Choking first aid such as the Heimlich maneuver for toddlers and back slaps for infants can prevent tragedy.

Published: October 31, 2019 | Updated: April 13, 2022

Choking first aid such as the Heimlich maneuver for toddlers and back slaps for infants can prevent tragedy.

Norton Children’s Prevention & Wellness cautions parents to always watch for choking hazards, but especially this time of year, as children tend to eat more candy and visit homes for holiday parties. Children, especially toddlers, like to put everything in their mouths, and with extra decorations out, more choking hazards may be present during the holiday season.

“A child can begin choking in an instant,” said Sharon Rengers, R.N., manager of Norton Children’s Prevention & Wellness. “While trying to prevent choking is important, it’s also critical that parents know what to do if a child starts to choke.”

Choking happens when a child eats something that blocks the airway and air cannot get into or out of the lungs. Sometimes all that is needed is a cough, and the item comes back up. But it can also be a life-threatening situation. If the brain goes without oxygen for more than four minutes, brain damage or death can occur.

How to prevent choking

• Prepare and cut food into small, bite-size pieces for young children: Cut grapes into quarters, cut hot dogs the long way and then into pieces (also removing the skin), and cook vegetables instead of serving raw.
• Teach children to chew their food completely before swallowing.
• Supervise mealtime for young children. Many choking cases occur when older brothers or sisters offer unsafe food to a younger child.
• Insist that children sit while they eat. They should never play, walk or run with food in their mouths.
• When purchasing toys, look for sturdy construction and follow age recommendations. For children under age 3, avoid toys with small parts. A toy is too small if it passes easily through an empty cardboard toilet-paper tube.
• Remind older children to store their toys and games with small parts out of reach of younger siblings.
• Examine toys regularly for damaged or broken parts.
• If you have child who is learning to walk or crawl, get down on the floor often to check for objects that could be put into the mouth and cause choking.

Choking first aid: How to do the Heimlich maneuver for a child

If the child can cough, cry, speak or breathe, you don’t need to do anything. If the child is conscious but cannot cough, cry, speak or breathe, follow these emergency first-aid steps for choking:

Heimlich maneuver: Toddler (child over 1) — abdominal thrusts

• Stand behind the child with your fists clasped between the navel and below the bottom of the breastbone.
• Give quick thrusts inward and upward.
• Repeat until the airway is clear or the child becomes unconscious.

(This information is not a substitute for an approved CPR course. Ask your doctor, the American Red Cross or American Heart Association for information on classes near you.)

Back slaps: Baby or infant

• Hold the infant face down on your forearm. Support the infant’s head and jaw with your hand.
• Give five back slaps with the heel of one hand between the shoulder blades.
• If the object does not come out after five back slaps, turn the infant over onto his or her back, supporting the head.
• Give five chest thrusts using two fingers of your other hand to push on the breastbone between the nipples. Push down and then let go.
• Repeat, giving five back slaps and chest thrusts until the infant can breathe, cough or cry, OR until he or she stops responding.

If the child becomes unconscious, have someone call 911 immediately. If you are alone and efforts to clear the obstruction are unsuccessful after two minutes, call 911 for emergency help. Continue rescue efforts under the direction of 911 personnel until help arrives.

Items that are more likely to cause choking

Latex balloons are the single most dangerous nonfood choking hazard. Never give them to young children, and supervise children up to age 11 when they play with balloons.

Food items hazardous for children under 5:

• Hot dogs
• Nuts
• Chunks of meat
• Grapes
• Hard or sticky candy, cough drops, gum, lollipops, marshmallows, caramels and jelly beans
• Peanut butter (especially in spoonfuls or with soft bread)
• Ice cubes and cheese cubes
• Foods that clump, are sticky or slippery, or are dry with hard texture

Household items that can be choking hazards

• Coins
• Marbles
• Small toy parts
• Pen caps
• Beads

A caution about button batteries

Every year, about 3,500 button battery swallowing cases are reported to U.S. poison control centers. The most serious cases involve nickel-size, 20 mm-diameter batteries. These can get stuck in the child’s throat and burn through the esophagus in as little as 2 hours. Repair can require feeding and breathing tubes and multiple surgeries. Inspect games or toys that include magnets. Inspect children’s play areas regularly for missing or dislodged magnets as well. If you find a household item missing a button battery and think it may have been swallowed by your child, seek medical attention immediately. Look for abdominal symptoms such as pain, nausea, vomiting or diarrhea.

What to do in an emergency

If you believe your child needs emergency care, contact your child’s doctor, call 911 or bring your child to a Norton Children’s emergency department any hour of the day or night. Norton Children’s facilities have the staff, equipment and technology to handle almost any pediatric emergency, from a fever to a life-threatening injury.