Infant choking is frightening because babies cannot tell you what is wrong, and their airways are so small that a blockage can become life threatening within moments. The good news is that the response is simple and can be learned in minutes. For a baby under one year the sequence is five back blows followed by five chest thrusts, and for a child over one it is closer to the adult sequence with gentler force. Never give abdominal thrusts to an infant.
Recognising Infant Choking in a Baby or Child
If a baby or child is coughing hard, crying or able to make sounds, air is still moving. Stay close, keep them calm and let them cough. Interfering at this stage can turn a partial blockage into a complete one.
Treat it as severe choking when you see:
- No sound, or a weak, ineffective cough
- Silent gasping or an inability to breathe in
- Skin turning blue or grey, especially around the lips
- Flaring nostrils and the soft tissue above the breastbone or between the ribs pulling inwards
- Floppiness or loss of responsiveness
Noisy breathing together with a fever, a barking cough or drooling points to an infection such as croup, not choking, and is handled differently.
Infant Choking First Aid for Babies Under One Year
- Get help. Shout for someone to call the emergency number. If you are alone, give the first cycle of back blows and chest thrusts, then call.
- Give five back blows. Sit down and lay the baby face down along your forearm, resting your arm on your thigh. Support the jaw with your fingers, keep the head lower than the chest, and use the heel of your free hand to give five firm blows between the shoulder blades.
- Turn the baby over. Sandwich the baby between your forearms, supporting the head and neck, and turn them face up, still with the head lower than the body.
- Give five chest thrusts. Using the heel of one hand, press down on the lower half of the breastbone, about one third of the depth of the chest, in five separate sharp thrusts. Do not press on the abdomen.
- Check the mouth. If you can see the object, take it out. Never sweep blindly with a finger.
- Repeat. Continue alternating five back blows and five chest thrusts until the object comes out or the baby becomes unresponsive.
Choking First Aid for Children Over One Year
For a conscious child, kneel or stand behind them, lean them forward and give five back blows between the shoulder blades, then five abdominal thrusts with a clenched fist just above the navel, pulling inward and upward. Use less force than you would for an adult, and match your technique to the size of the child. Alternate the two until the object is cleared or the child stops responding.
If the Baby or Child Stops Responding
Lay them on a firm surface, make sure help is on the way, and begin CPR. Before each set of breaths, look in the mouth and remove the object only if it is visible. Our guide to CPR for infants and children explains hand position, depth and rate. Continue until emergency responders arrive or the child starts to breathe normally.
Infant Choking Mistakes to Avoid
- Do not hold a baby upside down by the ankles or shake them.
- Do not give abdominal thrusts to a baby, as this risks injuring internal organs.
- Do not use finger sweeps unless you can see the object.
- Do not stop to look for the cause. Act on the signs.
Older manuals sometimes describe sitting a child across the lap with the head low and repeated lateral chest compressions. Current guidance uses the structured back-blow and thrust sequence above, so make sure any training you rely on is current.
After Infant Choking: Medical Follow-Up
Every infant or child who needed back blows, thrusts or CPR should be checked by a doctor the same day, even if they seem completely recovered. Small fragments can remain in the airway and cause breathing problems later.
Preventing Infant Choking at Home and in Childcare
Cut grapes, sausages and similar foods lengthwise, avoid whole nuts and hard sweets for young children, and make sure they sit down to eat. Keep coins, button batteries, balloons and small toy parts out of reach. Childcare settings should keep a current first aid-trained staff member on site and display emergency numbers near food preparation areas.
Frequently Asked Questions
Why are abdominal thrusts not used on babies?
A baby’s organs are less protected and can be injured by abdominal pressure, so chest thrusts are used instead.
At what age does the child sequence apply?
From about one year of age. For babies under twelve months use the back blow and chest thrust sequence.
Should I call the ambulance even if the object comes out?
Yes. After any infant choking episode, arrange at least a same-day medical check, because airway irritation and small remaining fragments can cause problems.
References and Further Reading
- American Heart Association and American Red Cross, Guidelines for First Aid
- American Red Cross, Infant Choking: How to Help
Last updated: October 2026
Prepared by: EHS Guidelines Editorial Team
This article is general educational information and is not a substitute for accredited first aid training or professional medical care. In an emergency, call your local emergency number immediately. Emergency numbers, medicines and protocols differ between countries, so follow local guidance.
Related Guides
- Choking First Aid for Adults: Back Blows and Abdominal Thrusts
- CPR for Infants and Children: Technique and Key Differences from Adults
- Airway Management: How to Open, Clear and Protect an Airway
- Vital Signs Observations: Pulse, Breathing, Conscious State and Skin
- Recovery Position: A Step by Step Guide
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