How to Respond to a Choking Emergency: A Step-by-Step Guide for Adults, Children, and Infants

Knowing how to respond to a choking emergency means you can act in the first seconds, when it matters most. This guide gives you one calm, ordered sequence for adults, children, and infants: recognizing severe choking, giving back blows and abdominal thrusts, using chest thrusts for babies, and starting CPR if the person becomes unresponsive. You need no prior training to follow it, and nothing to gather beforehand. It does not replace a certified, hands-on course, which remains the best preparation. Where the American Red Cross and the American Heart Association (AHA) teach different methods, both are explained, since guidance can be updated and you should follow the course you were taught.

Step 1: Recognize Whether the Choking Is Mild or Severe

The first decision is whether to act or to hold back. The two situations call for opposite responses.

Mild choking: the person can cough forcefully, speak, or breathe. Their airway is only partly blocked, and coughing is the most effective tool they have. Encourage them to keep coughing, stay beside them, and do not slap their back or put your fingers in their mouth. Interfering can move the object deeper.

Severe choking: the airway is blocked enough that air barely moves. Look for these signs:

The person cannot speak, cough, or breathe.

Any sounds are silent, weak, or high-pitched.

They clutch their throat with one or both hands. This is the universal choking sign.

Lips or skin turn bluish, or the face looks panicked and flushed, then pale.

Choking is easy to confuse with a heart attack, fainting, or an allergic reaction. If someone grabs their throat but you are not sure why, ask clearly, "Are you choking?" A nod, especially from someone who cannot talk, confirms it. Infants and young children cannot answer, so rely on what you see: sudden inability to cry or cough, a silent open mouth, or a color change shortly after eating or playing with small objects.

Use this decision rule. If the airway is clearly blocked, move to action immediately and do not wait to see whether it clears. If you are unsure, stay with the person, keep watching, and be ready to act the moment their coughing weakens or stops.

Step 2: Get Help and Call 911 Without Delay

Help should be on the way while you start treating, not after. If other people are nearby, point at one person and tell them directly: "Call 911 now." Pointing at a specific person works better than a general shout. Ask a second person to bring an automated external defibrillator (AED) if one is nearby, since the person may stop responding.

If you are alone with an adult or child, begin care first if the blockage is clearly severe, or put your phone on speakerphone and call while you act. Do not leave a choking person to look for a phone.

When the dispatcher answers, say your location first, then that someone is choking and whether the person is an adult, child, or infant. Stay on the line. Dispatchers are trained to coach you through the steps and will tell you when to change what you are doing.

Call even if the object comes out and the person seems fine. Some people have throat or airway injury from the object or from the force used to remove it, and others still have a partial blockage or can develop breathing trouble later. Advise a medical evaluation every time, and especially after abdominal thrusts or chest thrusts were needed.

Many places have Good Samaritan laws that protect people who give reasonable emergency care in good faith, but the details differ by state and situation. Check your local rules or ask your instructor in class rather than relying on a general assumption.

Step 3: Give Back Blows for a Conscious Adult or Child

The American Red Cross teaches a "five and five" approach for a conscious adult or child: 5 back blows, then 5 abdominal thrusts, repeated. AHA guidance for adults and children emphasizes abdominal thrusts as the main technique. Both organizations teach effective methods, and as of 2026 you should follow whichever your course taught. If you are not sure which applies to you, the sequence in this guide follows the Red Cross approach and notes the AHA difference where it matters.

For back blows:

Position yourself. Stand to the side of the person and slightly behind them.

Support the chest. Place one arm diagonally across their chest and hold firmly.

Lean them forward. Bend them at the waist until their upper body is close to parallel with the ground, so the object can fall out of the mouth instead of sliding deeper. For a small child, kneel or lower yourself to keep a stable hold.

Strike. Use the heel of your other hand to hit firmly between the shoulder blades. Deliver up to five separate blows, each meant to dislodge the object.

Check. Glance at the mouth and listen for breathing after each blow. If the object comes out or the person can cough, speak, or breathe, stop.

Use less force for a small child than for a large adult, but the blows should still be firm. Gentle pats will not move a lodged object. If five blows do not work, move straight to abdominal thrusts without pausing.

Step 4: Perform Abdominal Thrusts

Abdominal thrusts, sometimes called the Heimlich maneuver, use a sudden rise in pressure in the chest to push air out and force the object up. Done correctly, they are the central technique in AHA guidance and the second half of each Red Cross cycle.

Hand placement and motion

Stand behind the person and wrap your arms around their waist.

Make a fist with one hand and place the thumb side against the abdomen, just above the navel and well below the breastbone.

Grasp the fist with your other hand.

Pull in and up with quick thrusts. Treat each one as its own attempt to clear the airway, not as a squeeze.

Keep your fist away from the ribs and the tip of the breastbone, where force can cause injury.

Children, pregnancy, and larger abdomens

For a child, use the same technique but adjust your position and force to their size. Kneel behind them if needed so your fist lands in the right spot, and use less force than you would on an adult.

If the person is pregnant, or has a larger abdomen that you cannot reach around, use chest thrusts instead. Place your fist at the center of the breastbone, grasp it with your other hand, and thrust straight back toward the spine.

How long to continue

With the Red Cross method, alternate five back blows and five abdominal thrusts. With the AHA method, continue abdominal thrusts. In either case, repeat until the object comes out, the person can breathe or cough forcefully, or they become unresponsive. If they become unresponsive, go to Step 7.

Step 5: Help Yourself When You Are Choking Alone

If you are by yourself, the order matters. Call 911 first if you can reach your phone, even if you cannot speak. An open line may let dispatch trace your location and send help, and it leaves a record of what is happening. Unlock the door if you can do so quickly, so responders can reach you.

Then give yourself abdominal thrusts. There are two ways:

With your hands: make a fist and place the thumb side just above your navel, below the breastbone. Grasp it with your other hand and press inward and upward with quick, hard movements.

Against a firm object: lean over the back of a chair, a countertop edge, or a railing so the object presses into the same spot above your navel. Shove your body into it with a quick inward and upward motion.

Choose something solid at about waist height. Avoid sharp corners or anything that could press on your ribs or the tip of your breastbone, or that could shift under your weight. The pressure must be firm and quick, so do not hold back out of caution about bruising. A bruise is a minor cost compared with a blocked airway.

Repeat thrusts until the object comes out or help arrives. If you feel yourself losing consciousness, try to get to a place where responders can easily find you, such as near an open door.

It is worth rehearsing this once at home, slowly and without full force, so your hands know where to go. Under stress, a motion you have already practiced is far easier to carry out than one you have only read about.

Step 6: Respond to Choking in an Infant Under One Year

Infants need a different approach because their bodies are small and fragile. Never use abdominal thrusts on an infant. The sequence is 5 back blows followed by 5 chest thrusts, repeated. Both the Red Cross and the AHA teach this method for infants.

Back blows

Sit or kneel and place the infant face-down along your forearm.

Support the head and jaw with your hand, without pressing on the soft tissue of the throat.

Keep the head lower than the chest, and rest your forearm on your thigh for stability.

With the heel of your other hand, give up to five firm blows between the shoulder blades.

Chest thrusts

Place your free hand and forearm along the infant's back, then turn the infant face-up, supporting the head and neck. Rest your arm on your thigh, head still lower than the chest.

Put two fingers on the center of the chest, just below the nipple line.

Compress about 1.5 inches, then let the chest return. Give up to five thrusts.

The 1.5 inch depth reflects current Red Cross and AHA teaching for infants as of 2026, but confirm it in your course materials, since guidelines are periodically updated.

After each set, look in the mouth. Remove an object only if you can see it. Do not do blind finger sweeps, which can push the object farther back. Keep alternating back blows and chest thrusts until the object is out, the infant cries, coughs, or breathes, or the infant becomes unresponsive. If that happens, begin infant CPR as described in Step 7. Even if the infant recovers, a medical check is needed.

Step 7: Start CPR If the Person Becomes Unresponsive

If a person stops responding, the approach changes. Lower them carefully to the ground, on their back, and confirm that 911 has been called. If no one has called, do it now or have someone else do it.

Begin CPR with chest compressions. Do not stop to check for a pulse or to search the mouth first. Compressions can help move the object and keep blood circulating. Each time you open the airway to give breaths, look inside the mouth. If you see the object, remove it. If you do not, do not sweep blindly. Then continue with compressions and breaths according to the CPR method you were taught for the person's age.

If an AED has been brought, turn it on as soon as it arrives, attach the pads, and follow its voice prompts. Do not delay compressions while you set it up if another person can do it.

Continue until one of these happens:

Emergency medical services (EMS) takes over.

The person responds, coughs, or begins to breathe normally.

You are too exhausted to continue safely.

Reading about CPR and performing it are very different experiences. Compression depth, rate, and hand position are skills that build through practice on manikins, with an instructor correcting your technique in real time. Taylored Instruction offers CPR, First Aid, and BLS courses through both the American Red Cross and the American Heart Association, so you can train in the method your workplace or profession requires.

After the Object Is Out: Getting Checked and Getting Trained

Once breathing returns to normal, keep the person seated and calm, and make sure a medical professional checks them. Throat irritation, a lingering cough, or pain in the abdomen or chest after thrusts can point to an injury that is not obvious at first. If EMS arrived, let them decide whether further care is needed.

Then consider turning what you just read into a skill you own. A hands-on class lets you practice back blows, thrusts, and infant technique under an instructor's eye, with locations serving Vancouver WA, the Portland metro area, and San Luis Obispo CA.

Don't wait until an emergency happens. Get the life-saving certification you need today. Register for a CPR, First Aid, or Lifeguarding class and gain the confidence and skills to respond when it matters most.