Choking

When a child is choking, it means that an object — usually food or a toy — is stuck in the trachea (the airway), keeping air from flowing normally into or out of the lungs, so the child can’t breathe properly.

The trachea is usually protected by a small flap of cartilage called the epiglottis . The trachea and the esophagus  share an opening at the back of the throat, and the epiglottis acts like a lid, snapping shut over the trachea each time a person swallows. It allows food to pass down the esophagus and prevents it from going down the trachea.

But every once in a while, the epiglottis doesn’t close fast enough and an object can slip into the trachea. This is what happens when something goes “down the wrong pipe.”

Most of the time, the food or object only partially blocks the trachea, is coughed up, and breathing returns to normal quickly. Kids who seem to be choking and coughing but still can breathe and talk usually recover without help. It can be uncomfortable and upsetting for them, but they’re generally fine after a few seconds.

Choking Can Be an Emergency

Sometimes, an object can get into the trachea and completely block the airway. If airflow into and out of the lungs is blocked and the brain is deprived of oxygen, choking can become a life-threatening emergency.

A child may be choking and need help right away if he or she:

• is unable to breathe
• is gasping or wheezing
• can’t talk, cry, or make noise
• turns blue
• grabs at his or her throat or waves arms
• appears panicked
• becomes limp or unconscious

In those cases, immediately start abdominal thrusts (also known as the Heimlich maneuver), the standard rescue procedure for choking, if you’ve been trained to do so.

Abdominal Thrusts (The Heimlich Maneuver)

If you have kids, it’s important to get trained in both cardiopulmonary resuscitation (CPR) and the technique of abdominal thrusts (the Heimlich maneuver). Even if you don’t have kids, knowing how to perform these first-aid procedures will let you help if you’re ever in a situation where someone is choking.

The idea of abdominal thrusts is that a sudden burst of air forced upward through the trachea from the diaphragm will dislodge a foreign object and send it flying up into (or even out of) the mouth.

Though the technique is pretty simple, abdominal thrusts must be done with caution, especially on young children. They are safest when done by someone trained to do them. If done the wrong way, the choking person — especially a baby or child — could be hurt. There’s a special version of abdominal thrusts just for infants that is designed to lower the risk of injury to their small bodies.

The technique of abdominal thrusts and CPR are usually taught as part of basic first-aid courses, which are offered by YMCAs, hospitals, and local chapters of the American Heart Association (AHA) and the American Red Cross.

What to Do

Call 911 for any critical choking situation.

Here are several possible situations you might face and tips on how to handle them:

• If a child is choking and coughing but can breathe and talk, this means the airway is not completely blocked. It’s best to do nothing but watch the child carefully and make sure he or she recovers completely. The child will likely be fine after a good coughing spell. Don’t reach into the mouth to grab the object or even pat the child on the back. Either of these steps could push the object farther down the airway and make the situation worse. Stay with the child and remain calm until the episode passes.
• If a child is conscious but can’t breathe, talk, or make noise, or is turning blue, the situation calls for abdominal thrusts. Call 911 or tell someone nearby to call 911 immediately. Begin the thrusts if you’ve been trained to do so. If you haven’t been trained, and no one else is available who has been, wait until help arrives.
• If the child was choking and is now unconscious and no longer breathing, shout for help and call 911, or tell someone nearby to call 911 immediately. Then proceed immediately to CPR, if you’ve been trained in it. If you have not been trained, and no one else is available who has been, wait until help arrives.

When to Call the Doctor or Go to the ER

Take your child for emergency medical care after any major choking episode.

Also seek emergency medical care for a child if:

• there is a lasting cough, drooling, gagging, wheezing, difficulty swallowing, or difficulty breathing
• the child turned blue, became limp, or was unconscious during the episode, even if he or she seemed to recover
• you think the child has swallowed an object, such as a toy or battery

If your child had an episode that seemed like choking but fully recovered after a coughing spell, there is no need to seek immediate medical care but you should call your doctor.

Preventing Choking

All kids are at risk for choking, but those younger than 3 are especially vulnerable. Young children tend to put things in their mouths, have smaller airways that are easily blocked, and don’t have a lot of experience chewing so often swallow things whole.

You can help minimize the risks of choking:

• Avoid foods that pose choking risks (like hot dogs, grapes, raw carrots, nuts, raisins, hard or gummy candy, spoonfuls of peanut butter, chunks of meat or cheese, and popcorn), which are a similar size and shape as a child’s airway.
• At mealtime, be sure to serve a child’s food in small, manageable bites. That means cutting whole grapes into quarters, cutting hot dogs lengthwise and into pieces (and remove the tough skin), and cooking vegetables rather than serving them raw. Teach kids to sit down for all meals and snacks and not to talk or laugh with food in their mouths.
• Toys and household items also can be choking hazards — beware of deflated balloons, coins, beads, small toy parts, and batteries. Get down on the floor often to check for objects that kids who are learning to walk or crawl could put in their mouths and choke on. You’d be surprised by the things that routinely fall off counters or out of pockets and end up under furniture, behind curtains, etc.
• Choose safe, age-appropriate toys. Always follow the manufacturer’s age recommendations — some toys have small parts that can cause choking. To determine if a toy is too small, see if it passes easily through an empty cardboard toilet paper tube. If it does, it’s too small. Any object smaller than the size of a golf ball has the potential to enter the mouth and block the airway.

Take the time now to become prepared. CPR and first-aid courses are a must for parents, other caregivers, and babysitters. To find one in your area, contact your local American Red Cross, YMCA, or American Heart Association chapter, or check with hospitals and health departments in your community.