What to do if a child is choking

A child who is choking badly cannot make noise. That is the part people get wrong: the frightening cases are quiet.

If a child is coughing loudly, the airway is not fully blocked. The NHS advice is to encourage them to keep coughing and stay with them. Coughing is more effective than anything you can do with your hands.

If the cough is silent or weak, if they cannot cry or breathe, if they are going blue or clutching their throat — the blockage is complete, and you act.

Under one year old

Babies get back blows and chest thrusts. Never abdominal thrusts.

1. Lay the baby face down along your forearm or thigh, supporting the head and jaw, with the head lower than the body.
2. Give up to five sharp back blows between the shoulder blades with the heel of your hand. Check after each one to see whether the object has come out.
3. If it has not, turn the baby face up along your other forearm or thigh, still with the head lower than the chest.
4. Place two fingers in the middle of the chest, just below the nipple line, and give up to five sharp chest thrusts. The Red Cross describes these as about an inch and a half deep. Check after each one.
5. Repeat the cycle until the object comes out, the baby coughs or cries, or they become unresponsive.

If the baby becomes unresponsive, the Red Cross says to lower them onto a firm surface and begin CPR, starting with compressions. Look in the mouth before rescue breaths, and remove an object only if you can see it.

Over one year old

Children get back blows and abdominal thrusts.

1. If they are small, lay them face down across your lap. Otherwise support them leaning forward from behind.
2. Give up to five back blows between the shoulder blades with the heel of your hand, checking after each.
3. If that does not work, stand or kneel behind them and put your arms under theirs, around the upper abdomen.
4. Make a fist and place it between the navel and the ribs. Grasp it with your other hand and pull sharply inwards and upwards, up to five times, checking after each.
5. The NHS is explicit: do not apply pressure to the lower ribcage.
6. Repeat the cycle. Call 999 if the blockage has not cleared.

What not to do

Do not put your fingers in blindly. The NHS says not to poke blindly or repeatedly, because it pushes the object further down. Remove something only if you can see it and can hook it out.

Do not use abdominal thrusts on a baby under one. Both organisations are clear on this. Babies get chest thrusts.

Do not skip the ambulance because it worked. Abdominal thrusts can cause internal injury. The NHS advises medical assessment afterwards.

Where the two guidelines differ

The NHS and Red Cross agree on the substance — back blows first, chest thrusts for babies, abdominal thrusts for children, no blind sweeps. They word the timing of the call differently.

The Red Cross says to call as soon as you recognise a complete blockage. The NHS says to call if the obstruction is still there after a round of back blows and thrusts.

If anyone else is in the room, this is not a choice you have to make: send them to phone while you work.