What to Do If Someone Is Choking

The Universal Sign and How to Respond

A choking person will often clutch their throat with both hands -- the universal choking sign. They may be unable to speak, cough, or breathe, and their face may turn red or blue. If they can cough forcefully, do not intervene. Encourage them to keep coughing. Only act when the airway is fully or nearly fully blocked.

1. 1Tell the person you are going to help. If they cannot speak but nod, proceed. Have someone call 911.
2. 2Give 5 back blows. Stand to the side and slightly behind the person. Support their chest with one hand and lean them forward. Strike firmly between the shoulder blades with the heel of your other hand. Each blow should be a distinct, forceful hit.
3. 3Give 5 abdominal thrusts (Heimlich maneuver). Stand behind the person and wrap your arms around their waist. Place your fist just above the navel, thumb side in. Grab your fist with your other hand and pull sharply inward and upward.
4. 4Alternate 5 and 5. Continue alternating back blows and abdominal thrusts until the object is expelled, the person can breathe, or they lose consciousness.

If the Person Goes Unconscious

If a choking person becomes unresponsive, the situation is now a cardiac arrest until proven otherwise. Transition immediately to CPR. Do not waste time trying additional abdominal thrusts on an unconscious person.

1. 1Lower the person to the ground carefully, supporting their head.
2. 2Call 911 if not already done.
3. 3Begin CPR starting with chest compressions. Push hard and fast on the center of the chest, 30 compressions at 100-120 per minute.
4. 4Before giving rescue breaths, look in the mouth. Each time you open the airway to give breaths, look for the object. If you can see it, sweep it out with your finger. Do not perform blind finger sweeps -- you risk pushing the object deeper.
5. 5Continue CPR (30 compressions, 2 breaths) until the object is dislodged and the person breathes, or emergency responders arrive.

Choking in Infants and Children

Children under age 5 are at the highest risk for choking. The technique for infants (under 1 year) is different from adults. Never perform abdominal thrusts on an infant. Their organs are too fragile.

For infants under 1 year:

1. 1Hold the infant face-down on your forearm, supported on your thigh. Support the head and jaw with your hand, keeping the head lower than the body.
2. 2Give 5 back blows with the heel of your hand between the shoulder blades.
3. 3Turn the infant face-up. Support the back of the head. Place two fingers on the center of the breastbone, just below the nipple line.
4. 4Give 5 chest thrusts. Press down about 1.5 inches with each thrust. These replace abdominal thrusts for infants.
5. 5Alternate 5 back blows and 5 chest thrusts until the object comes out or the infant becomes unresponsive. If unresponsive, begin infant CPR.

For children ages 1 and older: use the same adult technique (5 back blows, 5 abdominal thrusts), adjusting your force for the child's size. Kneel behind a small child rather than standing.