Choking in Babies: Back Blows and Chest Thrusts

Babies explore with their mouths, and their airways are roughly the diameter of a drinking straw. Choking is one of the most common serious emergencies in the first two years of life, and the response is specific enough that guessing is not good enough.

Decide how bad it is first

A baby who is coughing forcefully or crying loudly is moving air, and the blockage is partial. Do not hit them. Watch them closely and let the coughing do the work, because a poorly timed blow can shift the object into a worse position.

A baby who is silent, who cannot cry or cough, whose efforts to breathe produce no sound, or who is turning blue has a severe blockage. Act immediately and shout for someone to call 000.

Five back blows

Lay the baby face down along your forearm with the head lower than the chest, supporting the jaw with your fingers but taking care not to compress the soft throat. Rest your forearm on your thigh for stability. Deliver up to five firm blows between the shoulder blades with the heel of your free hand. Check after each blow to see whether the object has come out.

Five chest thrusts

If back blows have not cleared it, turn the baby face up along your other forearm or thigh, still with the head lower than the chest. Place two fingers in the centre of the chest, on the lower half of the breastbone, and give up to five sharp inward thrusts. These are sharper and slower than compressions. Check between each one.

Keep alternating five back blows with five chest thrusts until the airway clears or the baby becomes unresponsive.

Never do these

• Never give abdominal thrusts to a baby. They are not used in Australian first aid at any age, and in an infant they risk serious internal injury.
• Never hold a baby upside down by the ankles or shake them.
• Never put your finger into the mouth to feel for the object. Remove it only if you can see it clearly and can hook it out safely.

If the baby becomes unresponsive

Place them on a firm surface, call 000 if nobody has yet, and begin infant CPR. Compressions generate pressure that frequently dislodges the object on their own. Each time you open the airway to give breaths, look inside the mouth and remove anything you can now clearly see.

Prevention is worth the effort

Cut grapes and cherry tomatoes lengthways into quarters, avoid whole nuts, popcorn and hard lollies under three years, keep small toy parts, coins and button batteries out of reach, and stay with a baby while they are eating. Button batteries deserve particular caution, because they cause severe internal burns and require an immediate trip to hospital even if the baby seems fine.

Our Childcare First Aid course drills this sequence on infant manikins. Book a session and get certified the same day.