Learn How to Respond to a Choking Emergency

Understanding Choking and When It Becomes an Emergency

Choking occurs when a foreign object becomes lodged in the airway, blocking the flow of air to the lungs. This can happen to anyone at any age, though young children between ages 1 and 4 face the highest risk according to the CDC. Every year, approximately 4,500 fatal choking incidents occur in the United States, with food being the most common culprit in adults and small objects in children. Knowing the difference between partial and complete airway obstruction is critical because your response depends on how severely the airway is blocked.

In a partial airway obstruction, the person can still cough, speak, or breathe, though with difficulty. You may hear a high-pitched sound when they breathe or see them struggle. This is actually a positive sign because the body's cough reflex is still working. In a complete airway obstruction, the person cannot cough, speak, cry, or breathe at all. They may make silent attempts to breathe, turn blue around the lips and fingernails, and lose consciousness within minutes. Time is critical in complete obstructions.

Common choking hazards in adults include large pieces of meat, hot dogs, hard candies, and nuts. In children, hazards include grapes, popcorn, carrots, peanut butter, and toys smaller than a toilet paper roll. Elderly people are at increased risk due to dental problems or difficulty swallowing. People with neurological conditions that affect swallowing, as well as those who eat too quickly or don't chew food thoroughly, face elevated risk.

Practical takeaway: Learn to recognize the universal choking sign—a person clutching their throat with one or both hands—and understand that any person who cannot cough, speak, or breathe needs your intervention right away.

How to Respond to Partial Airway Obstruction

When someone is choking but can still cough, speak, or breathe, your first response should be to encourage them to cough. Ask them "Are you choking?" If they can nod or answer, they have some airway function. Stay with them and let their own cough reflex work—it is often the most effective way to dislodge an object. Do not perform abdominal thrusts (also called the Heimlich maneuver) on someone with a partial obstruction because you risk converting it to a complete obstruction and making things worse.

Position yourself beside or slightly behind the person and remain ready to act if their condition changes. Watch their face for color changes and listen to their breathing. If they continue to cough productively and can speak or breathe between coughs, stay calm and keep reassuring them. If the coughing continues for more than a few minutes without dislodging the object, or if their breathing becomes more labored, you should call emergency services (911 in the United States) and be prepared to escalate to more aggressive treatment.

Some people panic when they begin to choke, which can make the situation worse. Your calm presence and encouragement to keep coughing can help them stay focused. If they are a child, never place your fingers in their mouth trying to remove the object unless you can clearly see and easily remove it. Fingers can push the object deeper into the airway or cause gagging that worsens the obstruction.

After the object is successfully coughed out, the person may feel sore in their throat or chest from coughing. This is normal, but if they continue to have difficulty breathing, chest pain, or any other concerning symptoms after the choking incident resolves, medical evaluation is still recommended. Sometimes small fragments remain or the airway becomes irritated and swollen.

Practical takeaway: For partial choking, encourage coughing and monitor closely, but do not intervene with abdominal thrusts unless the situation becomes a complete airway obstruction or the person's condition declines.

Performing Abdominal Thrusts for Complete Airway Obstruction

When someone cannot cough, speak, breathe, or make any sound, they have a complete airway obstruction and need abdominal thrusts. This technique, also called the Heimlich maneuver, was developed by Dr. Henry Heimlich in 1974 and remains a standard first aid response. The procedure creates an upward pressure that forces air from the lungs with enough force to expel the blocking object.

To perform abdominal thrusts on a conscious adult or child over one year old, stand behind the person and wrap your arms around their waist. Make a fist with one hand and place it slightly above the person's navel, well below the breastbone. Grasp your fist with your other hand. Pull your fist upward into the abdomen with quick, forceful movements. Perform 5 thrusts, then check if the object has been dislodged. If not, repeat the cycle of 5 thrusts and checking. Continue until the object comes out, the person begins to cough or breathe, or emergency responders arrive.

For an unconscious person or one who becomes unconscious during choking, call 911 immediately if this has not been done. Begin CPR by positioning the person on their back on a firm surface. Open the airway by tilting the head back slightly and lifting the chin. Before giving rescue breaths, look in the mouth—if you see the object and can easily remove it, do so. If you cannot see it or cannot easily grasp it, do not probe blindly. Proceed with 30 chest compressions followed by 2 rescue breaths, checking after each cycle to see if the object is now visible in the mouth. The compressions during CPR may help dislodge the object.

For infants under one year old, abdominal thrusts are not recommended because their organs are delicate. Instead, alternate between 5 back blows (firm strikes on the upper back between the shoulder blades) and 5 chest thrusts using 2 fingers on the breastbone, similar to infant CPR compressions.

Practical takeaway: Abdominal thrusts involve standing behind the person, placing your fist above the navel, and pulling upward forcefully in 5-thrust cycles until the object is expelled or the person becomes unconscious.

Special Situations: Pregnant Women, Obese Individuals, and Children

Pregnant women require a modified approach to abdominal thrusts. Place your fist at the base of the breastbone, slightly higher than you would for a non-pregnant person, rather than above the navel. Perform chest thrusts instead of abdominal thrusts to avoid putting pressure on the enlarged uterus. This protects both the mother and the developing baby while still creating the necessary force to dislodge the object.

For people with obesity, abdominal thrusts may be difficult to perform effectively because you may not be able to reach around them or generate sufficient force. Chest thrusts, performed in the same way as rescue breaths would be given during CPR, are a reasonable alternative. Position yourself behind the person, place your fist in the center of the chest, and perform forceful backward thrusts. Some training organizations now recommend chest thrusts as an equally valid technique for all populations because of these difficulties.

Children aged one year and older can receive abdominal thrusts similar to adults, but with less force adjusted for their smaller body size. For a very young child between 1 and 3 years old, you may kneel behind them or position them at a level where you can effectively wrap your arms around their waist. Position your fist above the navel but below the ribcage, and perform gentle but firm upward thrusts. Always check inside the mouth after each cycle of thrusts—children's objects sometimes dislodge into a position where you can now see and remove them.

For infants, as mentioned previously, use back blows and chest thrusts, not abdominal thrusts. Hold the infant face-down along your forearm with your hand supporting the head and jaw. Strike firmly between the shoulder blades with the heel of your other hand 5 times. Then turn the infant onto their back (supporting the head and neck), and give 5 chest thrusts with 2 fingers in the center of the chest, pressing downward about 1.5 inches. Repeat this cycle until the object is dislodged or emergency services arrive.