When babies are being breastfed or taking a bottle, they can choke on the milk. If they take in too much milk without swallowing it, this can get into the airway and block the flow of air. Babies commonly choke on mucus or curdled milk, so generally holding them on their sides and keeping their head lower than their bottom helps the liquid to drain out, as gravity will help.
When babies start crawling, they tend to put anything they can get their hands on in their mouths. Babies put objects in their mouth due to oral exploration, but also to ease discomfort when they are teething. It’s important as a parent, to be aware of objects that are commonly known to be choking hazards. These objects tend to be small and with the same round shape and size that easily can obstruct a child’s airway. This can be a small toy or food.
When children start weaning they can choke on a piece of food that lodges in their throat and obstructs their airway. They can also choke on small toys or dangerous objects such as button batteries that also can burn internally when swallowed (read more about button batteries under our ‘swallowing harmful substances blog’).
Why choking is alarming, is because it can be fatal and symptoms can deteriorate within seconds. Severe choking is silent, when a child is choking, they can’t cough and cry, they can’t make any noise. It’s really important that parents can recognise the symptoms of choking, and are able to identify the difference between a mild and severe airway obstruction.
An overall assessment of your child’s condition is crucial. Check their skin color - do they have a normal pink skin color or have their lips turned blue? Check their response levels – are they making any noise, can they cought or are they silent?
A mild airway obstruction, means that there is a partial blockage and that some air can still pass the lungs. At this stage a child can usually talk a little and they will cough. At this stage, it’s important that you encourage your child to keep coughing and monitor them carefully, as they can quickly deteriorate. A severe airway obstruction, means that there is a full blockage and the airway is completely blocked and not allowing any air to pass the lungs. At his stage, they can’t breathe, they cant make any noise. At this stage you must act fast, this could be a life-threatening emergency situation.
Babies won’t cry, cough or breath when they are choking. Act quick, as lack of oxygen within 4 minutes can lead to brain damage and within 6 minutes the brain starts to die.
What to do:
Give five back blows
When giving back blows to a baby, lift them up, position them down your forearm resting on your lap. Their head should be face downwards, lower than their bottom. This will allow gravity to work for you and allow drainage. If they vomit this won’t block their airway and vomit also helps with clearing the airway from blockage.
Use the heel of your hand to give back slaps firmly between the shoulder blades. Many parents worry over the fact that they would be ‘hitting’ their baby. It’s important that the back blows are done properly and that parents understand that they must be quick to assist their child in clearing their airway, as they are not able to breathe. The back blows create a pressure that can push the object out of the airway. For this to happen, the blows have to be firm to be effective, it’s not like when you winding your baby after they’ve just had their milk. The back blows can be given up to five times. If this doesn't work, try five chest thrusts.
When giving back blows to a child or an adult, stand next to them. Lean them forward while they are standing and give 5 firm back blows in between each blow. Make sure that you check after each blow that their airway is still obstructed. If this doesn't work, try five abdominal thrusts.
Give five chest thrusts
To give the five chest thrusts, you need to now hold your baby face upwards while supporting their head. While holding your baby on your lap, place two fingers in the centre of their chest and push firmly downwards. The chest thrusts will push the air out of the lungs which will hopefully help to dislodge the blockage.
For children over the age of one, we need to do abdominal thrusts (former called Heimlich maeuver). Get them to stand up leaning forwards. Stand behind them with your fist between their chest and belly button, pushing in and upwards. Never give abdominal thrusts to babies under the age of 1 or to a pregnant women. If abdominal thrusts have been given to a child or an adult, they have to be examined by a doctor afterwards, as abdominal thrusts can cause internal bleeding and injuries.
If the object doesn’t come out, ask someone to call for an ambulance or if you are on your own call 999 or 112 and put on the loud speaker on your phone. Never leave your baby, take them with you if you have to call for help. I would usually say contact the emergency services as soon as you have confirmed the signs of choking. As after only a few seconds they can become unconscious. Continue with 5 back blows and 5 chest thrusts on a baby and 5 back blows and 5 abdominal thrusts until the object dislodges or an ambulance arrives. If your baby or child becomes unconscious and stops breathing – start CPR.
When starting to wean your baby, avoid serving any foods that are choking hazards, including nuts, whole grapes, apples with the skin and cherries. Never leave a baby alone with food. Keep your baby sitting upright in her highchair while eating.
Don’t feed a child in pram and in the car
Make sure they are sitting upright and that they are sitting down and eating
Supervise children when they are eating
Cut foods halfway, long ways and be careful with ‘risky foods’ such as: grapes, hot dogs, raw vegetables such as carrots, popcorn, sweets, nuts, chunks of peanut-butter, marshmallows
Written by Fi Ramos, Public Health Nurse & First Aid Instructor at Act2care.
Information on this site is evidence based and provided to create awareness and advice only. If you are worried about a condition, seek medical advice.
Theoretical first aid tips are beneficial, however practical demonstrations and exercises are necessary for gaining high standard of first aid knowledge and skills.
If you are interested in gaining first aid skills, contact Fi to find our more about our paediatric first aid classes at firstname.lastname@example.org