Infant CPR and Choking First Aid for Babies Under One Year: Step-by-Step Guide

Quick answer: for a choking baby under one year old who cannot cry, cough or breathe, lay the baby face down along your forearm, give up to five firm back blows between the shoulder blades, then turn the baby over and give up to five chest thrusts with two fingers, and repeat until the object comes out or the baby becomes unresponsive. If the baby is unresponsive and not breathing normally, call 911 and start infant CPR: 30 compressions with two fingers at the center of the chest, about one-third the depth of the chest and 100 to 120 per minute, then two gentle breaths. Take a hands-on class to practice, because reading is not enough.

Few moments are more frightening for a parent or caregiver than seeing a baby stop breathing. The good news is that the steps for infants are simple, and they can be learned in an afternoon. The steps differ from those for older children and adults because babies are small, and a few details matter, such as where to place your fingers and how hard to press. This article is part of our emergency first aid guide for city households. It describes the standard approach taught by the American Red Cross and the American Heart Association, and it is not a substitute for a certified class.

Sources: American Red Cross infant choking and CPR guidance; American Heart Association (AHA) CPR and first aid guidelines for infants; American Academy of Pediatrics (AAP) HealthyChildren.org guidance on choking prevention; Centers for Disease Control and Prevention (CDC) information on choking hazards. This article is general information and does not replace training from a certified instructor or the instructions of a 911 dispatcher.

Who This Guide Covers

Infant techniques apply to babies under one year old. Children older than one year follow child techniques, and adults follow adult techniques. If you care for a baby in an apartment, a child care setting or a relative’s home, learn the infant steps and keep them posted where you can see them. Our guide on choking first aid for adults and children covers older age groups.

Choking or Something Else?

Babies make plenty of noise when they gag, cough or splutter, and a baby who is coughing forcefully is usually moving air. Do not hit the back of a baby who is coughing, crying or breathing, because that can push an object farther down. Let the baby cough.

Signs of severe choking in an infant

• The baby cannot cry or make any sound, or the cry is weak and silent
• A cough that is weak or has no sound
• Difficulty breathing, with high-pitched noises or no noise at all
• Skin, lips or nails turning blue or gray
• Panic, wide eyes or sudden limpness

If you see these signs, act at once.

What to Do for a Choking Infant

Follow these steps. If another person is with you, ask them to call 911 while you start. If you are alone, give the steps for about two minutes and then call 911 if the object has not come out, using speakerphone if you can.

Step 1: Give five back blows

1. Sit or kneel, and place the baby face down along your forearm, with the baby’s chest resting on your hand and your thumb and fingers supporting the jaw. Do not press on the throat.
2. Rest your forearm on your thigh for support, and keep the head lower than the chest.
3. Use the heel of your other hand to deliver up to five firm back blows between the baby’s shoulder blades.

Step 2: Give five chest thrusts

1. Place your free hand on the back of the baby’s head and neck, and sandwich the baby between your two forearms.
2. Turn the baby over onto the other forearm, face up, with the head lower than the chest.
3. Place two fingers in the center of the baby’s chest, just below the nipple line.
4. Push straight down about one-third the depth of the chest, which is about 1.5 inches (4 cm), up to five times.

Step 3: Repeat

Continue alternating five back blows and five chest thrusts until:

• The object comes out and the baby can breathe, cough or cry
• The baby becomes unresponsive
• Emergency responders arrive and take over

Important rules

• Do not use abdominal thrusts (the Heimlich maneuver) on babies under one year old.
• Do not do blind finger sweeps. Only remove an object you can see and easily reach, because poking around can push it deeper.
• Do not hang the baby upside down or shake the baby.
• Always call 911 if the baby was choking and needed these steps, even if the object comes out. The baby should be checked by a doctor.

What to Do If the Baby Becomes Unresponsive

If the baby stops responding, lay the baby on a firm, flat surface, such as the floor, and begin CPR. If you have not yet called 911, call now or have someone else do it. Each time you open the baby’s airway to give breaths, look in the mouth for an object, and remove it only if you can see it.

Infant CPR: Step-by-Step

CPR stands for cardiopulmonary resuscitation. It uses chest compressions and rescue breaths to keep blood and oxygen moving until help arrives.

Step 1: Check responsiveness and breathing

• Tap the bottom of the baby’s foot and shout the baby’s name.
• Look at the chest for no more than 10 seconds. If the baby is not breathing, or is only gasping, begin CPR.

Step 2: Call 911

• With a helper present, send that person to call 911 and to bring an automated external defibrillator (AED) if one is nearby.
• When you are alone with a phone, put it on speaker and call. With no phone, give about two minutes of CPR and then go call. Our guide on how to call 911 and what to say explains what dispatchers will ask.

Step 3: Give 30 compressions

• Place the baby on a firm, flat surface.
• Place two fingers of one hand in the center of the chest, just below the nipple line.
• Push down about one-third the depth of the chest, about 1.5 inches (4 cm).
• Compress at a rate of 100 to 120 per minute, about the pace of many popular songs.
• Let the chest rise fully between compressions.
• Count out loud to keep the pace.

If two rescuers are present and trained, they can use the two-thumb encircling-hands technique, where both thumbs press the chest while the fingers wrap around the baby’s ribs. Two trained rescuers use a ratio of 15 compressions to two breaths.

Step 4: Give two rescue breaths

• Tilt the head gently into a neutral position, with the chin slightly lifted. Do not tilt the head back far, because a baby’s airway is small and can close.
• Cover the baby’s mouth and nose with your mouth, or use a barrier device if you have one.
• Give one breath over about one second, watching for the chest to rise. Use only the amount of air that is in your cheeks, because the baby’s lungs are small.
• Give a second breath.
• If the chest does not rise, reposition the head and try again once, and then go back to compressions.

Step 5: Keep going

Continue cycles of 30 compressions and two breaths until:

• The baby starts to breathe or move
• An AED is ready to use
• Emergency responders take over
• You are too exhausted to continue and no one can relieve you

Why Hands-Only CPR Is Not Recommended for Babies

Hands-only CPR works well for teens and adults who collapse suddenly, because sudden collapse in adults is usually caused by a heart problem. Infants and young children more often stop breathing because of choking, drowning or other breathing problems, so they need rescue breaths along with compressions. If you are unwilling or unable to give breaths, compressions alone are better than doing nothing, but breaths are part of the standard approach for infants. Our guide on hands-only CPR and AED basics explains the adult technique.

Using an AED on an Infant

An AED is a device that analyzes the heart rhythm and can deliver a shock when needed. If an AED is available:

• Turn it on and follow the voice prompts.
• Use infant or pediatric pads and a pediatric dose attenuator if the device has them, for babies under one year old.
• If pediatric pads are not available, use adult pads rather than waiting. Place them so they do not touch each other, usually one on the front of the chest and one on the back.
• Do not touch the baby while the device analyzes or delivers a shock.
• Resume CPR right after the shock, unless the machine instructs otherwise.

After the Emergency

• Stay with the baby and keep the baby warm.
• Tell the 911 operator and paramedics what happened, what you did and how long the baby was unresponsive.
• Let paramedics decide whether the baby should go to the hospital. After choking or CPR, a medical evaluation is necessary, even if the baby seems fine.
• Take care of yourself afterward. It is normal to feel shaky, upset or guilty. Talk with a doctor, counselor or trusted friend if you need support.

Preventing Choking in Babies and Toddlers

Most choking can be prevented. The AAP and CDC recommend these steps:

Safe feeding

• Always supervise a baby who is eating, and keep the baby seated.
• Cut food into small pieces, and cook foods until soft.
• Avoid foods that are common choking hazards for children under four: whole grapes, hot dogs, nuts, hard candy, popcorn, raw carrots, chunks of meat, chunks of cheese and spoonfuls of peanut butter.
• Cut round foods such as grapes, cherry tomatoes and hot dogs lengthwise into quarters.
• Do not feed a baby in a car, because it is harder to notice a problem.

Safe play

• Keep coins, buttons, small magnets, button batteries, marbles, balloons and small toy parts out of reach.
• Check toys for loose parts, and follow age labels.
• Remove pillows, bumpers and soft items from the crib, which also supports safe sleep. See our guide on building a first aid kit for a small apartment for items that suit a home with a baby.

Safe home

• Keep a clear area around cribs and play spaces, and crawl around on the floor to look for small objects.
• Keep older siblings’ toys with small pieces separate from the baby.
• Make sure all caregivers know the steps, including grandparents and babysitters.

Learn the Skills in a Class

Reading is a good start, but hands-on practice builds confidence and muscle memory. Look for classes taught by certified instructors:

• American Red Cross: offers infant and child CPR and first aid courses, including in-person and blended formats.
• American Heart Association: offers CPR and first aid courses for the public and for child care providers.
• Hospitals and fire departments: many offer low-cost or free classes for parents and caregivers.
• Child care and parenting groups: some arrange group classes for members.

A class uses a manikin sized like an infant, so you can feel the right depth and rhythm. Review your skills every one or two years, because guidelines are updated and skills fade without practice.

Quick Reference Card

Print or copy this short list and keep it where you will see it.

• Choking, cannot cry or breathe: five back blows, five chest thrusts, repeat.
• Unresponsive and not breathing normally: call 911, start CPR.
• CPR: two fingers, center of the chest, one-third depth, 100 to 120 per minute, 30 compressions then two breaths.
• No abdominal thrusts for babies under one year old.
• Always get medical care after a choking episode or CPR.

Planning for Apartment Living

In an apartment, a few extra steps can save time in an emergency.

• Know your building’s street address, unit number and entry instructions, and have them ready to tell the dispatcher.
• Ask neighbors or the building manager whether the building has an AED in the lobby or fitness room.
• If you live in a building with an elevator or buzzer system, ask a neighbor to hold the door for responders, or send someone to meet them.
• Keep your phone charged and within reach.
• Post the emergency number and poison control number, which is 1-800-222-1222, near the phone.

Frequently Asked Questions

Do you use abdominal thrusts on a choking baby?

No. For babies under one year old, use back blows and chest thrusts. Abdominal thrusts can injure an infant.

How deep should infant CPR compressions be?

Push down about one-third the depth of the chest, which is roughly 1.5 inches (4 cm), at a rate of 100 to 120 compressions per minute.

Should I call 911 before starting CPR on a baby?

With a helper nearby, have that person call while you start. Alone with a phone, call and use speaker mode. Alone without a phone, give about two minutes of CPR before going to call.

Can I do hands-only CPR on a baby?

Babies usually need rescue breaths because their emergencies are often breathing-related. If you cannot give breaths, compressions are better than nothing.

When should a baby who choked see a doctor?

Always. Even if the object comes out and the baby seems fine, call 911 or seek immediate medical evaluation after severe choking or CPR.