Choking First Aid: Back Blows, Thrusts and What Changes for Babies

In short

For a choking adult or child over 1, give up to 5 back blows, then up to 5 abdominal thrusts, and repeat. Babies under 1 get back blows and chest thrusts, never abdominal thrusts. Since 2025 the Resuscitation Council UK and the American Heart Association teach the same order.

Emergency if: They cannot cough, speak, cry or breathe: have someone call emergency services now while you give back blows and thrusts. If they become unresponsive, start CPR.

On this page

Mild or severe: the cough decides

Suspect choking when someone suddenly cannot speak or cough, especially while eating. A child may be unable to speak, and a baby unable to cry. Ask "Are you choking?" If they can cough loudly, speak or breathe, the airway is only partly blocked, and coughing is the best way to clear it. Encourage it and stay with them, watching for the cough to weaken.

Severe choking looks different: a cough that is silent or no longer working, no voice, no air moving. That is when you step in. The Resuscitation Council UK (RCUK) and the American Heart Association (AHA) both say to get emergency services called for severe choking. If someone is with you, send them to call now, on speaker, while you start.

Adults and children over 1

Give up to five back blows first. Lean them forward and give sharp blows between the shoulder blades with the heel of your hand. A small child can be laid face down across your lap. Check after each blow whether it has cleared.

If it has not, give up to five abdominal thrusts. Stand behind them and put your arms around the upper part of the belly. Make a fist and place it between the navel and the bottom of the breastbone, grasp it with your other hand, and pull sharply inwards and upwards. Then go back to five back blows, and keep alternating five and five.

Stop as soon as they cough, cry, breathe or speak. RCUK's first-aid guidance says that if the first five thrusts have not worked, call emergency services if that has not happened already, and keep going until it clears or the person becomes unresponsive. Do not sweep a finger blindly around the mouth: it can push the object further in. Only take out something you can clearly see.

Six numbered steps for adults and children over 1. 1: encourage coughing. 2: get emergency services called, at the latest if the first 5 thrusts have not worked. 3: up to 5 back blows between the shoulder blades. 4: up to 5 abdominal thrusts, fist between navel and breastbone, pulling in and up. 5: keep alternating 5 and 5, stopping when they cough, cry or breathe. 6: if unresponsive, start CPR. — The 5-and-5 cycle taught by both RCUK and the AHA since their 2025 guidelines.

The guidelines now agree

If you learnt choking first aid from an older course, it may have taught abdominal thrusts alone. The AHA's 2025 guidelines changed that: for children it says treatment now starts with back blows instead of abdominal thrusts, and for adults it recommends repeated cycles of five back blows followed by five abdominal thrusts. RCUK teaches the same sequence.

The AHA gives its reasons. A study of 709 people who choked found back blows cleared the airway more often and caused fewer injuries than abdominal thrusts, and abdominal thrusts have caused rare but serious internal injuries. Using one 5-and-5 pattern at every age also makes it simpler to teach.

One NHS page on children still says the order of back blows and thrusts does not matter. The newer RCUK and AHA guidelines both put back blows first, so that is the order this guide follows.

Pregnancy, and people you cannot reach around

Abdominal thrusts are not always possible. For a person in the later stages of pregnancy, or someone whose belly you cannot get your arms around, the AHA says to alternate five back blows with five chest thrusts instead, pressing on the breastbone rather than the belly.

Anyone who has had abdominal thrusts should be checked by a doctor afterwards, even if they feel fine, because RCUK says complications and injuries can happen. The NHS gives the same advice for children, adding that part of the object may have been left behind.

Babies under 1

Never give a baby abdominal thrusts. The AHA says they risk injuring a baby's abdominal organs. Instead, lay the baby face down along your forearm, with your arm resting on your thigh, supporting the head and keeping it lower than the chest. Give up to five sharp blows between the shoulder blades with the heel of your hand.

If that does not clear it, turn the baby face up, head still low, and give up to five chest thrusts on the breastbone, sharper than CPR compressions. Keep alternating five back blows and five chest thrusts, and stop as soon as the baby coughs, cries or breathes.

The hand position for chest thrusts is where the guides part ways. RCUK uses two thumbs on the breastbone with your hands wrapped around the chest. The AHA now uses the heel of one hand. An NHS page still describes two fingers just below the nipple line. RCUK's wider advice is that being willing to act matters more than small details, so if you have trained in one method, use it. Whatever happens, get the baby checked by a doctor afterwards.

Five numbered steps for a baby under 1. 1: shout for help and call emergency services on speaker. 2: up to 5 back blows with the baby face down along your forearm, head lower than the chest. 3: up to 5 chest thrusts with the baby face up, head low. 4: keep alternating 5 and 5, stopping when the baby coughs, cries or breathes. 5: if unresponsive, start baby CPR. — Babies get back blows and chest thrusts only. RCUK, the AHA and the NHS describe the chest-thrust hand position differently.

If they become unresponsive

If a choking person goes limp and stops responding, lower them carefully to the floor, make sure emergency services have been called, and start CPR. For an adult, that means chest compressions straight away, 5 to 6 cm deep at 100 to 120 a minute.

For a child or baby, RCUK says to start CPR with five rescue breaths as soon as they become unconscious, then continue with children's CPR. The AHA starts with compressions at every age. Both say that when you open the mouth to give breaths, take out an object only if you can see it, never with a blind sweep.

Keep going until help arrives or the person starts breathing. Our guide to hands-only CPR covers the technique for each age.

When to act

Same-day — call promptly

The object came out, but abdominal thrusts or chest thrusts were used, or the person was a baby or young child: get them checked by a doctor today, even if they seem well.

Emergency — act now

They cannot cough, speak, cry or breathe: have someone call emergency services now while you give back blows and thrusts. If they become unresponsive, start CPR.