Emergency!

What to do if your child is choking

What to do if your child is choking

Airway obstruction, including choking, suffocation and strangulation, is the leading cause of unintentional death in the United States among children under the age of 1. Worse, it can kill silently and quickly.

To prepare yourself, take a CPR class and practice the skills you learn. (To find a class near you, contact the American Heart Association, 800-242-8721, americanheart.org; the American Red Cross, 202-303-4498, redcross.org; or the YMCA, 888-333-9622, ymca.net.) In the meantime, here's a primer on what to do if you suspect your child is choking.

What to look for: Sudden inability to speak or cry; weak, ineffective coughs; and high-pitched or no sounds while breathing in. Fingers and lips may be blue-tinged, with the discoloration spreading to the arms, neck and chest. Older children may make the universal sign of choking (hands at the throat).

WHAT TO DO

If child is 1 year or younger and conscious:

1.Position the infant facedown along your forearm, head lower than his body; support his jaw and head with your hand. If necessary, sit or kneel, resting your arm and the infant's torso in your lap or on your thigh.

2.Deliver up to five "back blows" (strike the baby's back with the heel of your free hand between the shoulder blades). Stop if the infant expels the object or begins to cough or breathe.

3.If the object is not expelled after five back blows, turn the infant onto his back while supporting the head. Place two fingers on his breastbone, one finger width below the nipples. Using your fingers, give up to five "chest thrusts" (quick downward thrusts to the chest) at a depth equal to one-third to one-half the depth of the infant's chest. Stop if the object is expelled or the infant begins to cough or breathe.

4.Alternate performing five back blows and five chest thrusts until the object is expelled or the infant becomes unconscious.

5.If the infant becomes unconscious, proceed to Step 1 below.

If child is 1 year or younger and unconscious:

1. See if you can rouse the infant: Flick the bottom of his foot or rub his back.

2. If the infant doesn't respond, do the following:

  • Lay the infant faceup on a firm surface, tilt his head back slightly and lift his chin. Open his mouth and look for a foreign object. If you see an object, remove it; do not stick your fingers into the infant's mouth unless you can see the object.
  • See if the infant is breathing: Look at his chest to see if it is moving, listen for breathing and feel his chest to see if it is moving. If he is breathing, the infant likely isn't choking. Call 911 and follow the emergency dispatcher's instructions.
  • If the infant is not breathing, perform "rescue breaths": Place your mouth over his nose and mouth to form a seal. Give two gentle breaths lasting about 1 second each.
  • As you perform the rescue breaths, watch to see if the chest rises (this means air is getting in). If so, look for any movement, coughing or breathing. If any of these are present, turn him onto his side and call 911.
  • If the infant's chest doesn't rise as you perform rescue breaths, or if he shows no movement, coughing or breathing, assume there is an airway obstruction. Perform five chest thrusts to try to remove the object (see Step 3 above).
  • Call 911 regardless of whether the baby expels the object or shows any movement, coughing or breathing.
  • Continue chest thrusts until the object is expelled, help arrives or the infant shows any movement, coughing or breathing.

If child is 1 to 8 years old and conscious:

1.For an older child, ask, "Is something stuck in your throat?" If the child nods yes, ask, "Can you speak?" If the child shakes his head or cannot make any sound, try to keep him calm by telling him you are going to help. For a younger child, look for signs of choking described under "What to look for" (above).

2.Perform "abdominal thrusts" to try to remove the object:

  • Stand or kneel behind the child and wrap your arms around his waist. Make a fist with one hand and place the thumb side of your fist against the child's upper abdomen, below the rib cage and above the navel.
  • Grasp your fist with your other hand and press into the upper abdomen with a quick upward thrust. Do not squeeze the rib cage with your forearms.

3.Repeat abdominal thrusts until the object is expelled or the child becomes unconscious. If the child becomes unconscious, proceed to Step 1 below.

If child is 1 to 8 years old and unconscious:

1. See if you can rouse the child: Tap on his foot, rub his back or shout.

2. If the child doesn't respond, do the following:

  • Place the child faceup on a firm surface, tilt his head slightly back and lift his chin. Open his mouth and look for a foreign object. If you see an object, remove it; do not stick your fingers into the child's mouth unless you can see the object.
  • See if the child is breathing: Look at his chest to see if it is moving, listen for breathing and feel his chest to see if it is moving. If he is breathing, the child likely isn't choking. Call 911 and follow the emergency dispatcher's instructions.
  • If the child is not breathing, perform rescue breaths: Place your mouth over his mouth and pinch the nostrils together. Give two breaths lasting about 1 second each.
  • As you perform the rescue breaths, watch to see if the chest rises (this means air is getting in). If so, look for movement, coughing or breathing. If any of these are present, turn the child onto his side and call 911.
  • If the chest doesn't rise as you perform the rescue breaths, the child likely has an airway obstruction. Call 911 immediately and follow the emergency dispatcher's instructions.

Prevention

• Never feed a child under 3 years uncut hot dogs, hard candy, nuts, grapes, popcorn or raw carrots. Keep out of reach any items that are easy to choke on, such as coins, beads, disc batteries, pills and vitamins, and small toys and balls.

• Cut up any food not soft enough to dissolve in the mouth, such as meat (including hot dogs), into fingertip-size pieces.

• Supervise children while they eat. Make them eat slowly. Don't let them crawl or run around with food in their mouths.

• Anything that can fit through a toilet-paper tube (other than food) can choke a child and should be kept out of reach.

• Never give balloons to infants or young children. They are extremely easy to choke on and can be deadly.

Information provided here is not intended to replace your physician's advice. In any emergency situation, it's best to call your child's doctor or 911 as quickly as possible.

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