Clinical Reference Systems: Pediatric Advisor 10.0
Choking is the coughing spasm and sputtering that happen
when liquids or solids get into the airway. (This is called
aspiration.) A child's cough reflex will clear the windpipe
of liquid within 10 to 30 seconds. Complete blockage occurs
when solid food or a foreign object becomes lodged in the
voice box. (It can also occur with severe croup.) If this
happens a child is unable to breathe, cry, or speak. The
child will be in a state of panic, and if the obstruction
isn't removed in 1 or 2 minutes, the child will pass out.
- Call the rescue squad (911) IMMEDIATELY.
Call the rescue squad (911) immediately in all cases of
choking on a solid object.
In general, choking on liquids is temporary and
harmless. Call the rescue squad if your child chokes on
a liquid and turns blue, becomes limp, or passes out.
- Encourage coughing.
As long as your child is breathing and coughing, do
nothing except encourage him to cough the material up by
himself. The main purpose of your child's cough reflex
is to clear the windpipe. Don't give your child
anything to drink because fluids may take up space
needed for the passage of air.
- Heimlich maneuver if a child over 1 year old stops
If your child can't breathe, cough, or make a sound,
proceed with high abdominal thrusts. Grasp your child
from behind, just below the lower ribs but above the
waist, in bear-hug fashion. Give a sudden upward jerk
at a 45-degree angle to try to squeeze all the air out
of the chest and pop the lodged object out of the
windpipe. Quickly repeat this upward abdominal thrust
10 times in rapid succession.
If your child is unable to stand and is too heavy for
you to suspend from your arms, lay him on his back on
the floor. Put your hands on both sides of the abdomen,
just below the ribs, and apply sudden, strong bursts of
- Back blows and chest compressions if a child under
1 year old stops breathing
If your infant can't breathe or cough, place him face
down over your knees or forearm (that is, use gravity to
help propel the object out). Then deliver 5 hard blows
with the heel of your hand between the shoulder blades
in rapid succession. (This is not helpful in older
If the child does not start breathing again, lay your
child on his back on the floor and apply 5 rapid chest
compressions over the lower breast bone (sternum) using
(These revised first aid measures were recommended by
the American Academy of Pediatrics in 1993.)
- Resuscitation if your child passes out from choking
The rescue squad should be on its way.
Quickly open your child's mouth and look inside with a
light to see if there is an object that can be removed
with your fingers or tweezers (usually there is not).
Don't put your fingers into your child's mouth unless
you already see the object. Doing this blindly can
wedge an object deeper into the voice box (larynx).
If you know how, begin mouth-to-mouth resuscitation.
Air can usually be forced past the foreign object. If
mouth-to-mouth breathing doesn't move the chest, repeat
the abdominal thrusts (if over 1 year old) or chest
compressions (if under 1 year old).
Choking can be life-threatening, so try to prevent it from
happening again by not giving young children foods or small
objects that are most likely to cause choking.
Foods that are most likely to cause choking are nuts of any
kind, sunflower seeds, orange seeds, cherry pits, watermelon
seeds, gum, hard candies, popcorn, raw carrots, raw peas,
raw celery, and tough meats. Do not give these hard foods
to children who are less than 4 years old. They do not have
enough molar teeth to chew them well and they may not
understand that some seeds should be spat out rather than
The soft foods that most often cause fatal choking are hot
dogs, sausages, and grapes. These foods must be chopped up
before serving. Warn baby-sitters and older siblings not to
share these foods.
Choking on a rubber balloon is the leading cause of deaths
resulting from choking on objects other than foods. Most
incidents occur when children suddenly inhale a deflated
balloon they have been chewing. Warn your child never to
chew or suck on pieces of rubber balloons. Even teenagers
have died from this freak accident. Chewing on an inflated
balloon is also dangerous because it could burst. Mylar
helium balloons are safer, but rubber balloons are fine if
they are used with supervision.