Choking in babies and children: first aid and CPR basics

If your baby is choking and cannot cough, cry or breathe, act at once: give up to 5 firm back blows, then up to 5 chest thrusts, and repeat. For a child over one, use tummy thrusts instead of chest thrusts. Shout for someone to call 112 or 108 for an ambulance. If your child stops responding, start CPR straight away. Below, Dr Dutta answers the questions parents ask her, and urges you to take a hands-on first aid class too.

How do I know if my baby is choking?

A choking baby usually goes quiet. They cannot cry, cough or make sounds, because the airway is blocked.

Current UK resuscitation guidance says to suspect choking when an older child cannot speak, or a baby or small child cannot cry.¹ Other signs you may see:

• a sudden start while eating or playing with small objects
• a weak, silent cough or no cough at all
• struggling to breathe, with the chest sucking in
• lips or face turning blue or grey
• floppiness or not responding

A baby who is coughing hard, crying or going red but still breathing is usually clearing the airway alone. Stay close and let them cough.

What should I do first if my baby is choking?

If your baby is coughing strongly, let them cough and watch closely. If the cough is weak or silent, or they cannot breathe, start back blows straight away and shout for help.

The UK guidance asks you to phone for an ambulance early, and to encourage an older child to keep coughing while they still can.¹ In India, dial 112, or 108 for an ambulance. Put the phone on speaker so your hands stay free. Do not run out of the room to find help while the baby is still choking. Call out loudly instead.

Do not hang the baby upside down by the legs or shake them. These old home remedies waste time and can cause injury.

How do I give back blows to a baby under one year?

Lay your baby face down along your forearm, head lower than the chest, and give up to 5 sharp blows between the shoulder blades with the heel of your other hand.¹

1. Sit or kneel. Rest your forearm on your thigh for support.
2. Hold the baby's jaw with your thumb and fingers. Keep your fingers off the soft neck.
3. Give each blow firmly, as a separate attempt to shift the object.
4. Check after each blow whether the food has come out.

If 5 back blows do not work, move on to chest thrusts. The 2025 American guidelines for infants advise repeated rounds of 5 back blows and 5 chest thrusts.²

How do I give chest thrusts to a choking baby?

Turn the baby onto their back, lay them on your knees with the head supported, and give up to 5 short, sharp pushes on the lower half of the breastbone.¹

The UK guidance describes wrapping your hands round the chest, both thumbs on the breastbone, as for CPR, but pressing more sharply.¹ Each push is a fresh attempt to pop the object out. Look in the mouth after each round.

Then go back to 5 back blows, then 5 chest thrusts, and keep repeating. The American and UK guidance both use this back-and-forth pattern for a baby who is still awake.^1,2

Can I do the Heimlich manoeuvre (tummy thrusts) on a baby?

No. For babies under one year, the 2025 American guidelines say to use chest thrusts and not abdominal (tummy) thrusts.²

A baby's liver and other organs sit high and are poorly protected by the ribs, so a hard upward squeeze into the tummy could injure them. Chest thrusts push air out of the lungs without that risk. Save tummy thrusts for children over one.

What do I do if a child over one year is choking?

Ask them to cough. If they cannot, give up to 5 back blows, then up to 5 abdominal (tummy) thrusts, and repeat.^2,3

The 2025 American guidelines, summarised for Indian paediatricians in Indian Pediatrics, now advise giving a choking child 5 back blows, then 5 tummy thrusts, and repeating the pair.^2,3

• Back blows: lean a toddler forward across your lap, or bend an older child forwards, and strike between the shoulder blades.
• Tummy thrusts: stand or kneel behind the child. Put your fist between the belly button and the bottom of the breastbone, cover it with your other hand, and give a quick, hard pull in and up.¹

Dr Dutta advises that any child who needed tummy thrusts sees a doctor the same day, even if they seem fine, because thrusts can occasionally injure the organs inside.

Should I put my finger in my baby's mouth to pull the food out?

No. Do not sweep a finger blindly around the mouth. The UK guidance warns against blind finger sweeps.¹

A finger poking around can push the food further down and turn a partial block into a complete one. Look into the mouth instead. If you can clearly see the object near the front, you may lift it out with one careful sweep.¹ If you cannot see it, carry on with back blows and thrusts.

Many grandmothers reach in with a finger out of instinct. Gently stop them and explain why.

What if my baby stops responding while choking?

Start CPR straight away. Lay the baby on a firm, flat surface and give 5 rescue breaths, then chest compressions.¹

The UK guidance says to begin CPR with five rescue breaths as soon as a choking child becomes unconscious.¹ Make sure someone has called an ambulance. Before each set of breaths, look in the mouth and remove an object only if you can see it.

Keep going until help takes over or the baby starts breathing normally.

How do I do CPR on a baby?

Check whether the baby responds, call for an ambulance on speaker, open the airway, give 5 rescue breaths, then give chest compressions.¹

1. Check: speak loudly and tap the foot. No reaction means call 112 or 108 at once.¹
2. Open the airway: keep a baby's head in a neutral position, with a slight head tilt and chin lift.¹
3. Look for breathing for no more than 10 seconds. If in doubt, treat it as not normal.¹
4. Give 5 rescue breaths: seal your mouth over the baby's mouth and nose and blow steadily for about 1 second, enough to make the chest rise.¹
5. Start compressions on the lower half of the breastbone, then keep going with 30 compressions and 2 breaths. Rescuers trained in children's life support use 15 compressions to 2 breaths instead.¹

This guide follows the 2025 UK steps, which start with 5 breaths. American courses start with compressions. Both work; use whichever you were taught.

If you are alone with no phone, the UK guidance says to give CPR for 1 minute before you leave to get help.¹

How hard and fast should I press during baby CPR?

Press down by at least one third of the depth of the chest, at a speed of 100 to 120 pushes a minute.¹

That is roughly the beat of a fast song. Let the chest come all the way back up after each push. If you are not trained in children's life support, use 30 compressions to 2 breaths; trained rescuers use 15 to 2.¹

For a child over 1 year, press on the lower half of the breastbone with the heel of one hand, or with both hands, again to at least one third of the chest depth.¹

Do not be timid. A shallow push moves very little blood, so press firmly and keep the pauses short.

Is two-finger CPR still used for babies?

No. The 2025 American guidelines dropped the two-finger method because it often fails to push deep enough.²

Instead they recommend either the two-thumb method, with both hands wrapped around the chest, or the heel of one hand.^2,3 The UK guidance advises the two-thumb encircling method for babies.¹ If you learned two-finger CPR some years ago, it is worth doing a refresher course.

What if I don't want to give rescue breaths?

Give chest compressions anyway. Compressions alone are far better than doing nothing.

UK guidance says ambulance call handlers should encourage compression-only CPR when a bystander is not willing or able to give breaths.¹ My advice is simple: if you can give breaths, give them. If you cannot, push hard and fast until help comes.

What is the difference between gagging and choking?

Gagging is noisy and normal; choking is usually silent and dangerous. A gagging baby coughs, splutters and pushes food forward. A choking baby cannot make sound or breathe.

NHS weaning advice describes gagging as part of learning to eat. Signs include watery eyes, the tongue pushing forward and retching to bring food to the front of the mouth.⁴ Gagging is a reflex that protects the airway, so let your baby work through it. Do not pat the back or reach into the mouth while a baby is gagging.

Step in only if the noise stops, breathing stops or the colour changes. That is choking.

Does baby-led weaning make choking more likely?

Not when it is done with care. A New Zealand trial of 206 babies found no difference in choking between a modified baby-led approach and spoon feeding.⁵

In that trial, about 35% of all babies had at least one choking episode from 6 to 8 months of age, whatever the feeding style. Babies in the baby-led group gagged more at 6 months but less at 8 months.⁵ The worrying finding was that many families in both groups offered foods with a high choking risk.⁵

So the method matters less than the food you offer and whether you stay with your baby while they eat.

Which foods are choking hazards for babies and toddlers?

Small, round, hard or sticky foods are the main danger. Children aged 3 years or under are at the highest risk.⁶

The American Academy of Pediatrics names food, coins and toys as the main causes of choking injury in children.⁶ In a US study of emergency visits for food choking, hard sweets, other sweets, meat and bones were most often involved.⁷ Whole grapes fit a child's airway closely and have caused serious choking.⁸

Common risks in Indian homes:

• whole grapes and cherry tomatoes: cut into quarters⁴
• jamun, ber, litchi and other stone fruits: remove the stone or seed first,⁴ then chop the flesh small
• whole nuts and peanuts: NHS advice is no whole nuts under 5 years⁹
• roasted chana, popcorn and hard boiled sweets
• fish with bones and meat with small bones
• a spoonful of thick nut butter on its own⁹
• litchi, mango and jackfruit seeds left within reach

How can I make mealtimes safer for my baby?

Sit your baby upright and stay with them for the whole meal. NHS weaning advice says to always stay with your baby while they eat.⁴

• Sit them upright, in a high chair with the harness fastened.⁴ Dr Dutta also advises never feeding a baby lying down.
• Offer soft foods that squash between your fingers.
• Cut small round foods into quarters.⁴
• Do not let toddlers eat while running, laughing loudly, or in a moving car or auto.
• Do not force feed or pour liquids into the mouth of a crying child.
• Keep coins, small toys, button batteries and bottle caps out of reach.

Older siblings often share snacks like peanuts or chana with the baby. Explain to them, kindly, which foods are not for the little one.

When should I call an ambulance or go to hospital after choking?

Call for help at once if your child cannot breathe, cough or cry, or turns blue or floppy. Go to hospital the same day after any serious choking episode, even if the object came out.

• your child is not responding or is not breathing normally: call 112 and start CPR
• back blows or thrusts have not cleared the blockage
• you gave chest or tummy thrusts, even if it worked
• there is a lasting cough, wheeze, noisy breathing or drooling afterwards
• you think a piece may still be stuck, or a peanut or seed may have gone down the wrong way
• your child keeps coughing days later or gets a chest infection that does not clear

A small piece of food, especially a peanut, can slip into the lungs and cause a cough or pneumonia later. Tell the doctor about any choking episode, even if it happened weeks ago.