Choking and the Heimlich maneuver: First aid guide

Ahmed Raza

Written by Lorraine Anne Liu, RN, a registered nurse and cum laude graduate with experience in OR, ICU, delivery room, and OPD. She specializes in pediatric care and primary health care nursing and is certified in BLS, IV therapy, and cardiac assessment.

Understanding choking

Choking happens when a foreign object, usually food, becomes lodged in the throat or windpipe, blocking airflow to the lungs. This can quickly become a life-threatening emergency requiring immediate action. If not treated promptly, choking can lead to unconsciousness or death (National Safety Council, 2020).

This content is included in our CPR, first aid, and AED course and our health care provider courses.

Common causes of choking

Choking can happen to anyone but is most common in children and older adults. According to the National Safety Council (2020), choking is the fourth leading cause of unintentional injury-related deaths in the U.S., with 1,430 deaths in adults over 74 years old.

Common causes of choking include:

• Swallowing food too quickly or not chewing properly
• Talking or laughing while eating
• Alcohol or drug use impairing swallowing reflexes
• Certain medical conditions, like Parkinson’s disease or stroke, which make swallowing difficult

Choking hazards for infants and toddlers

Young children are at a higher risk of choking because they are still learning to chew and swallow properly. They also tend to put objects in their mouths. The CDC (2023) lists the following as common choking hazards for children:

• Whole grapes, cherries, berries, or melon balls
• Hot dogs, meat chunks, or sausages
• Large pieces of cheese or string cheese
• Hard candy, gum, marshmallows
• Popcorn, nuts, and peanut butter
• Chips, pretzels, or granola bars

To prevent choking, always supervise children while they eat and cut food into small pieces.

Signs of choking

A choking person may not be able to speak or ask for help. Look for these warning signs:

• Coughing or gagging
• Clutching the throat
• Struggling to breathe or turning blue
• Inability to speak
• Loss of consciousness

Prevention tips

While choking can happen unexpectedly, the risk can be reduced by following these guidelines:

• Eat slowly and chew food well
• Avoid talking or laughing while eating
• Do not drink excessive alcohol before eating
• Ensure children’s play areas are free of small objects
• Monitor individuals with swallowing difficulties

The Heimlich maneuver(abdominal thrusts)

The Heimlich maneuver is an emergency technique to help a choking person. It uses abdominal thrusts to force air from the lungs and push out the object blocking the airway. This maneuver can be performed by anyone, even without medical training.

How to perform the Heimlich maneuver on adults and children (over 1 year old)

1. Stand behind the choking person.
2. Place one clenched fist above their navel, below the ribcage.
3. Grasp your fist with your other hand.
4. Quickly pull inward and upward in a sharp motion, repeating 6–10 times.
5. Continue until the object is expelled or emergency help arrives.

Special cases

• Pregnant or Obese Individuals: Use chest thrusts instead of abdominal thrusts.

• Infants (Under 1 Year Old): Do not use the Heimlich maneuver. Instead:
  1. Give five firm back blows between the shoulder blades.
  2. If the object is not removed, turn the infant over and perform five chest thrusts using two fingers in the center of the chest.
  3. Repeat until the object is expelled or medical help arrives.

Conclusion

Choking is a serious emergency, but quick action can save lives. Understanding the risks, recognizing the signs, and knowing how to respond with techniques like abdominal thrusts or infant back blows can prevent tragedy. Being prepared with basic first aid knowledge can make all the difference in a life-threatening situation.

References

• Centers for Disease Control and Prevention (CDC). (2023). Choking prevention for children. Retrieved from https://www.cdc.gov
• National Safety Council. (2020). Injury Facts: Choking statistics. Retrieved from https://www.nsc.org
• American Red Cross. (2020). First Aid/CPR/AED participant’s manual.