Heimlich maneuver: First aid for choking on food

Children younger than five are at the greatest risk of choking on food, but it can happen to anyone. Adults can choke on food when its not chewed properly and they’re more prone to it when consuming alcohol. A quick response using choking first aid, which may include the Heimlich maneuver, can prevent brain damage and even death.

Food choking hazards and signs of a problem

Any small object is a choking hazard for a young child. They put objects in their mouths out of curiosity and often don’t chew food into small pieces. For children and adults, be especially careful with foods that have membranes.

“These are foods like whole grapes, cherry tomatoes and hot dogs,” said Cally Gordon, Marshfield Clinic Health System Emergency Medicine Physician Assistant. “These have the potential to be soft enough to fit within the airway, but not allow air to pass.”

If someone starts choking on an object of any kind, they may display several signs, including coughing, gagging, an inability to talk, noisy breathing or sudden loss of consciousness. The universal distress signal is grabbing at the throat with one or both hands.

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How to respond to a choking emergency

The first thing is for you or someone nearby to call 911. The next action depends on the person’s age, size, breathing capability and level of consciousness, Gordon says.

If the person is conscious and actively coughing, breathing or speaking, encourage them to cough forcefully to try to dislodge the item.
If the person is conscious, but unable to breath, cough or speak, abdominal thrusts (otherwise known as the Heimlich maneuver) are needed. Position yourself behind the person with your hands together, one in a fist and the other wrapped around it. Place your hands a few inches above the belly button, and forcefully push into their abdomen in a slight upward direction. Keep doing this until the object is removed or the person loses consciousness.
If the person is pregnant or you can’t wrap your arms around their abdomen, perform chest thrusts. These are similar to abdominal thrusts, but your hands are placed at the base of the breastbone.
If the patient is not conscious or loses consciousness while you are attempting to help them, carefully lower them to the floor and perform chest compressions.
For infants who are not coughing, breathing or speaking, sit down and place them face down on your leg or forearm. Firmly deliver five back blows between the shoulder blades. Turn the infant over once these are done. Then perform five chest compressions in the center of the chest, just below the nipple line. Repeat this process until the airway is cleared or they become unresponsive. If they become unresponsive, initiate chest compressions.

“It’s important to note that in any scenario, only reach a finger into a person’s mouth to try to sweep out the object if you can see it,” Gordon said. “Never do a blind finger sweep if you can’t see the object, because that could push the object deeper.”

See a health care provider after a choking episode

If you are successful at administering first aid and helping someone who was choking on food, they should see a doctor for follow-up.

While rare, injuries to internal organs can occur from abdominal thrusts, back blows or chest thrusts. Additionally, there can be side effects that need to be evaluated if the person had low oxygen levels for any period of time.

“It’s often said that lack of oxygen to the brain can cause permanent damage in as little as four minutes,” said Gordon. “While that is true, it’s more accurate to note that the time in which an individual can develop brain damage will vary based on the situation, their medical history and other factors.”