Choking

Air enters the lungs via the trachea (windpipe). Choking is caused when a foreign object, like a hard lump of food, a marble or false teeth goes into the trachea instead of the oesophagus (food pipe). If the object is at the entrance to the trachea (epiglottis), a good cough will more than likely push it out. If the object has made its way past the epiglottis, coughing may prevent the object from going further down the trachea. Sometimes, an inhaled object may cut off the airway completely.

Choking may be a life-threatening medical emergency, because the brain can only survive a few minutes without oxygen.

First aid can save the life of a choking person if applied correctly and immediately. Procedures for managing choking are different for adults and children. Always call triple zero (000) in an emergency.

The suggestions in this fact sheet are not a substitute for first aid training. Everyone should learn first aid skills.

Symptoms of choking

A person with a partly blocked airway can still breathe, speak or cough. Symptoms include:

• Panicked and distressed behaviour
• Inability to talk in complete sentences or at full volume
• Coughing, wheezing, gagging
• Unusual breathing sounds, such as wheezing or whistling, or no sound at all
• Clutching at the throat
• Watery eyes
• Red face.

If the person’s airway is completely blocked and they cannot breathe, speak or cough at all, they will show some or all of the above symptoms including vigorous attempts to breathe, then turning pale and then blue due to lack of oxygen (cyanosis), before collapsing into unconsciousness.

First aid for choking if the adult or infant is conscious

Conscious adult

To begin with, reassure the person. Encourage them to breathe and cough. If coughing does not remove the blockage:

• Call triple zero (000) for an ambulance
• Bend the person well forward and give 5 back blows with the heel of your hand between their shoulder blades, checking to see if the blockage has been removed after each blow.
• If the blockage has not cleared after 5 blows, give up to 5 chest thrusts by placing one hand in the middle of their back for support and the heel of the other hand on the lower part of their breastbone – checking if the blockage has been removed after each thrust.
• If the person becomes blue, limp or unconscious, start CPR.

Conscious infant

• Immediately call Triple Zero (000) for an ambulance. Stay on the phone.
• Place the infant with their head downwards on your forearm, supporting the head and shoulders on your hand.
• Hold the infant’s mouth open with your fingers.
• Give up to 5 sharp blows to the back between the shoulders with the heel of one hand, checking if the blockage has been removed after each blow. The aim is to remove the obstruction, not deliver all 5 blows.
• If the blockage has come loose or been removed, turn the infant onto their side and use your fingers to remove any visible object that may have come loose. Do not blindly sweep the cavity with a finger.
• If the blockage has not been removed after 5 blows, place the infant on their back on a firm surface.
• Place 2 fingers on the lower half of the sternum (the CPR compression position) and give up to 5 chest thrusts, checking if the blockage has been removed after each thrust. Support the infant’s head with your other hand.
• If the blockage has not been removed after 5 thrusts, continue alternating 5 back blows with 5 chest thrusts until medical aid arrives.
• If the infant becomes blue, limp or unconscious, start CPR

Positioning

Note that the positioning used for adults and children is different from that required for babies.

• For an adult or child– ask the person to lean over with their hands on their knees or sit in a chair leaning forward. The amount of force used on a child is less than that used on an adult
• For a baby – place the baby on your lap or forearm, with their head lower than their body. Ensure that you have them in a firm hold. The amount of force is less than that used on a child.
  

Managing the unconscious person (adult, child, infant)

If at any time the person becomes unconscious:

• Call triple zero (000).
• Remove any visible obstruction from the mouth.
• Commence cardiopulmonary resuscitation (CPR).

Cardiopulmonary resuscitation (CPR)

First aid CPR procedure includes:

• Place the person on their back on the floor (place a baby on a firm surface, such as a table).
• Tilt the person's head gently back, pinch the nostrils closed, cover their mouth with yours to create a seal and blow firmly. (If doing CPR on a baby, do not tilt a baby’s head back. Instead, cover their nostrils and mouth with your mouth. Blow in puffs.)
• Place the heel of one hand on the lower half of the person’s breastbone. Place the other hand on top of the first hand and interlock your fingers. Keep your fingers up so that only the heel of your hand is on the person’s chest. Use two fingers only for compressions on babies.
• Press down firmly and smoothly (compressing to one third of chest depth) 30 times. Then administer two breaths. Repeat at the rhythm of five cycles in two minutes.
• Continue CPR until ambulance officers take over, the person recovers, or you are unable to continue.

Performing first aid on yourself

If you are choking:

• Try to stay calm. Attract someone's attention for help.
• Attempt forceful coughing. Lean as far forward as you can. Hold onto something that is firmly anchored, if possible. Breathe out and then take a deep breath in and cough. This may eject the foreign object.
• Make sure you are leaning well forward before anyone slaps you on the back. This minimises any potential for the object to slip further down your trachea (windpipe).

Children and choking

Infants and small children under 5 years, learn about their environment by touching and feeling, and often by putting things in their mouths. But they have small airways that can be easily blocked.

Note that in a young child, their struggle to breathe may not last long and the stopping of frantic activity may signal a serious or life-threatening situation, rather than a sign that the blockage has been dislodged. Look for other signs and symptoms such as the child’s responses, a pale face, or cold and clammy skin. These are signs that the child is in shock.

Immediate steps when a child is choking

When a child is choking:

• Immediately check if the child is still able to breathe, cough or cry. If so, they may be able to dislodge the object by coughing.
• Follow the step for managing choking outlined under First aid for choking if the adult or infant is conscious
• Stay with the child and watch to see if their breathing improves.
• If the child is not breathing easily within a few minutes, call triple zero (000).
• If, after the coughing settles down, there is any continued noisy breathing or coughing, take the child to see a doctor, as the object may have lodged in the windpipe or airway. If this is the case, it will need to be removed in hospital using a special instrument.

Precautions to prevent children choking

Small children are at risk from choking on food and small items such as buttons or beads. Parents can take many precautions to reduce the risk of their child choking.

The molars (back teeth) are used for grinding and mashing foods. Children don't start getting their molars until they are somewhere between 12 and 18 months of age, and it may take a further two years or more until all the molars are through and the child is very good at chewing. This means they are vulnerable to choking on hard foods such as raw carrot, chunks of apple, lollies, popcorn or peanuts.

Suggestions to prevent choking include:

• Hard foods should be cooked, mashed, grated or avoided altogether.
• Cut meat into small, manageable pieces for your child, and remove tough skins from sausages and frankfurters.
• Cut food lengthwise to make it narrower.
• Supervise your child while they are eating.
• Explain to your child the importance of eating food quietly and while sitting down.
• Don't try to feed them if they are laughing or crying.

Remove choking hazards

Parents should be aware of potential choking hazards. Suggestions include:

• Treat any object smaller than a ping-pong ball (such as coins, buttons, marbles and beads) as a possible choking threat. Keep these small objects out of your child's reach.
• Polystyrene beads, found in beanbags and some stuffed toys, are easily inhaled. Check toys regularly for signs of wear and tear.
• If you spot a potential choking hazard, remove or secure it immediately.
• Only buy toys from reputable manufacturers. Toys should comply with the Australian Standard AS1647.
• Warning labels on toys, such as 'Not suitable for children under three years', means that small parts may present a choking hazard. The label doesn't refer to skill level.
• Keep balloons away from small children. A bitten balloon may burst and send fragments down the child's throat.
• Older children in the household should be warned not to leave potentially dangerous items near young children.
• Peanuts are a well-known hazard.

First aid courses for treating children

Emergency medical treatment for young children isn't always the same as for adults, which is why all parents should take a course in paediatric (child) first aid.

Where to get help

• In an emergency, call triple zero (000)
• Emergency department of the nearest hospital
• Your GP (doctor)
• Community Information team (formerly Safety Centre), Royal Children’s Hospital Tel. (03) 9345 5522
• Maternal and Child Health Line, Victoria (24 hours) Tel. 132 229
• For first aid training, contact St John Ambulance Australia (Victoria) or Australian Red Cross