Babies are notorious explorers who like to experience the new world by putting various objects into their mouths. This is how a happy play date can turn into a horror show for the unsuspecting parent: babies love to put different items such as peanuts, seeds, small pieces of toys, buttons and especially coins inside their mouths and these objects can seldom get stuck into their airways, causing them to start choking. Foreign object obstruction of the airway happens rather suddenly with the onset of sudden respiratory distress, marked with coughing, gagging or a harsh, vibrating noise while breathing known as stridor. This is why everybody, not only the parents, must be educated to administer appropriate first aid help. Contact your local Red Cross organisation and get a proper training before you encounter a serious situation, such as having a baby that is choking.
In the meantime, follow these advices so you can familiarise yourself better with the steps you should take when faced with this problem.
It is crucial that you remain calm at all times so you can properly assess the situation. Seeing someone choke is a stressful event, but it will only worsen the situation if you start panicking; so stay calm, yet be alerted. Is the child showing signs of coughing? If so, is the cough strong and loud? If the child is aware and able to breathe before coughing, showing signs such as crying and is able to have a verbal response to the questions you might ask, encouraging the spontaneous cough is sufficient enough at the time. Continue to check if the situation deteriorates to an ineffective cough or until the child coughs up the foreign object, thus relieving the obstructed airway.
However, should you see a child that is conscious, yet obviously gasping for air, having an ineffective, weak and silent cough; proceed by rapidly and confidently placing 5 back blows or 5 abdominal thrusts, when the child is older than 1 year.
Back blows for infants, babies younger than 1 year old and small children:
- These blows are found to be more effective when the child is positioned head down, so it might be easier for you to place the child across your lap as you are sitting or kneeling. Support the child’s head by placing the thumb of one hand near the angle of their lower jaw and one or two fingers from the same hand on the similar spot on the opposite side of the jaw, all by making sure you are not squeezing the child’s head, as this will only aggravate the situation.
- With the heel of your other free hand, deliver 5 sharp and distinct blows right to the middle of the back between the child’s shoulder blades. Remember, the point is to help relieve the obstruction with each blow, rather than deliver 5 consecutive blows. Should the blows fail to force out the foreign body, use chest thrusts for infants. Remember never to use abdominal thrusts, commonly known as Heimlich manoeuvre in infants and small children, as they can cause massive injury to the infant.
Back blows for older children
- Place the child in a similar position as with the position of a baby younger than a year. Support the child’s head by holding near the angles of the lower jaw, yet do not compress them. If you find it impossible to hold the child across your lap, support the child in a position leaning forward and proceed by delivering 5 sharp blows right at the middle of the back with the heel of your other hand. If these back blows do not dislodge the foreign object and the child is still conscious, switch to abdominal thrusts.
Chest thrusts for infants, babies younger than 1 year old and small children:
- While you are holding the child downwards, safely across your lap (or down your thigh), turn the child with the head facing you, referred as supine position. Support the child by positioning your free arm along the child’s back and holding the head with your hand.
- Look for the landmark for chest compressions, which is approximately a finger’s breadth above the lower end of the breastbone.
- Execute the 5 chest thrusts by using only 2 fingers of your other hand. The thrusts should be sharper and delivered at a slower rate than when giving chest compressions.
Abdominal thrusts for older children:
- While kneeling or standing behind the child, place your arms under the child’s arms, as if you are hugging the child from behind.
- Clench your fist and place it in the area between the lower edge of the child’s breastbone and the belly button.
- Grasp your fist with the other hand and sharply pull inwards and upwards, repeating this manoeuvre up to 5 times. Ensure that the pressure is not put on the child’s rib cage or the lower part of the child’s breastbone, as it may result in abdominal trauma.
Should the object not be expelled after the series of thrusts and back blows, continue with the appropriate sequence and do not abandon the child at this moment: call out or send for help, if help was not available up until now. If the item was successfully dislodged, continue by assessing the child and seek medical assistance should you have any doubts.
However, if the child is unconscious, immediately send for help and proceed by laying the child on the ground and opening the child’s mouth to look for the obvious obstruction. If you manage to see and locate it, try to take it out with a single sweep of your finger. Do not try to pull a blind sweep or repeated finger sweeps as these actions might push the foreign body deeper into the child’s airways. Tilt the child’s head backwards, slightly lifting the chin with your other hand and give 5 rescue breaths. Ensure that the breaths are given properly: cover the infant’s mouth and nose with your own mouth.
Alternatively, lightly pinch the nose of the child with two fingers of your one hand while performing the mouth to mouth rescue breaths. It is important that you notice that each breath makes the child’s chest rise. If not, reposition the head before you make your next attempt. There is no need to worry about the foreign item at this point: maintaining a proper breathing and circulation is far more important and by performing the rescue breaths you will administer oxygen despite the obstruction.
Proceed by doing chest compressions. Grasp the lower chest of the child with your hands so that you can position your thumbs just above the child’s breastbone when dealing with infants and little children. Locate the lower half of the breastbone, with the tips of your thumbs pointing towards the head of the child, and support the back of the child with the rest of your fingers. Begin pushing to about 4 cm of the chest wall. Each set of 15 compressions should be followed by giving 2 effective breaths as well, each breath taking up to a second.
For an older child, proceed by doing compressions by placing the heel of your one hand above the lower half of the child’s breastbone, positioning yourself just above the child’s chest; and with maintaining your arm absolutely straight, compress the chest wall to at least 5 cm. If the child is larger, you might want to have both of your hands laced together. Ensure you are not pushing onto the child’s rib cage, but on the lower half of the breastbone! The same cycle of 15:2 compressions and rescue breaths should be maintained.
Do not stop with the CPR until the child starts to wake up, moves, and opens eyes and starts breathing normally or healthcare workers arrive at the scene so they can assist or take over.
Make sure you know what to do by enrolling on a First Aid course! Contact your local Red Cross organisation for more in-depth information.