  • Difficulty breathing (ribs and chest pull inward)

  • Grabs at throat or waves arms

  • Appears panicked

  • Face begins to turn blue

  • Loss of consciousness

What if I’m unsure my child is choking?

All the above signs indicate your child is, in fact, choking and needs immediate attention. (Again, have someone call 911 while you help your child.) However, there are some choking signs that don’t warrant your knee-jerk intervention.

If your little one is having some difficulty breathing, BUT can speak, has a robust cry, or has a strong cough, don’t rush in with any abdominal thrusts or back-smacks. Instead, allow your child’s cough to dislodge the choked-on item. The American Academy of Pediatrics (AAP) notes that this approach can be significantly more effective than any intervention you may want to offer. That said, always be ready to act if any choking symptoms get worse. For example, a partial blockage of the airway can turn into a complete one.

What NOT to Do If Your Child Is Choking

Again, if your kiddo is gagging and coughing, but can breathe, talk, and cough, it really is best to do nothing at this point but remain calm and keep a keen eye on your child. (We know that’s hard!) Experts affirm that your child’s coughing spell most likely can dislodge what’s stuck. At the same time, DO NOT…

  • Reach into your child’s mouth to grab the object

  • Pat your child on the back

  • Raise your child’s hands above their head

These actions may actually push the stuck object farther down your child’s airway, making the situation worse. 

What to Do If Your Baby Is Choking

Because it bears repeating, let’s say it again: If your baby is choking, call 911 immediately—or have someone else do it. If your baby (12 months old or younger) isn’t forcefully coughing or crying, do the following:

  • Step 1: Lay your baby along your forearm, face down.

  • Step 2: Hold your baby’s chest in your hand and their jaw with your fingers, making sure Baby’s head is facing downward, lower than their body. (You can use your lap for support.)

  • Step 3: Use the heel of your free hand to give your baby up to five quick and forceful whacks between their shoulder blades.

If the object does not become dislodged after five whacks, try this:

  • Step 1: Continuing to use your lap for support, turn your baby face-up.

  • Step 2: Cradle your baby’s head.

  • Step 3: Place two fingers on the middle of their breastbone just below the nipples.

  • Step 4: Give your baby up to five quick thrusts downward. Chest compressions should be one-third to one-half the depth of Baby’s chest.

  • Step 5: Continue five back blows followed by five chest thrusts until the object is dislodged.

  • Step 6: It’s important to get your baby checked out after a choking incident to make sure nothing is still lingering in their lungs.

What to Do If a Choking Baby Loses Consciousness

Dispatchers should be on their way if you’ve already called 911. While you wait, do the following if your baby has become unresponsive, stops breathing, or has turned blue:

  • Yell for help.

  • If you know how to do it, give infant CPR. (How-tos below.)

  • If 911 has not been called yet, do so after one minute of CPR.

  • If you can see the object blocking your baby’s airway, try to carefully remove it with your finger. ONLY do this if you can see the offending object.

How to Do Infant CPR

Do not jump to CPR (aka cardiopulmonary resuscitation) unless it’s absolutely necessary. If your little one is able to cough and cry, let them cough the object up. If your baby cannot clear the object while coughing, call 911 and give back blows and chest thrusts while you wait for help to arrive. However, if your baby has no pulse, administer CPR until help arrives.

  • Step 1: Gently place your baby on their back on a firm, flat surface.

  • Step 2: Place both thumbs, side-by-side, in the center of Baby’s breastbone, just below their nipples.

  • Step 3: Use your other fingers to encircle your baby’s chest toward the back, which offers support.

  • Step 4: With both thumbs, press down hard and fast on your baby’s chest, completing 30 compressions. Your baby’s chest needs to completely rise after each compression. (Chest compressions should be one-third to one-half the depth of Baby’s chest. Try your best not to press at the very end of the breastbone.)

  • Step 5: Open your baby’s airway by lifting their chin with one hand and tilting their head (gently push on their forehead) with the other hand.

  • Step 6: Blow two quick breaths into your baby’s mouth, allowing the air to exit before giving the next breath.

  • Step 7: Place your ear next to your baby’s mouth and nose and listen for breath. At the same time, watch for chest movement and feel for your little one’s breath on your cheek. 

If your infant is not breathing:

  • Step 1: Cover your baby’s mouth and nose tightly with your mouth. (Or cover their nose and hold their mouth shut.)

  • Step 2: Keep your baby’s chin lifted and head tilted.

  • Step 3: Give two quick breaths. Each should take roughly one second and make Baby’s chest rise.

  • Step 4: Repeat rescue breathing, chest compressions, and checking for breathing until your baby recovers or help arrives.

  • Step 5: Go to the doctor even if your baby seems fine. A part of the choked-on object may remain in your child’s lung.

While this is a great guide, it’s significantly more helpful to take an infant and child CPR course. The American Red Cross offers in-person and online CPR classes, as do many hospitals and local parenting organizations (our friends at Boober offer an online Infant Safety and CPR class). Ask your pediatrician for guidance if needed.

What to Do If Your Toddler or Young Child Is Choking

If your child is between the ages of 1 and 8, a lot of the same rules apply, including allowing your tot to cough up the offending object if they can. So, if your kiddo is still making sounds, instruct them to cough and ask them, “Are you choking?” If your child indicates yes, cannot respond, or exhibits the telltale choking signs (they have a weak, ineffective cough and/or make soft or high-pitched sounds on the inhale), call 911 (or have someone else do it) and begin the Heimlich maneuver:

  • Step 1: Stand behind your child, wrapping your arms around their waist.

  • Step 2: Make a fist with one hand where your thumb is facing your child. Place your fist slightly below your kiddo’s chest and just above their belly button.

  • Step 3: With your other hand, grab your fist.

  • Step 4: With a quick upward push, press into your child’s abdomen. Repeat this inward-upward thrust until the object comes out.

  • Step 5: Once the offending object comes out, head to the doctor just in case part of the object is still in your child’s lung.

What to Do if Your Toddler or Young Child Loses Consciousness

If you’ve already called 911, help is coming! If you’ve yet to call, do it now—or have someone else do it for you. While you wait for rescuers to arrive do the following:

  • Step 1: Lay your child on the floor, flat on their back on a firm, flat surface.

  • Step 2: Open your child’s mouth, wrapping your fingers around their lower jaw. Use your thumb to hold their tongue as to draw the tongue away from the back of the throat.

  • Step 3: Peer into the back of your child’s throat. If you can see the object they’re choking on, try to remove it with a very careful sideways sweep of your finger. (Please do not push the object even further down! This can worsen the blockage.)

If your child is not breathing....

  • Step 1: Gently tilt your child’s head back and lift their chin.

  • Step 2: Place your mouth over your child’s mouth then pinch their nose shut.

  • Step 3: Give two slow breaths, each lasting one and a half to two seconds.

  • Step 4: If your child is still unconscious, return to the Heimlich maneuver, but do it while kneeling at your child’s feet. Place the heel of one of your hands between their rib cage and belly button. Put your other hand on top of the first one.

  • Step 5: Firmly but gently push into your child’s abdomen, using six to 10 rapid inward, then upward thrusts.

  • Step 6: Repeat the finger sweep, slow breaths, and abdominal thrusts until your child begins breathing or help arrives.

How to Do CPR on a Toddler

If 911 hasn’t been called yet, have someone do that for you. If you are alone, do it yourself, but do not leave your child unattended. Remember, CPR should only be used when a child has no pulse.

  • Step 1: Place your child on their back on a firm, flat surface and kneel beside them.

  • Step 2: Put the heel of one of your hands in the center of your child’s chest.

  • Step 3: Press down hard and fast about 2 inches. Do 100 to 120 compressions a minute. That’s roughly the same number of beats per minute as the song “Staying Alive,” according to the American Heart Association (AHA). (For those of us who missed the disco era, the AHA has put together a whole playlist of songs with 100 to 120 beats per minute, including more contemporary hits, like “Can’t Stop the Feeling.”)

  • Step 4: Open your child’s airway slightly past-neutral position by lifting their chin and gently tilting their head.

  • Step 5: Offer two rescue breaths.

  • Step 6: Continue the patterns of 30 chest compressions and two breaths until you notice your child coming to or a medical professional takes over.

How to Do CPR on a Child

If your young child is no longer a toddler, all the basic rules still apply. The only real difference is the way you perform chest compressions. Here’s how to perform CPR on a child:

  • Step 1: Place your child on their back on a firm, flat surface. Kneel next to them.

  • Step 2: Place the heel of one of your hands on the center of the child’s chest. Put your other hand on top and interlace your fingers.

  • Step 3: Position your shoulders directly over your hands. Lock your elbows and keep your arms nice and straight.

  • Step 4: Press down hard and fast about 2 inches, allowing your child’s chest to return to normal position after each compression. Do 100 to 120 compressions a minute.

  • Step 5: Open your child’s airway slightly past-neutral position by lifting their chin and gently tilting their head.

  • Step 6: Give two rescue breaths.

  • Step 7: If your child’s pulse has not returned, continue offering 30 chest compressions and two breaths until your child’s status changes or a medical pro arrives.

While the above should serve as a quick refresher, it’s important that all parents and other adults, like babysitters and grandparents, who spend time with children take an infant and child CPR course. Reach out to your pediatrician for help finding one in your area.

Do anti-choking devices work?

Today you can find a few different kinds of plunger-like items sold in stores that are marketed as choking rescue devices. While the manufacturers share testimonials stating that their devices have saved numerous lives, a 2020 study concluded that there’s “insufficient evidence to support or discourage their use.” Translation: We don’t yet know how safe or effective anti-choking devices are. But we do know that the American Red Cross, the AAP, and other respected organizations advocate for learning Heimlich maneuver and CPR to best aid a choking child.

How to Prevent Choking

Babies love to put things into their mouths! While it’s an important way that little one’s explore their environment, if babies get their hands on objects that can easily block their small windpipe, choking can occur. Here are some basic tips to help keep your baby from choking.

Skip these foods before age 4:

  • Chewing gum

  • Chips, popcorn, and pretzels

  • Chunks of cheese and string cheese

  • Chunks of hard raw fruits and vegetables

  • Chunks of meat

  • Gobs or spoonfuls of nut and seed butters, such as peanut butter

  • Gummies, including gummy vitamins

  • Hard or sticky candy

  • Marshmallows

  • Raisins

  • Uncut olives, grapes, cherries, melon balls, cherry tomatoes, and berries

  • Whole nuts and seeds

  • Whole hot dogs and sausages

Keep these items away from babies and young children:

  • Amber teething necklaces

  • Balloons

  • Batteries, especially button-size batteries

  • Broken crayons

  • Buttons

  • Coins

  • Erasers

  • Jewelry (such as rings, earrings, and pins)

  • Marbles and small balls

  • Nails, bolts, and screws

  • Paperclips

  • Pen or marker caps

  • Pet food kibble

  • Push pins

  • Safety pins

  • Small caps for bottles

  • Small hair bows, barrettes, rubber bands

  • Small magnets

  • Toys with small parts and doll accessories

  • Vending-machine toys

 For more on how to prevent choking in little ones, check out our complete guide.

Childproof your surroundings:

  • Crawl on your floor like you’re a child and check for small objects or toy parts.

  • Look under rugs, between furniture cushions, and on counters or shelves within your child’s reach for small objects.

  • Instruct your kiddos not to put pencils, crayons, or erasers in their mouths.

  • Check toys and stuffed animals for loose or broken parts often.

  • Never leave loose game parts in easy reach of younger children.

  • Safely throw out or recycle all batteries, especially button batteries.

  • Keep small refrigerator magnets at the tip-top of your appliance.

  • Always follow all manufacturers' age recommendations when buying toys.

For more help childproofing your home and your hotel room or vacation rental, see Dr. Harvey Karp’s go-to childproofing tips. Plus, learn what 10 household objects you need to keep out of Baby’s reach.

 

More health and safety need-to-knows:

 

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REFERENCES

  • Mothers’ knowledge of administration of first aid to preschoolers in choking incidents, Archives of Physiotherapy and Global Researches, 2016
  • American Academy of Pediatrics (AAP): Responding to a Choking Emergency
  • Injury Facts: Preventable-injury-related deaths by age and cause, United States, 1999-2020
  • American Speech-Language-Hearing Association: 5 Myths and Truths About Choking
  • Nemours KidsHealth: First Aid: Choking
  • MedlinePlus: Choking - infant under 1 year
  • American Red Cross: Child & Baby CPR
  • MedlinePlus: CPR - infant
  • Stanford Medicine Children’s Health: How to Help a Choking Child
  • Nemours KidsHealth: Household Safety: Preventing Choking
  • AAP: Choking Prevention
  • American Heart Association CPR & First Aid Emergency Cardiovascular Care: Be the Beat

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    Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.