Choking First Aid for Adults, Children and Infants: Back Blows, Abdominal Thrusts and What to Do Next

Quick answer: if an adult or child over 1 cannot cough, speak or breathe, the American Red Cross teaches “five-and-five”: give 5 firm back blows between the shoulder blades with the heel of your hand, then 5 quick abdominal thrusts just above the navel, and keep alternating until the object comes out, the person can breathe or cough forcefully, or they become unresponsive. For infants under 1, use 5 back blows and 5 chest thrusts with two fingers, never abdominal thrusts. Call 911, and if the person becomes unresponsive, begin CPR.

Choking happens when food or an object blocks the airway. A completely blocked airway stops oxygen from reaching the brain, and the person can lose consciousness within minutes. Because help may not arrive in time, the people nearby are the ones who make the difference.

This guide follows training guidance from the American Red Cross, with prevention advice from the American Academy of Pediatrics (AAP) and the U.S. Consumer Product Safety Commission (CPSC). It is part of our apartment emergency preparedness guide. Reading is not a substitute for hands-on training, and a first aid and CPR class lets you practice these skills safely.

Sources: American Red Cross, choking first aid steps for adults, children and infants and First Aid/CPR/AED participant materials; American Heart Association first aid and CPR guidance; American Academy of Pediatrics, HealthyChildren.org choking prevention guidance; U.S. Consumer Product Safety Commission, small parts regulations for children under 3; National Capital Poison Center, button battery guidance. Checked October 2026.

How to Recognize Choking

Someone with a partially blocked airway may still be able to cough forcefully and breathe. Someone with a severely blocked airway cannot. Signs of choking described in Red Cross training include:

• Clutching the throat with one or both hands, often called the universal sign of choking
• Inability to speak, cry or breathe
• A weak or ineffective cough
• High-pitched noises or no sound while trying to breathe
• Skin, lips or nails turning bluish or gray
• Panic, then loss of consciousness if the blockage is not cleared

If they can cough forcefully

A strong cough is the body’s best tool. If the person is coughing forcefully, encourage them to keep coughing. Stay with them and be ready to act if the cough becomes weak or stops.

Ask first

Ask, “Are you choking? Can I help?” A choking person will often nod. For a child, get permission from a parent or guardian if one is present. If the person cannot respond and the situation is urgent, act.

Adults and Children Over 1: Five-and-Five

The Red Cross method for a conscious adult or child who cannot cough, speak or breathe is to alternate back blows and abdominal thrusts.

Step 1: Call for help

Have someone call 911 right away. If you are alone with the person, begin first aid first and call when you can. Putting the phone on speaker while you work is helpful.

Step 2: Give 5 back blows

1. Stand slightly behind the person. For a child, you may need to kneel.
2. Support their chest with one arm and lean them forward at the waist.
3. Strike firmly between the shoulder blades with the heel of your other hand, 5 times.

Each blow should be a separate, forceful attempt to dislodge the object.

Step 3: Give 5 abdominal thrusts

1. Stand behind the person and wrap your arms around their waist.
2. Make a fist and place the thumb side just above the navel, well below the breastbone.
3. Grab your fist with your other hand.
4. Give quick, upward thrusts into the abdomen, 5 times.

Abdominal thrusts are widely known as the Heimlich maneuver.

Step 4: Keep alternating

Continue cycles of 5 back blows and 5 abdominal thrusts until:

• The object is forced out,
• The person can breathe or cough forcefully, or
• The person becomes unresponsive.

If the Person Becomes Unresponsive

If the person collapses, carefully lower them to the floor. Make sure 911 has been called, and begin CPR.

Red Cross training teaches responders to look in the mouth before giving rescue breaths and to remove an object only if they can see it. Never do a blind finger sweep, which can push an object deeper.

If you are not trained in rescue breaths, chest compressions alone still help. Our guide to hands-only CPR and AED basics explains how to give compressions and use an AED.

Infants Under 1 Year: Back Blows and Chest Thrusts

Infants need a different technique. Abdominal thrusts are not used on babies under 1 because they could injure internal organs.

Back blows

1. Lay the baby face down along your forearm, supporting the head and jaw with your hand. Keep the head lower than the chest.
2. Rest your forearm on your thigh for support.
3. Give 5 firm back blows between the shoulder blades with the heel of your hand.

Chest thrusts

1. Turn the baby face up, supporting the head, and keep the head lower than the chest.
2. Place two fingers in the center of the chest, just below the nipple line.
3. Give 5 quick chest thrusts, pushing down about 1.5 inches.

Keep going

Alternate 5 back blows and 5 chest thrusts until the object comes out, the baby can breathe, cough or cry forcefully, or the baby becomes unresponsive. If the baby becomes unresponsive, call 911 if no one has, and start infant CPR.

Special Situations

Pregnant or larger people

When you cannot reach around the person’s abdomen, or the person is in later pregnancy, Red Cross training calls for chest thrusts instead of abdominal thrusts. Place your fist against the center of the breastbone and pull straight back with quick thrusts.

Wheelchair users

For someone in a wheelchair, lock the wheels and give abdominal thrusts from behind if you can reach. If the chair’s back is in the way, follow the method taught in your training class, and call 911.

If you are choking and alone

Call 911 if you can, even if you cannot speak; dispatchers may still be able to trace the call or hear what is happening. Then give yourself abdominal thrusts:

1. Make a fist and place it just above your navel.
2. Grab it with your other hand and thrust inward and upward.
3. Or lean over a firm object, such as the back of a chair or a countertop edge, and press your upper abdomen against it forcefully.

Repeat until the object comes out.

After a Choking Episode

Even when first aid works, follow-up matters. Abdominal and chest thrusts can cause injuries, and part of an object may still be in the airway. The Red Cross advises that the person be checked by a medical professional after receiving abdominal thrusts. Seek care right away for persistent coughing, trouble breathing, wheezing, difficulty swallowing or pain.

Preventing Choking at Home

Young children

The AAP notes that young children are at high risk because their airways are small and they are still learning to chew. Its guidance for children under 4 includes avoiding or carefully preparing foods such as:

• Hot dogs, which should be cut lengthwise and into small pieces
• Whole grapes and cherry tomatoes, which should be cut into small pieces
• Nuts and seeds
• Popcorn
• Hard or sticky candy, gum and marshmallows
• Chunks of meat or cheese
• Spoonfuls of nut butter

Children should sit while eating, with an adult watching, and should not eat while running, playing or riding in a car.

Small parts and toys

The CPSC bans toys and products with small parts intended for children under 3. Older siblings’ toys, coins, magnets, balloons and small household items still find their way into little hands. Balloons are a particular concern; uninflated balloons and broken pieces can block a child’s airway.

Button batteries

Button batteries are a choking hazard and also a serious internal burn hazard if swallowed. The National Capital Poison Center advises going to the emergency room immediately if a child swallows one, and its Button Battery Ingestion Hotline is available at 800-498-8666. Keep devices with button batteries secured and store spare batteries out of reach.

Adults

Adult choking often involves food. Practical habits include:

• Cutting food into small pieces
• Chewing slowly and thoroughly
• Avoiding talking or laughing with food in your mouth
• Being careful with alcohol during meals, which can dull swallowing reflexes
• Watching older adults and people with swallowing difficulties during meals

Choking or Something Else?

Several emergencies can look like choking at first glance, and the right response differs:

• Severe allergic reaction (anaphylaxis). Swelling of the lips, tongue or throat, hives and trouble breathing after eating can signal anaphylaxis rather than a blockage. Call 911 and help the person use their epinephrine auto-injector if they have one.
• Heart attack or cardiac arrest. A person who collapses suddenly while eating may be having a cardiac event. If they are unresponsive and not breathing normally, call 911 and start CPR either way.
• Asthma attack. Wheezing and difficulty breathing without food or an object involved points to asthma. Help the person use their inhaler and call 911 if breathing does not improve.
• Seizure. Never put anything in the mouth of a person having a seizure. Time it, protect their head and call 911 if it lasts more than five minutes.

When in doubt, call 911 and describe exactly what you see. Dispatchers are trained to coach callers through first aid.

Older Adults and Swallowing Problems

Older adults face a higher risk of choking, especially those who have had a stroke or live with conditions such as Parkinson’s disease or dementia that affect swallowing. Difficulty swallowing is called dysphagia. Signs include coughing or throat clearing during meals, a wet or gurgly voice after eating and food left in the mouth.

If you notice these signs in a family member, talk with their doctor. A speech-language pathologist can evaluate swallowing and may recommend specific food textures, thickened liquids or eating positions. Sitting upright during meals and for a while afterward, eating slowly and avoiding distractions all help.

Choking in Public Places

Restaurants and cafeterias are common places for adult choking. Embarrassment sometimes leads a choking person to leave the table for the restroom, where no one can help. If you are with someone who suddenly stops talking and gets up in distress, follow them and ask if they are choking. Staying in sight of others gives the best chance that someone can step in quickly.

Get Trained

The Red Cross, American Heart Association and many local fire departments and hospitals offer first aid and CPR courses, including classes focused on infants and children. Hands-on practice with manikins builds confidence that reading alone cannot. Many courses take just a few hours.

Keep a printed choking chart on the refrigerator, especially in homes with babies and toddlers, and stock a first aid kit for a small apartment for the injuries that do not require 911.

Quick Reference

Who	First aid
Adult or child over 1, conscious	5 back blows, then 5 abdominal thrusts, repeat
Pregnant or larger person	5 back blows, then chest thrusts
Infant under 1	5 back blows, then 5 chest thrusts with two fingers
Anyone who becomes unresponsive	Call 911 and begin CPR
Yourself, alone	Abdominal thrusts with your fist or against a chair back

Frequently Asked Questions

Should I slap someone on the back if they are coughing?

No. If a person can cough forcefully, encourage them to keep coughing. Back blows are for people who cannot cough, speak or breathe.

Can I do abdominal thrusts on a baby?

No. Infants under 1 should get back blows and chest thrusts, not abdominal thrusts.

What if I cannot see the object?

Never do a blind finger sweep. Remove an object only if you can see it in the mouth.

Do I still need a doctor if the object comes out?

The Red Cross advises a medical check after abdominal thrusts, since they can cause injury. Seek care for ongoing coughing, trouble breathing or pain.

How do I help myself if I am choking alone?

Give yourself abdominal thrusts with your fist or by pressing your upper abdomen against the back of a chair or a countertop.

The Bottom Line

Recognize choking quickly, call 911, and alternate 5 back blows with 5 abdominal thrusts for adults and children, or 5 back blows with 5 chest thrusts for infants. Start CPR if the person becomes unresponsive, get a medical check afterward and take a hands-on class so you are ready.