Choking Response: Heimlich Maneuver for All Ages

Recognizing Choking

The difference between a complete airway obstruction and a partial one determines your response.

Partial obstruction: The person is making noise — coughing, wheezing, or speaking in some capacity. The airway has some air movement. Do not intervene with back blows or abdominal thrusts. Encourage them to cough forcefully. A strong cough generates more airway pressure than any maneuver you can apply externally. If the cough is effective, it will clear the obstruction. If the cough weakens or the person cannot maintain effective coughing, proceed to intervention.

Complete obstruction: The person cannot speak, cannot cough, cannot breathe. May make no sound at all, or only a high-pitched wheezing (stridor) around the obstruction. Will use the universal choking sign (hands to throat). Will rapidly become cyanotic (blue around the lips, face turning red then purple) as oxygenation drops.

This is a time-sensitive emergency. Without intervention, a person with a complete airway obstruction will lose consciousness in approximately 3-4 minutes.

Adult and Child Technique (Over Age 1)

Back Blows

Stand behind and slightly to the side of the choking person. Have them lean forward — this positions the airway horizontally so gravity can assist dislodging the object.

Deliver 5 firm heel-of-hand blows to the center of the back, between the shoulder blades. These need to be forceful. "Firm" means hitting hard enough to create impact. Gentle taps accomplish nothing.

After each blow, check if the obstruction has cleared (the person can breathe or speak).

Abdominal Thrusts (Heimlich Maneuver)

If 5 back blows do not clear the obstruction:

1. Stand directly behind the person, feet shoulder-width for stability.

2. Make a fist with one hand. Place the thumb side of the fist against the person's abdomen — above the navel and well below the breastbone (lower end of sternum). The exact position matters: too high and you risk bruising the ribs; too low and you push against the intestines, not the diaphragm.

3. Grasp your fist with your other hand.

4. Deliver a sharp, forceful thrust inward and upward simultaneously. The vector is toward the diaphragm. This compresses the lungs from below, generating a burst of airway pressure that expels the obstruction.

5. Deliver 5 abdominal thrusts, checking for obstruction clearance after each set.

6. Alternate: 5 back blows, 5 abdominal thrusts. Repeat.

Each cycle may need to be more forceful than the last. The object may be partially dislodged and needing one more push.

If the Person Goes Unconscious

Do not try to hold them up. Lower them to the ground on their back. Call 911 if not already done.

Begin CPR. When you open the airway to give rescue breaths: look in the mouth. If you can see the object, remove it. Perform a finger sweep only if the object is visible — blind finger sweeps push objects deeper in infants and should be used only in adults when you can see the object.

After delivering 2 rescue breaths (or attempting), resume compressions. The compressions themselves may dislodge the object through chest compression pressure.

Pregnant Women and Obese Patients

Abdominal thrusts are not appropriate when the abdomen cannot be compressed effectively (pregnancy, severe obesity).

Use chest thrusts instead:

Stand behind the person. Place your fist on the center of the sternum — the same position as CPR chest compressions, not the abdomen. Grasp with the other hand. Deliver firm backward thrusts (straight back, not upward). Alternate with back blows.

Infant Choking (Under Age 1)

Infants receive a different technique because their anatomy and fragility differ from older children.

Never use abdominal thrusts on infants. The abdominal organs are relatively larger and less protected. Abdominal thrusts in infants risk organ damage.

Back Blows

Support the infant along your forearm, face-down. The head should be lower than the chest — gravity assists. Support the head by holding the jaw, not by placing fingers in the mouth.

Deliver 5 back blows between the shoulder blades with the heel of your hand. These should be firm but appropriate for an infant — you are hitting a small body.

Chest Thrusts

After 5 back blows, turn the infant face-up, still supported along your forearm. The head remains lower than the chest.

Place two fingers on the center of the chest, one finger-width below the nipple line. Give 5 chest thrusts, compressing 1.5 inches — the same depth as infant CPR compressions.

Alternate 5 back blows and 5 chest thrusts.

After each back blow or chest thrust, look in the mouth. If you can see the object, use a finger to carefully remove it. Do not blindly sweep fingers in an infant's airway.

Airway Obstruction in the Field

When choking occurs in a remote setting without emergency services:

For partial obstruction: Keep the patient calm. Encourage coughing. A controlled environment prevents panicking, which causes further muscle spasm and worsens obstruction. Most partial obstructions resolve with coughing.

For complete obstruction: All the same technique, but you are the only resource. If the person loses consciousness and your airway-clearing efforts are not working, begin CPR. The abdominal compressions of CPR may dislodge the object. Continue until the object is expelled or you have exhausted your ability.

Visualization and manual removal: If you have a headlamp and can see the object in the throat, careful manual removal with fingers or tweezers is an option. This requires the patient to be cooperative (difficult in a panicking awake patient) or unconscious. Blind probing should not be attempted — you will push the object deeper.

When Objects Are Clear

After clearing a choking episode:

• The person may have throat soreness, hoarseness, or coughing for hours after clearing
• Abdominal thrusts occasionally cause internal injury: internal bleeding, rib fractures, bruising to abdominal organs. If there is abdominal pain, chest pain, or significant tenderness after the episode, seek evaluation.
• The person should eat and drink cautiously until the airway and throat soreness resolve
• For infants, pediatric evaluation is recommended after a significant choking episode to confirm no residual aspiration