Choking Management

What should I do if my child is less than one year of age and begins to choke?
The first step is to call for emergency medical services or have someone else make the call.  Place your child head down on your forearm position at a 60 degree angle and support the head and neck carefully.  Rest your forearm against your body (such as against your leg) for added support.  If your child is large, you may want to lay him face down over your lap, while firmly supporting the head and keeping the head lower than the trunk.
Next, give four rapid blows with the heel of your hand to the infant’s back, striking high between the shoulder blade.
If the blockage is not relieved, then turn the infant over laying the child face up on a firm surface.  Give four rapid chest thrust over the breast bone using two fingers to depress the baby’s chest to a depth of one –half to one inch and then let up.  Do this four times in a row.
If breathing still does not start, then open the mouth with thumb held over the tongue and fingers wrapped around lower jaw.  This is a tongue-jaw lift maneuver and will draw the tongue away from the back of the throat and may help clear the airway.
If you can see the foreign body, it may be removed with a sideways sweep of your finger.  Remember never to poke the finger straight into the throat, and be very careful with any finger sweeps because they may cause further blockage.
If your infant still does not begin to breathe, then place your mouth over his mouth and nose and give two quick shallow breaths.  If breathing does not then start, repeat the previous steps and begin CPR.
What rules should I follow if my child is over one year  of age?
The first step is as previously described.  You should make certain that you or someone else had called for emergency medical services.
Place the child on his back and kneel at his feet.  Put the edge of one of your hands in the midline between the navel and the rib cage.  Place the second hand on top of the first.  Press firmly but gently into the abdomen with a rapid inward and upward thrust.
Repeat this maneuver six to ten times.
These abdominal thrusts are called the Heimlich Maneuver.  If breathing does not start, open the airway using the tongue-jaw lift technique previously described.  If you can see the foreign body you can try to remove it with a sideways sweep of your finger.  Be careful to prevent any object from being forced down further into the airway.
If your child does not begin to breathe right away, attempt to restore breathing with the mouth-to- mouth technique.  If this fails, repeat a series of six to ten abdominal thrusts.
Are there any children where the Heimlich Maneuver should not be performed?
The Heimlich Maneuver should not be done on children under the age of one year due to the damage or injury from the abdominal pressure.
How can the child be  positioned when the Heimlich Maneuver is performed?
In older children the Heimlich Maneuver can be performed when the child is standing or sitting.  It can also be done while the child is lying in a face up position.
Is it enough for me to know what to do for my child in case of choking or should I know more?
Basic information on what to do in case of choking is not enough for parents.  All parents or caretakers of children should be able to perform basic cardiopulmonary resuscitation (CPR).  A CPR course should be taken by all child caretakers.
Where can I obtain further information concerning CPR and choking?
Information describing the above techniques and problems can be obtained from the American Trauma Society, 1400 Mercantile Lane, Suite 188, Landover, Maryland 20785, or from the American Academy of Pediatrics, Department of Publications, 141 North Westpoint Blvd., Elk Grove Village, Illinois 60009-0927.
What should I remember about choking?
Choking can happen to anyone, especially children.  It is important that you know how to deal with choking and more importantly that you learn CPR.