If a child is choking and cannot breathe, speak, or cough, call 911 and begin the five-and-five approach: alternate 5 back blows between the shoulder blades with 5 abdominal thrusts just above the belly button. For infants under one year old, use chest thrusts instead of abdominal thrusts. If the child becomes unresponsive, begin CPR immediately. Do not perform a blind finger sweep.
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How to Recognize When a Child Is Choking
Choking occurs when the airway becomes partially or completely blocked by a foreign object, which can lead to unresponsiveness and death if not addressed quickly. In young children, choking is particularly common, and certain behaviours such as talking or laughing with a full mouth or eating too quickly can increase the risk. A child who is choking typically has a panicked, confused, or surprised facial expression and may place one or both hands on their throat. Signs of choking include the inability to speak, cry, or cough forcefully if the airway is completely blocked, and the child’s skin may turn pale or bluish as oxygen is deprived.
Mild Choking vs Severe Choking
Not all choking emergencies require intervention. A mild blockage means the airway is only partially blocked and the child can still cough, speak, or cry. For children over 1 year old who are choking but are still making sounds, encourage them to cough. Encouraging a child to cough is an effective way to naturally clear an airway blockage without intervention. Do not interfere with a child who is coughing forcefully.
A severe choking emergency means the airway is completely blocked. Signs of severe choking include silent coughing, inability to speak or cry, blue or pale skin, clutching the throat with one or both hands, and high-pitched sounds or no sounds at all. If a child is showing signs of severe choking, such as silent coughing or bluish skin, immediate action is required to clear the blockage.
Child Choking First Aid: Step by Step
Step 1: Assess the Situation and Call for Emergency Help
If a child is choking and cannot breathe, speak, or cough, call 911 immediately or instruct someone nearby to call while you begin first aid. Do not leave the child alone. If you are alone, perform 5 cycles of back blows and abdominal thrusts before calling 911 if the obstruction has not cleared.
Step 2: Five Back Blows
Lean the child forward into a forward leaning position, supporting their upper body with one arm across their chest. Using the heel of your free hand, deliver 5 firm back blows between the child’s shoulder blades. Each blow should be a separate, distinct strike aimed at creating an artificial cough effect to dislodge the foreign object. Check the child’s mouth after each set of back blows to see if the object has been expelled. If you can see the object in the child’s mouth, carefully remove it with your fingers. Do not perform a blind finger sweep, as doing so may push the obstruction deeper into the airway.
Step 3: Perform Abdominal Thrusts (Heimlich Maneuver)
The Heimlich maneuver, also known as abdominal thrusts, is a first aid technique used to relieve choking by applying pressure to the abdomen to expel an object blocking the airway. It is recommended for adults and children over the age of one who are choking and cannot speak, cry, or breathe. To perform child abdominal thrusts:
- Kneel or stand behind the child and wrap your arms around their waist
- Make a clenched fist with one hand and place the thumb side of your fist against the child’s upper abdomen, slightly above the belly button and well below the breastbone
- Grasp your fist with your other hand
- Pull sharply inwards and upwards with quick, firm thrusts
- Give 5 abdominal thrusts, each a separate and distinct movement
After 5 abdominal thrusts, check the child’s mouth again. If the object is visible, remove it carefully. Do not perform a blind finger sweep.
Step 4: Alternate Five Back Blows and Five Abdominal Thrusts
Alternate between 5 back blows and 5 abdominal thrusts, checking the child’s mouth after each cycle. Continue this pattern until the object is expelled, the child can breathe normally, emergency help arrives, or the child becomes unresponsive. Use this sequence for a choking person who cannot speak, cry, or cough forcefully.
Step 5: Begin CPR If the Child Becomes Unresponsive
If the child loses consciousness, carefully lower them to a flat surface. Call 911 if not already done. Begin CPR immediately, starting with chest compressions. Before giving rescue breaths, look in the child’s mouth each time you open the airway. If you can see the foreign object, remove it. Never perform a blind finger sweep on an unresponsive child. Continue cardiopulmonary resuscitation until emergency help arrives or the child begins breathing normally. Intermediate / Intermediate/Standard First Aid with CPR C covers the full transition from choking response to CPR as part of the core curriculum.
Infant Choking First Aid: Under One Year Old
For infants under one year old, the technique is different. Abdominal thrusts are never used on infants because they risk serious injury to internal organs. Instead, use chest thrusts.
Infant Back Blows
Hold the infant face down along your forearm, supporting the baby’s face in your hand with the baby’s head lower than the chest. Using the heel of your other hand, deliver 5 firm back blows between the infant’s shoulder blades. Support the infant’s head carefully throughout.
Chest Thrusts for Infants
After 5 back blows, turn the infant face up on your forearm, keeping the head lower than the body. Place two fingers on the centre of the child’s chest, just below the nipple line. Give chest thrusts 5 times, pressing down approximately one-third to one-half the depth of the chest. Check the infant’s mouth after each cycle. If an object is visible, remove it carefully. Do not perform a blind finger sweep. Alternate 5 back blows and 5 chest thrusts until the object is cleared or the infant becomes unresponsive. If the infant loses consciousness, begin infant CPR immediately and call 911.
What NOT to Do with an Infant
- Do not perform abdominal thrusts on an infant under one year old
- Do not shake or hang the infant upside down during a choking emergency as this risks further injury
- Do not perform a blind finger sweep
- Do not give liquids or force the infant to vomit, as this may worsen the airway blockage
For Parents and Caregivers
Learn This Skill in a Real Classroom
Reading about choking first aid is a start. Hands-on practice is what builds the confidence to act in a real emergency. Child Care First Aid courses are specifically designed for parents, grandparents, and childcare workers.
Performing Abdominal Thrusts
Perform Abdominal Thrusts on a Child
To correctly perform abdominal thrusts on a child, stand or kneel behind the child. Wrap your arms around their waist. Make a clenched fist with one hand. Place the thumb side of your fist against the child’s upper abdomen, between the belly button and the lower end of the breastbone. Grasp your fist firmly with your other hand. Pull sharply inwards and upwards in five quick, distinct thrusts. Each thrust should apply enough pressure to create an artificial cough that dislodges the object.
Performing Abdominal Thrusts on Yourself
To perform the Heimlich maneuver on yourself if you are choking and alone, place a clenched fist slightly above your belly button and grasp it with the other hand. Bend over a hard surface such as a chair back or countertop and thrust inward and upward firmly. This self-applied pressure can dislodge a foreign object when no one is available to help.
Aid Choking: What NOT to Do
Knowing what not to do is as important as knowing the correct steps. Common mistakes can worsen the obstruction or injure the child.
Do not perform a blind finger sweep. Only remove an object from the child’s mouth if you can clearly see it. Blind finger sweeps risk pushing the obstruction deeper into the airway.
Do not give liquids or force vomiting. Do not give the child anything to eat or drink or force them to vomit, as this may worsen the airway blockage.
Do not shake or hang the child upside down. This risks further injury and does not help clear the blockage.
Do not slap a choking child on the back while they are upright. Back blows must be delivered with the child leaning forward so gravity assists the dislodging of the object.
Do not delay calling 911. If back blows and abdominal thrusts do not clear the blockage within the first two cycles, call 911 while continuing the five-and-five approach.
Emergency Help: When to Call 911 for a Choking Child
Call 911 immediately in any of the following situations:
- The child cannot breathe, speak, or cough
- Back blows and abdominal thrusts have not cleared the blockage after several cycles
- The child becomes unresponsive or loses consciousness
- The child’s skin turns blue or grey
- The child is an infant under one year old with a suspected airway blockage
- The object has been removed but the child is still having difficulty breathing
After a choking incident, even if the object has been successfully removed, seek medical help. Internal injuries from abdominal thrusts or residual airway inflammation may require assessment. The Canadian Red Cross recommends that any child who received abdominal thrusts during a choking emergency be evaluated by a healthcare professional.
How to Prevent Choking in Children
Prevention is the most effective approach to child choking emergencies. The following strategies reduce choking risk significantly.
Foods That Pose a Choking Risk
Parents should supervise mealtimes with young children and avoid giving them foods that can easily get lodged in the throat, such as hot dogs, nuts, hard candies, grapes, large pieces of meat, popcorn, and raw carrots. Cut all food into small pieces appropriate for the child’s age. Teach children to sit while eating, eat slowly, and not talk or laugh with food in their mouth.
Small Objects and Toys
To prevent choking in children, keep small objects like marbles, coins, latex balloons, and button batteries out of reach, especially for children under 4 years old. Small toys or toys with small parts should be kept out of the child’s reach. Regularly inspect play areas for small objects that could be swallowed.
Supervision and Safe Habits
Supervise young children during mealtimes and playtime. Teach older children about choking risks. Ensure toys are age-appropriate and inspect them regularly for broken pieces. Keep the child’s reach clear of small objects at floor level.
How First Aid Training Prepares You for Choking Emergencies
First aid training courses often include instruction on how to respond to choking emergencies, teaching techniques such as back blows and abdominal thrusts. Certified first aid training courses are designed to prepare individuals to act quickly and effectively in choking emergencies, which can be life-threatening. Hands-on practice in a training environment builds the muscle memory needed to perform these techniques confidently under the pressure of a real emergency.
Intermediate / Intermediate/Standard First Aid with CPR C courses cover adult, child, and infant choking response, including the Heimlich maneuver, back blows, chest thrusts, and the transition to CPR when a choking victim becomes unresponsive. Child Care First Aid courses provide additional training specifically focused on pediatric emergencies, making them ideal for parents, grandparents, childcare workers, and teachers.
The Canadian Red Cross recommends that anyone who regularly cares for children complete first aid and CPR certification that covers pediatric choking response. Private group training can be arranged for daycares, schools, and organizations that want to ensure their entire team is prepared.
Key Takeaway
If a child is choking, use the five-and-five approach: alternate 5 back blows between the shoulder blades with 5 abdominal thrusts above the belly button. For infants under one year old, replace abdominal thrusts with chest thrusts. Never perform a blind finger sweep. If the child becomes unresponsive, begin CPR immediately and call 911. Hands-on first aid training is the most effective way to build the confidence and competence to act correctly under pressure.
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Frequently Asked Questions: Child Choking First Aid 2026
Q1: What is the first thing to do if a child is choking?
A: If a child is choking and cannot breathe, speak, or cough, call 911 immediately and begin the five-and-five approach. Lean the child forward and deliver 5 firm back blows between the shoulder blades. Then give 5 abdominal thrusts by placing a clenched fist above the belly button and pulling sharply inwards and upwards. Alternate between back blows and abdominal thrusts until the object is dislodged or emergency help arrives.
Q2: How do you perform abdominal thrusts on a child?
A: Stand or kneel behind the child and wrap your arms around their waist. Make a clenched fist and place the thumb side against the child’s upper abdomen, above the belly button and below the breastbone. Grasp your fist with your other hand and pull sharply inwards and upwards. Give 5 abdominal thrusts in quick, distinct movements. Check the child’s mouth after each cycle for the object, removing it only if clearly visible.
Q3: What is the difference between child and infant choking first aid?
A: For children over one year old, the five-and-five approach uses 5 back blows and 5 abdominal thrusts. For infants under one year old, abdominal thrusts are never used because they risk injuring internal organs. Instead, alternate 5 back blows with 5 chest thrusts, using two fingers placed just below the nipple line on the infant’s chest. Hold the infant face down for back blows and face up for chest thrusts.
Q4: What should I do if the choking child becomes unresponsive?
A: If the child loses consciousness, carefully lower them to a flat surface. Call 911 if not already done. Begin CPR immediately, starting with chest compressions. Each time you open the airway to give rescue breaths, look in the child’s mouth. If you can see the foreign object, remove it carefully. Do not perform a blind finger sweep. Continue cardiopulmonary resuscitation until emergency help arrives.
Q5: What is the Heimlich maneuver?
A: The Heimlich maneuver, also known as abdominal thrusts, is a first aid technique used to relieve choking by applying pressure to the abdomen to expel a foreign object blocking the airway. It is recommended for children over one year old and adults who are choking and cannot speak, cry, or breathe. The technique involves placing a clenched fist above the belly button and pulling sharply inwards and upwards in five quick thrusts.
Q6: Should I do a finger sweep to remove the object?
A: Only remove an object from the child’s mouth if you can clearly see it. Do not perform a blind finger sweep, as this may push the obstruction deeper into the airway. After each cycle of back blows and abdominal thrusts, look in the child’s mouth. If the object is visible, carefully remove it with your fingers.
Q7: When should I call 911 for a choking child?
A: Call 911 immediately if the child cannot breathe, speak, or cough, if back blows and abdominal thrusts have not cleared the blockage within several cycles, if the child becomes unresponsive, if their skin turns blue, or if the child is an infant. After the object is removed, seek medical help regardless, as internal injury from abdominal thrusts or residual airway swelling may require assessment.
More FAQs: Prevention, Infants, and Training
Q8: What foods are most likely to cause choking in children?
A: Foods most likely to cause choking in young children include hot dogs, grapes, nuts, hard candies, popcorn, raw carrots, large pieces of meat, and chunks of cheese. Cut all food into small pieces appropriate to the child’s age. Supervise mealtimes and teach children to sit while eating and not talk or laugh with food in their mouth.
Q9: How do I perform infant choking first aid?
A: For infants under one year old, hold the infant face down along your forearm with the head lower than the body. Deliver 5 firm back blows between the shoulder blades. Then turn the infant face up and give 5 chest thrusts using two fingers placed just below the nipple line on the chest. Alternate between back blows and chest thrusts, checking the mouth after each cycle. Never use abdominal thrusts on an infant.
Q10: What objects are most likely to cause choking in young children?
A: Young children most commonly choke on food and small objects including coins, marbles, button batteries, small toys, latex balloons, and small pieces of broken toys. Keep all small objects out of the child’s reach, especially for children under 4 years old. Inspect play areas regularly and ensure toys are age-appropriate.
Q11: Can a child choke on something and still be able to breathe?
A: Yes. A mild or partial airway blockage allows some air to pass, so the child may still be able to cough, speak, or breathe with difficulty. In mild choking, encourage the child to cough, as this is the most effective way to naturally clear a partial blockage. Only intervene with back blows and abdominal thrusts if the child cannot breathe, speak, or cough at all.
Q12: What is the five-and-five approach?
A: The five-and-five approach is the primary first aid procedure for a conscious, severely choking child or adult. It involves alternating between 5 back blows to the area between the shoulder blades and 5 abdominal thrusts to the upper abdomen. After each set of five, check the mouth for the object. Continue alternating until the object is dislodged, the person can breathe normally, or emergency services take over.
Q13: Is choking first aid different for large children vs small children?
A: The technique is the same for all children over one year old, but the amount of force applied should be proportional to the child’s size. For a small child, gentler back blows and abdominal thrusts are appropriate. For a larger child approaching adult size, more force may be needed. The positioning and mechanics of the five-and-five approach remain consistent regardless of the child’s size.
Q14: What should I do after a child has been successfully treated for choking?
A: After the object has been removed and the child can breathe normally, seek medical help. The Canadian Red Cross recommends that any child who received abdominal thrusts during a choking emergency be evaluated by a healthcare professional. Internal injuries, rib bruising, or residual airway swelling may not be immediately apparent. Keep the child calm, monitor their breathing, and transport to a healthcare provider.
Q15: Where can I learn child choking first aid in Canada?
A: Coast2Coast First Aid and Aquatics offers Canadian Red Cross certified Intermediate / Intermediate/Standard First Aid and Child Care First Aid courses across more than 30 locations in Ontario, Nova Scotia, Alberta, and California. All course levels cover child and infant choking response, including back blows, abdominal thrusts, chest thrusts, and the transition to CPR. Online blended learning is available for those who prefer to complete theory at home before attending an in-person skills session.
The information in this article is for educational and informational purposes only and does not constitute medical advice. In any choking emergency, always call 911 immediately. Choking response techniques should be learned and practised under the supervision of a qualified first aid instructor. Coast2Coast First Aid Inc. assumes no liability for any outcomes resulting from the application or misapplication of information in this article.
Content reviewed by the Coast2Coast First Aid and Aquatics certified instructor team. Child choking first aid information sourced from the Canadian Red Cross First Aid Guidelines, the CSA Z1210:24 First Aid Training Standard, and Health Canada child safety guidelines. Coast2Coast First Aid Inc. is Canada’s largest Canadian Red Cross Training Partner. Last reviewed: May 2026. For corrections or additional information, contact info@c2cfirstaidaquatics.com or 1-866-291-9121.
