We all hope we’ll never be put in the position of having to save a child’s life, but it could happen. Children test their physical limits and get caught in all kinds of dangerous situations. They choke on food, fall off bikes and play equipment, and wade into water unsupervised.
This step-by-step guide explains the basics of first aid for choking and CPR, but please don’t rely on it as your sole source of information. Set aside a few hours to take an infant and child CPR course to learn and practice the proper techniques. These techniques differ depending on the age of the child, and doing them improperly can be harmful.
The following instructions are for children ages 1 to 12. To find out what to do when a baby younger than 12 months is choking or needs CPR, see our illustrated guide to infant CPR.
Step 1: Assess the situation quickly.
If a child is suddenly unable to cry, cough, or speak, something is probably blocking her airway, and you’ll need to help her get it out. She may make odd noises or no sound at all while opening her mouth. Her skin may turn bright red or blue.
If she’s coughing or gagging, it means her airway is only partially blocked. If that’s the case, let her continue to cough. Coughing is the most effective way to dislodge a blockage.
If the child isn’t able to cough up the object, ask someone to call 911 or the local emergency number as you begin back blows and abdominal thrusts (see step 2, below).
If you’re alone with the child, give two minutes of care, then call 911.
On the other hand, if you suspect that the child’s airway is closed because her throat has swollen shut, call 911 immediately. She may be having an allergic reaction – to food or to an insect bite, for example – or she may have an illness, such as croup.
Also call 911 right away if the child is at high risk for heart problems or if you witnessed the child suddenly collapse.
Step 2: Try to dislodge the object with back blows and abdominal thrusts.
- First do back blows
If a child is conscious but can’t cough, talk, or breathe, or is beginning to turn blue, stand or kneel slightly behind him. Provide support by placing one arm diagonally across his chest and lean him forward.
Firmly strike the child between the shoulder blades with the heel of your other hand. Each back blow should be a separate and distinct attempt to dislodge the obstruction.
Give five of these back blows.
- Then do abdominal thrusts
Stand with one foot in front of the other, or kneel behind the child, and wrap your arms around his waist.
Locate his belly button with one or two fingers. Make a fist with the other hand and place the thumb side against the middle of the child’s abdomen, just above the navel and well below the lower tip of his breastbone.
Grab your fist with your other hand and give five quick, upward thrusts into the abdomen. Each abdominal thrust should be a separate and distinct attempt to dislodge the obstruction.
- Repeat back blows and abdominal thrusts
Continue alternating five back blows and five abdominal thrusts until the object is forced out or the child starts to cough forcefully, speak, cry, breathe, or becomes unresponsive. If he’s coughing, encourage him to cough up the object.
- If the child becomes unresponsive
If a child who is choking on something becomes unresponsive, you’ll need to do a modified version of CPR:
Place the child on his back on a firm, flat surface. Kneel beside his upper chest. Place the heel of one hand on his sternum (breastbone), at the centre of his chest. Place your other hand directly on top of the first hand. Try to keep your fingers off the chest by interlacing them or holding them upward.
Perform 30 compressions by pushing the child’s sternum down about 2 inches. Allow the chest to return to its normal position before starting the next compression.
Open the child’s mouth and look for a blockage. Never put your finger in his mouth unless you actually see a blockage. If you can’t see one and you put your finger in his mouth, you might accidentally push the object deeper into his throat. If you see something, remove it with your fingers.
If you’re unable to remove the blockage and the child is still unresponsive, give him two rescue breaths, like this:
Tilt the child’s head back with one hand and lift his chin slightly with the other. This will open his airway. Pinch the child’s nose shut, place your mouth over his, and exhale into his lungs until you see his chest rise.
If you don’t see the chest rise, repeat the cycle of giving 30 compressions, checking for the object, and trying to give two rescue breaths until the object is removed and the child starts to breathe on his own, or help arrives.
After the incident, have the child checked by a healthcare provider.
HOW TO PERFORM CPR
What is CPR?
CPR stands for cardiopulmonary resuscitation. This is the lifesaving measure you can take to save someone who shows no signs of life, meaning he is unconscious and not breathing.
CPR uses chest compressions and rescue breaths to make oxygen-rich blood circulate through the brain and other vital organs until the child revives or emergency medical personnel arrive. Keeping oxygenated blood circulating helps prevent brain damage – which can occur within a few minutes – and death.
If you have not been trained in CPR (which includes chest compressions and rescue breaths), you should only attempt to do the chest compressions.
Follow these steps:
Step 1: Check the child’s condition.
Tap on the child’s shoulder and call her name. If she doesn’t respond, have someone call 112 or the local emergency number. (If you’re alone with the child, give two minutes of care as described below, then call 112 yourself.)
Place the child on her back on a firm, flat surface. Kneel beside her.
Make sure she isn’t bleeding severely. If she is, take measures to stop the bleeding by applying pressure to the area. Don’t administer CPR until the bleeding is under control.
Step 2: Give 30 chest compressions.
Place the heel of one hand in the centre of the child’s chest, with your other hand on top. Try to keep your fingers up off her chest by interlacing them or holding them upward. Position your body so that your shoulders are directly over your hands. (For a small child, you can use a one-handed CPR technique: place the heel of one hand in the centre of the child’s chest.)
Keeping your arms straight, push straight down about 2 inches, and then let the chest to return to its normal position. Push hard and push fast. Compressions should be smooth, not jerky.
Do 30 chest compressions at the rate of two per second. Count out loud: “One and two and three and…,” pushing down as you say the number and coming up as you say “and.” (The song Staying Alive has the rhythm you’re shooting for.)
Continue giving compressions until:
- You notice an obvious sign of life.
- An AED (automated external defibrillator) is ready to use.
- You have performed approximately 2 minutes of CPR and another person is available to take over.
- You have performed approximately 2 minutes of CPR, you are alone with the child, and you need to call 911 or the designated emergency number.
- Emergency medical personnel take over.
- You are too tired to continue.
- The scene becomes unsafe.
Even if the child seems fine by the time help arrives, a doctor will need to check her to make sure that her airway is completely clear and she hasn’t sustained any internal injuries.