Choking

Choking happens fast, often at mealtimes, and a person who cannot breathe needs help within seconds. The steps are simple to remember: cough, back blows, abdominal thrusts, call for help.

Is it mild or severe?

• Ask, 'Are you choking?' If they can breathe, speak or cough, they may be able to clear it themselves.
• St John Ambulance signs: difficulty breathing, speaking or coughing; a red, puffy face; distress, pointing to the throat or grasping the neck.
• If they cannot breathe, cough or make any noise, they need your help straight away.
• Encourage a person who can still cough to keep coughing, and remove any obvious obstruction from the mouth.
• Do not slap the back of someone who is coughing effectively; coughing is the best way to clear the object.

Step 1: up to five back blows

• Stand to the side and slightly behind them. Support their upper body with one hand and help them lean well forward.
• Give up to five sharp blows between the shoulder blades with the heel of your other hand.
• Check their mouth after each blow and remove anything you can clearly see.
• If the object comes out, stop. If not, move on to abdominal thrusts.

Step 2: up to five abdominal thrusts

• Stand behind them and put your arms around their waist.
• Make a fist and place it between their belly button and the bottom of their chest (the ribs), then grasp it with your other hand.
• Pull sharply inwards and upwards, up to five times.
• Check their mouth after each thrust.
• For a child over one, HSE Ireland says stand or kneel behind them, place the fist just above the navel and below the ribs, and avoid pressing on the ribs.

Step 3: call 998 and keep going

• If the blockage has not cleared after five back blows and five thrusts, call 998 straight away (or get someone else to).
• Repeat cycles of five back blows and five abdominal thrusts, checking the mouth each time, until help arrives.
• If they become unresponsive at any point, call 998 if not done and start CPR (lesson fa-03).
• HSE Ireland advises that a child should still get medical help even if the object comes out, in case part of it remains or they were injured.

Babies under one are different

• Never use the adult technique on a baby. HSE Ireland teaches back blows and chest thrusts, not abdominal thrusts, for babies under one.
• Back blows: sit down and lay the baby face down along your forearm, resting on your knee, supporting the head and jaw, with their head lower than their body. Give up to five back slaps between the shoulders with the heel of your other hand.
• Chest thrusts: turn the baby face up along your forearm, resting on your thigh and supporting the head, then use two fingers in the middle of the chest (on the breastbone, in line with the armpits) to give up to five sharp pushes.
• Only remove an object you can see; do not sweep a finger blindly in a baby's mouth.
• A paediatric first aid course lets you practise these on a training manikin, which is the only safe way to learn them.