Choking First Aid for Babies and Children: What to Do Right Now

If your baby suddenly can't breathe and can't cry, this is what to do in the next 60 seconds.

This is an emergency. If your baby is unresponsive or turning blue, call 1669 (Thailand EMS) immediately — then begin the steps below. If you are alone with the baby, begin the steps first, then call.

Choking is one of the most common causes of accidental injury in children under 5 [1]. This article covers two distinct techniques — one for infants under 12 months, one for children 12 months and older — cross-checked against Mayo Clinic [1], the NHS [2], and the British Red Cross [3][4].

A note on CPR: this article covers the choking response only. If your child becomes unresponsive, begin CPR immediately. CPR steps (compressions, rescue breaths, AED use) are covered in a dedicated CPR guide.

Is This Choking? (vs Gagging, vs Coughing)

Not every noise a baby makes at the table is choking. The distinction matters because intervening in the wrong situation can make things worse.

Effective cough or gag (partial obstruction) The child is coughing forcefully, making noise, or gagging. Their face is flushed (not blue). They can breathe between coughs.

What to do: Do NOT intervene with back blows or thrusts. A strong cough is more effective than any technique you can apply from outside. Stay close, encourage the cough, and watch.

Take the child to the ER if the cough doesn't clear the obstruction within a few minutes, or if the child becomes distressed.

Complete obstruction (act immediately) The child:

• Cannot breathe, cry, cough, or make noise
• Is turning blue (lips, fingertips, face)
• Is clutching their throat
• Is limp or panicking

This is a complete obstruction. Begin the technique for your child's age right now.

Infant Under 12 Months — Back Blows + Chest Thrusts

Never use abdominal thrusts (the Heimlich maneuver) on an infant under 12 months. The liver and internal organs are unprotected. Use back blows and chest thrusts only [1][2].

Step 1 — Position the infant face-down on your forearm

Sit down. Lay the infant face-down along the length of your forearm, resting your forearm on your thigh. Support the infant's head and jaw with your hand. The head must be lower than the body — gravity helps the obstruction move toward the mouth [1][2].

Step 2 — Deliver 5 back blows

Using the heel of your free hand, deliver 5 firm back blows between the infant's shoulder blades. Each blow should be sharp and deliberate [1][2]. After each blow, check if the object has been dislodged.

Step 3 — Turn the infant face-up for chest thrusts

Turn the infant face-up along your thigh, keeping the head lower than the body. Support the head.

Step 4 — Deliver 5 chest thrusts

Place two fingers on the infant's sternum, just below the nipple line (the centre of the chest, one finger-width below the line between the two nipples). Give 5 downward chest thrusts, pressing down about 1.5 inches (≈4 cm) — roughly one-third the depth of the infant's chest [1][2].

These chest thrusts are different from CPR compressions — they are slower and more deliberate, intended to create a pressure surge to expel the obstruction.

Step 5 — Repeat and call 1669

Continue alternating 5 back blows and 5 chest thrusts. After the second cycle, call 1669 if you haven't already. Do not stop the cycles while waiting for help to arrive.

If the infant goes unresponsive → see below.

Child 12 Months and Older — Heimlich Maneuver (Abdominal Thrusts)

For children aged 12 months and older, use back blows followed by abdominal thrusts (the Heimlich maneuver) [1][4].

Step 1 — Deliver 5 back blows

Lean the child forward. Using the heel of your hand, deliver 5 firm back blows between the shoulder blades. Check after each blow for the object.

Step 2 — Position for abdominal thrusts

Stand or kneel behind the child. For small children, kneel to get to their height. Wrap both arms around the child's waist.

Step 3 — Deliver 5 abdominal thrusts

Make a fist with one hand. Place the thumb side of the fist against the child's abdomen, just above the navel and well below the ribcage. Grasp the fist with your other hand.

Deliver 5 firm, quick inward-and-upward thrusts, as if trying to lift the child slightly [1][4].

Step 4 — Repeat and call 1669

Continue alternating 5 back blows and 5 abdominal thrusts. Call 1669 if you haven't already. Continue until the object is expelled, help arrives, or the child becomes unresponsive.

Important: Do not apply pressure to the lower ribs or sternum during abdominal thrusts — this can cause injury [2].

If the Child Goes Unresponsive — CPR + 1669

If at any point the child stops responding:

1. Call 1669 immediately (or have someone call while you continue).
2. Lay the child on their back on a firm, flat surface.
3. Look in the mouth. If the obstruction is clearly visible and you can grasp it easily, remove it. Never do blind finger sweeps — pushing blindly can force the object deeper [2].
4. Begin CPR — chest compressions and rescue breaths. With each compression cycle, briefly look in the mouth for any visible obstruction before continuing.

For detailed CPR steps (compression depth, rate, rescue breath technique), refer to a certified CPR course or the dedicated CPR guide on this site. CPR is a skill best learned hands-on — consider booking a first-aid class before you need it.

Prevention — Reducing the Risk Before It Happens

Most infant and toddler choking is caused by food and small objects. These measures reduce risk significantly [5]:

Food safety by age

• Under 12 months: No whole or large-piece solid foods. Ensure age-appropriate textures.
• Under 4 years: Avoid whole grapes, cherry tomatoes, nuts, popcorn, hard candy, marshmallows, raw carrots, and uncut hot dogs. Cut grapes and cherry tomatoes lengthwise in quarters. Cut hot dogs lengthwise, then into pieces.
• Any age: Supervise every meal. Do not let children eat in the car, while running, or while lying down.

Toy and object safety

• Toys labelled for children under 3 must pass the small-parts cylinder test: no object less than 3.2 cm in diameter (roughly the size of a 10-baht coin) should be accessible to a child under 3 years.
• Check the floor, sofa, and car seats regularly for coins, batteries, buttons, and pen caps.
• Button batteries are a particular hazard: they cause rapid, severe internal burns if swallowed — call 1669 immediately if ingestion is suspected.

After: When to Go to the ER Even if the Obstruction Cleared

Go to the ER if:

• The child's breathing remains noisy, laboured, or unusual after the obstruction cleared
• The child is drooling excessively or cannot swallow
• The child is very pale, tired, or distressed after the incident
• You used abdominal thrusts — internal bruising is possible even when the technique worked correctly [2]
• You are not certain the object came all the way out

Summary

If your child is choking right now: call 1669 (Thailand EMS, 24 hours).

The best preparation for a real choking emergency is taking a certified first aid and CPR class before you need it. The techniques above are accurate, but there is no substitute for hands-on practice.