7.3 Infant Choking & The Unresponsive Choking Patient
Key Takeaways
For a conscious infant with severe foreign-body airway obstruction, alternate 5 back blows with 5 chest thrusts until the object is expelled or the infant becomes unresponsive.
The 2025 infant choking update uses the heel of one hand for chest thrusts; do not use the retired two-finger technique and never use abdominal thrusts on an infant.
Support the infant securely with the head lower than the trunk during back blows and chest thrusts, without pressing on the soft tissues of the neck.
If an infant or child with severe obstruction becomes unresponsive, start CPR beginning with compressions and do not perform a pulse check first.
Each time the airway is opened during CPR, remove a foreign body only if it is visible; blind finger sweeps can push the object deeper.
7.3 Infant Choking & The Unresponsive Choking Patient
Foreign-body airway obstruction (FBAO) in an infant requires a different technique from choking care in an adult or child. The infant's abdomen is not used for thrusts. Current 2025 AHA/AAP guidance calls for alternating 5 back blows and 5 chest thrusts, and the chest thrusts are delivered with the heel of one hand.
Decide whether the obstruction is mild or severe
An infant with a mild obstruction can cough forcefully or make sounds and has meaningful air exchange. Allow the infant to cough, remain close, and watch for worsening. Do not begin back blows or thrusts while the cough is forceful.
An infant with a severe obstruction cannot cry or cough effectively, cannot breathe adequately, may make little or no sound, and can become cyanotic or less responsive. Activate emergency response and begin the obstruction-relief sequence.
Five back blows
- Sit or kneel so you can support the infant safely.
- Place the infant face down along your forearm, with the forearm supported on your thigh.
- Support the infant's head and jaw without pressing on the throat or soft tissue under the chin.
- Keep the head lower than the trunk.
- Using the heel of your free hand, deliver 5 firm, distinct back blows between the shoulder blades.
After each blow, recognize that the object may be expelled. If the infant still has severe obstruction after 5 blows, turn the infant for chest thrusts.
Five heel-of-one-hand chest thrusts
- Place your free forearm along the infant's back and support the back of the head.
- Hold the infant securely between your forearms and turn the infant face up.
- Keep the head lower than the trunk and support your forearm on your thigh.
- Place the heel of one hand on the lower half of the sternum.
- Deliver 5 distinct chest thrusts, allowing the chest to return after each thrust.
Warning
The 2025 technique uses the heel of 1 hand for infant choking chest thrusts. Older instructions that use 2 fingers for chest thrusts are no longer current. Abdominal thrusts are not recommended for infants.
Continue cycles of 5 back blows and 5 chest thrusts until the object is expelled or the infant becomes unresponsive. Do not suspend the infant by the feet, shake the infant, or probe the mouth blindly.
If the choking patient becomes unresponsive
When an infant or child with severe FBAO becomes unresponsive:
- Place the patient supine on a firm, flat surface.
- Activate the emergency response system and send for an AED if that has not already occurred.
- Start CPR beginning with chest compressions. Do not perform a pulse check first.
- Each time you open the airway to provide breaths, look in the mouth.
- Remove an object only if it is visible and can be removed safely.
- Never perform a blind finger sweep.
- Attempt breaths and continue the age-appropriate CPR sequence.
The 2025 pediatric guideline directs rescuers to start CPR for an unresponsive infant or child with severe FBAO without a pulse check. Chest compressions can create pressure that helps move the object while also supplying circulation if arrest has occurred.
For an adult who becomes unresponsive from severe FBAO, begin CPR starting with compressions and activate emergency response. The same visible-object rule applies: look when opening the airway and remove only what can be seen. Do not keep performing standing back blows or abdominal thrusts after the person is unresponsive.
Why blind finger sweeps are harmful
A blind sweep means inserting a finger when no object is visible. That can push an object farther into the airway or injure the mouth and throat. A visible-object removal is different: if the object is plainly seen when the airway is opened and can be grasped safely, remove it before attempting breaths.
Do not repeatedly interrupt compressions to search deep in the throat. Open the airway at the normal point in the CPR cycle, look, remove a visible object if present, and attempt breaths. If the chest does not rise, reposition the airway and continue the obstruction CPR sequence rather than using excessive ventilation force.
How choking thrusts differ from CPR compressions
Both use the lower half of the sternum, but the purpose and cadence differ:
| Technique | Pattern | Hand method |
|---|---|---|
| Conscious infant FBAO chest thrusts | 5 distinct thrusts alternating with 5 back blows | Heel of 1 hand |
| Infant CPR | Continuous compressions in a 30:2 or 15:2 ratio | Heel of 1 hand or 2-thumb-encircling hands |
Do not count choking thrusts at the CPR rate, and do not insert rescue breaths between back-blow/chest-thrust cycles while the infant remains conscious.
Common exam distinctions
- Forceful cough or effective cry: observe and allow coughing.
- Severe obstruction in a conscious infant: 5 back blows, then 5 heel-of-one-hand chest thrusts.
- Severe obstruction in a conscious child or adult: 5 back blows, then 5 abdominal thrusts; use chest thrusts when the abdomen cannot be encircled or in late pregnancy.
- Unresponsive infant or child with FBAO: begin CPR with compressions and no pulse check.
- Object not visible: no finger sweep.
The safest memory line is: infant—back blows and heel-of-one-hand chest thrusts; unresponsive—CPR and look before breaths.
A conscious 7-month-old infant has severe foreign-body airway obstruction. Which sequence is current for 2025?
Five abdominal thrusts followed by 5 rescue breaths
Five back blows followed by 5 heel-of-one-hand chest thrusts
Continuous two-finger chest compressions at the CPR rate
A blind finger sweep followed by an AED shock
An infant with severe FBAO becomes unresponsive. What should the rescuer do next?
Check the brachial pulse for 30 seconds before acting.
Continue conscious choking thrusts while holding the infant upright.
Place the infant on a firm surface and begin CPR with compressions, without a pulse check first.
Perform repeated blind finger sweeps.
During CPR for an unresponsive choking patient, when should a rescuer remove a foreign body from the mouth?
After every compression cycle, whether or not an object is seen
Only after the AED advises a shock
Never, even when the object is clearly visible
Only when the object is visible and can be removed safely
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