In short
Encouraging a forceful cough comes first; back blows and abdominal thrusts follow if breathing stops, with a different, gentler technique for infants under one year.
On this page
01
Let Them Cough First
A person who is coughing forcefully, speaking, or making sound is still moving air, and the best help is to encourage that cough and stay close rather than intervene immediately. Forceful coughing is the body's own airway-clearing reflex working, and interrupting it with back blows too early can push an object further down.
True danger signs look different: no sound at all, a weak or silent cough, clutching the throat, bluish lips, or panic without any air movement. That combination means the airway is blocked and it's time to act immediately rather than wait and watch a few more seconds. The moment the airway seems completely blocked — silent coughing, no air moving, no sound — call emergency services (or point at someone and tell them to call) while you continue back blows and thrusts. Do not wait for collapse to make the call.
02
Adults and Children Over One
Standard public first-aid teaching for a choking adult or child over one year combines firm back blows between the shoulder blades with abdominal thrusts, alternating between the two. Stand slightly behind and to the side, deliver sharp blows with the heel of the hand, then move to thrusts if blows alone don't clear it.
For abdominal thrusts, stand behind the person, wrap your arms around their waist, make a fist just above the navel, and pull sharply inward and upward in quick, distinct movements. Continue alternating back blows and thrusts until the object comes out, the person can breathe or cough on their own, or they lose consciousness.
03
Infants Need a Different Technique
A choking infant under one year is never treated with abdominal thrusts, since it risks injuring organs that sit differently in a baby's small frame. Instead, support the infant face-down along your forearm, head lower than the chest, and deliver up to five firm back slaps between the shoulder blades with the heel of your hand.
If back slaps alone don't clear the object, turn the infant face-up, still supported along your arm, and give up to five chest thrusts using two fingers on the center of the breastbone. Alternate back slaps and chest thrusts, checking the mouth briefly between rounds, until help arrives or the airway clears.
04
If They Become Unconscious
If a choking person loses consciousness, lower them carefully to the ground, call emergency services immediately if that hasn't happened yet, and begin CPR starting with chest compressions. Each time you open the airway to give breaths, look inside the mouth briefly for a visible object before continuing.
Emergency dispatchers are trained to talk a caller through hands-only CPR step by step in real time, so staying on the phone matters as much as starting compressions does. Do not stop compressions to search repeatedly for an object you cannot see; keep going until help takes over.
05
Myths and Missteps
Slapping a choking person hard on the back while they're upright and coughing normally isn't helpful and can startle a partially dislodged object into a worse position; save back blows for when coughing has already failed. Giving water to "wash it down" is another reflex to resist — swallowing while the airway is blocked can worsen the block.
Reaching blindly into a person's mouth to fish out an object you can't see risks pushing it deeper rather than out, and should be avoided unless the object is clearly visible and easy to grasp. Trust the sequence of coughing, back blows, and thrusts rather than improvising extra steps.
Sources
- Chokingmedlineplus.gov
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