What to know about choking

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Choking is a medical emergency that occurs when a foreign object lodges in the throat, blocking the airway. Because choking prevents a person from breathing, it cuts off oxygen to the brain. Choking can cause fatalities without immediate help.

In many cases, if a person is choking, they may clutch their hands to their throat in an attempt to clear the blockage. Some of the signs that someone is choking include:

• inability to talk
• breathing difficulties
• breathing that squeaks
• weak coughing
• a red, puffy face
• lips or skin turning blue
• loss of consciousness

The most common objects to cause choking are pieces of food. However, people, especially children, may choke on toys, coins, and other small objects.

Choking hazards include food and household items:

• hotdogs or sausages
• fish with bones
• popcorn
• candy or chewing gum
• smaller whole fruits such as berries and nuts
• peanut butter
• ice cubes
• latex balloons
• marbles
• pen caps
• buttons
• batteries
• earrings
• erasers
• holiday decorations

Someone who is choking requires immediate help. Adults should use the Red Cross “five-and-five” technique. The approach involves a combination of five back blows and five abdominal thrusts. The technique is also known as the Heimlich Maneuver. However, experts do not recommend the Heimlich Maneuver for children younger than 1 year old or for pregnant individuals.

The first step is to verify that the individual is choking and obtain their consent to help them.

To perform the five back blows:

1. Stand behind the person.
2. Place one arm across their chest to support them.
3. Bend them at the waist so their chest is parallel to the ground.
4. Deliver five firm blows between their shoulder blades with the heel of the other hand.

If the person is still choking, the next step is to perform five abdominal thrusts:

1. Stand behind the choking person with one leg forward between their legs.
2. With one arm, reach around their abdomen and locate their navel.
3. Place a fist just above their navel with the thumb facing the abdomen.
4. Hold this fist with the other hand and thrust inward and upward with a quick, jerking motion.

Alternate between five back blows and five abdominal thrusts until the blockage clears or the individual becomes unresponsive.

Children and infants

For children and infants, the first step is to attempt to clear the airway with fingers, being careful not to push any objects farther into the throat. If this is unsuccessful, use the following technique:

1. Sit down and hold the child face down on the forearm, which rests against the thigh.
2. Support their head and neck with one hand and ensure their head is lower than their abdomen.
3. Give up to five back slaps between their shoulder blades with the heel of the other hand.
4. If this is unsuccessful, turn the child to face upward, supporting their head with the hand.
5. Place two fingers on the breastbone, slightly below the nipple line.
6. Perform five chest thrusts about 1.5 inches deep at a rate of one per second.
7. Continue the cycle of back slaps and chest thrusts until the child expels the object or they become unresponsive.

If an individual becomes unresponsive, call 911 (or the local emergency number) and begin CPR.

These are the steps for adults and children ages 9 years and older:

1. Ensure the individual is lying on their back on a flat surface.
2. Kneel at their side.
3. With straight elbows, position the hands one on top of the other in the center of the chest, palms down.
4. Lean forward and begin chest compressions by pushing down at least 2 inches at a rate of 100 times per minute.
5. Allow the person’s chest to rise completely after each compression.
6. After 30 compressions, tilt the person’s head, lift their chin, and administer two rescue breaths, each lasting 1 second.
7. Repeat the process until the person begins breathing or professional medical help arrives and takes over.

It is important to note that compression-only CPR at a rate of 100 compressions per minute is better than no CPR at all, for example, if the rescuer cannot give rescue breaths or chooses not to.

Choking is the fourth leading cause of unintentional injury death. In 2015, 5,051 people died from choking, and 2,848 (56%) of these individuals were older than age 74 years. People older than age 60 years are also at risk.

Additionally, there is a strong association between having dementia or Parkinson’s disease and choking.

Children under age 5 years are at greater risk of choking injury and death, and at least one child dies from choking on food every day in the United States. In addition, more than 12,000 children visit the emergency room each year for food choking injuries. Children are particularly at risk of choking because their windpipe is extremely small.

After a choking incident, an individual may experience throat irritation or damage. Additionally, complications of the Heimlich Maneuver include abdominal injuries and vomiting.

People should seek urgent medical help if they have a persistent cough after choking or feel as though something is still in the throat.

The most significant complication of choking is the risk of death from asphyxiation.

Adults can take the following preventive measures to help avoid choking:

• Cut food into small pieces.
• Chew food thoroughly before attempting to swallow.
• Avoid laughing and talking while eating.
• Be mindful while eating.

Caregivers can help prevent choking in children by taking the following steps:

• Cut food into tiny pieces.
• Do not offer children under 5 years old any foods that are small, round or hard, such as grapes, hotdogs, or candy.
• Do not feed children when they are lying down or playing.
• Supervise children when they are eating or playing.
• Keep small objects out of reach, including toys, buttons, and magnets.
• Check the home often for small objects children can access.
• Inspect toys regularly for any loose parts.
• Check new toys for potential choking hazards.

Choking is a serious situation that can lead to fatalities.

If an individual chokes, it means their airway is blocked with an object, preventing them from breathing. They require emergency medical assistance to clear the blockage and allow them to breathe.

Young children under 5 years old are particularly at risk of choking, as they often put objects in their mouths. Additionally, people over 60 years old may experience choking as they may use dentures or have trouble swallowing, contributing to the risk. Dementia and Parkinson’s disease both also increase the risk of choking.

If someone is choking, the person assisting should use the five and five technique, which involves the cycles of five back slaps followed by five abdominal thrusts until the blockage clears.

People should also seek medical attention after a choking incident if they have a persistent cough or feel as though an object is still in their throat.