Pediatrics

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Choking Dangers

Choking occurs when something blocks the airway. When the airway is completely blocked, the child cannot breathe. Choking can be a frightening emergency. If you act quickly, you can help the child breathe.

Partial Blockage

If the child can speak or cough loudly, the airway is not completely blocked. You should NOT try to open the airway. If you are worried about the child's breathing, call 9-1-1.

If you determine there is blockage:

  • shout for help
  • begin the first aid techniques below
  1. Find out if the child can breathe, cry, or speak. See if the child has a strong cough. (A strong cough means there is little or no blockage and a child may dislodge the item if there is blockage.) If you think a child is choking, ask the child "are you choking?" If the child nods, ask "can you speak?" If the child can't speak, cough loudly, or cry, tell the child you are going to help.
  2. DO NOT start first aid if there is a strong cough or if there is little or no blockage. This can turn a partial blockage into a complete blockage. If the child is coughing, crying, or speaking, DO NOT do anything but call your doctor for further advice.

Complete Blockage

Signs of choking in the child with a complete airway blockage:

  • inability to breathe at all
  • weak cough and a loss of color
  • sudden cough, gag or high-pitched noisy breathing
  • demonstrate the choking sign (holding the neck with one or both hands)
  • bluish lips or skin
If you determine there is blockage:

  • shout for help
  • begin the first aid techniques below

For Infants Younger Than 1 Year Old

  1. Support the head and neck in your hand and place the infant’s face and head down on your forearm with the infant’s head lower than his or her trunk. Rest your forearm on your thigh to support the infant.
  2. With the heel of your other hand, give up to five back blows forcefully between the infant’s shoulder blades.
  3. If the blockage is not relieved, turn the infant over while supporting the head and neck with your hand with the infant face-up on your forearm. Give up to five quick, downward chest thrusts with your middle and ring fingers near the center of the breastbone.
    • NOTE: If the infant is large, you may want to lay the child over your lap
  4. Firmly support the head, holding it lower than the trunk. Repeat steps 1, 2, and 3 until the object is coughed up, or until the infant is able to breathe or becomes unconscious.
  5. If the infant becomes unresponsive or is found unresponsive, place infant face up. Lift jaw and tongue. This is called the jaw lift. It draws the tongue away from the back of the throat and may help clear the airway. If a foreign object is seen, sweep it out with your finger. NEVER poke the finger blindly straight into the throat. Only try a finger sweep if you can actually see the object. Otherwise, you may cause further blockage.
  6. If the infant does not begin to breathe right away, tilt his or her head back and place your mouth over the mouth and nose of the infant. Attempt two slow breaths to see whether the chest will rise, which would mean that the blockage has been relieved.
  7. If the chest does not rise, tilt the head again and repeat the two rescue breaths. If the chest still does not rise, then the blockage still has not been relieved.
  8. Again, give up to five back blows and chest thrusts as in steps 1-3.
  9. Perform the jaw lift and look for the foreign object. If you see it, sweep it out with your finger. Repeat steps 5 through 8 until the object is coughed up, or until rescue breathing is successful.
  10. After performing these steps for 1 minute, you can break and call for an ambulance. If the child is small, you may want to carry him or her to the phone and continue rescue breathing while calling for help. You should have the phone number for emergency medical services (EMS) by your phone.

For Children Older Than 1 Year

When a child is choking and can't breathe or speak, you MUST give abdominal thrusts (the Heimlich maneuver). The Heimlich maneuver pushes air from the child's lungs which helps to remove the blocking object. You should give abdominal thrusts until the object is forced out or the victim becomes unresponsive.

If the child is coughing, crying, or speaking, DO NOT do any of the following, but call your doctor for further advice. Begin the following if the child is choking and is unable to breathe.

  1. Stand behind the child with your arms around the chest, just below the child’s armpits.
  2. Place your fist with the thumb against the middle of the child’s abdomen, just above the navel. Grasp your fist with your other hand.
  3. Give up to five quick upward thrusts without touching the bones in the chest. Continue thrusts until the object is coughed up, or until the child is able to breathe or becomes unconscious.
  4. Make sure you or someone you know has called for emergency medical services.
  5. If the child becomes unresponsive or is found unresponsive, place the child on his or her back.
  6. Lift jaw and tongue. This is called the jaw lift and may help clear the airway. If a foreign object is seen, sweep it out with your finger. NEVER poke the finger blindly straight into the throat. Only try a finger sweep if you can see the foreign object. Otherwise, you may cause further blockage.
  7. Tilt the child’s head back. Seal your lips tightly around the child’s mouth, and pinch the nose shut.
  8. Give two slow breaths until the chest gently rises.
  9. If the chest does not rise, re-tilt the head and seal your lips tightly around the child’s mouth, and pinch the nose shut.
  10. Give two more slow breaths until the chest gently rises.
  11. If air won’t go in, kneel beside the child or straddle his or her hips.
  12. Put the heel of one hand in the midline between the belly button and rib cage. Place the second hand on top of the first. Then press firmly, but gently, into the abdomen with a rapid inward and upward thrust. Repeat this step up to five times.
  13. Repeat steps 6 through 11 or until the object is coughed up or rescue breathing is successful.
  14. After performing these steps for 1 minute, you can break and call for an ambulance if that has not already been done. You should have the phone number for emergency medical services (EMS) by your phone.

Understanding choking prevention procedures will reduce the chance of serious injury. The information in this brochure can help you to prevent or respond to a choking event. However, it is not a substitute for an approved first aid course or cardiopulmonary resuscitation (CPR) course available in your community. As a parent, do your part by knowing first aid for a choking child or infant. Parents are encouraged to enroll in a Basic Life Support class, offered by the American Red Cross or the American Heart Association to learn choking prevention procedures and CPR for infants and children. Your pediatrician can also help you understand these steps and talk to you about the importance of supervising mealtime and identifying dangerous foods and objects.

Common items associated with choking in infants and children:

Foods (Not to be eaten by children less than 4 years old)

  • hot dogs
  • nuts
  • chunks of meat
  • grapes
  • hard candy
  • popcorn
  • chunks of peanut butter

Household Items:

  • balloons
  • coins
  • marbles
  • small toy parts
  • pen caps
  • small button-type batteries

For Questions or Emergency Care:
Call the office at 601-984-5160. You may need to speak with the doctor on-call.

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