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Choking first aid and the Heimlich maneuver

What to do, step by step, when a baby, a child or an adult is choking. The steps are different for babies under 1, so learn both.

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Choking first aid and the Heimlich maneuver

Quick answer

If someone is choking and can’t cough, cry, speak or breathe, call emergency services and start first aid straight away. Babies under 1: repeat 5 back blows and 5 chest thrusts, using the heel of one hand, with baby’s head lower than the chest. Children and adults: repeat 5 back blows and 5 abdominal thrusts (the Heimlich maneuver). If they stop responding, start CPR.

  • A strong cough means air is moving: let them cough and stay close
  • Never use abdominal thrusts (the Heimlich) on a baby under 1
  • Keep going in cycles until the object comes out or they stop responding
  • Never do a blind finger sweep; remove only what you can see
  • Always see a doctor afterwards, even if they seem fine

STEP 1

Is it choking?

Choking means the airway is blocked and air can’t get in or out. The key test is sound: if they can cough hard, cry or talk, air is moving. Encourage them to keep coughing, don’t pat their back and don’t reach into their mouth.

Act straight away if you see any of these signs:

  • Can’t cough, cry, speak or breathe, or the cough becomes weak and silent
  • A high-pitched squeak or no sound at all when trying to breathe
  • Hands clutching the throat (the universal choking sign) or a panicked look
  • Lips or face turning blue or gray
  • In babies: silent, struggling, or suddenly floppy

In babies, noisy gagging with new textures is normal and different from choking. Read gagging vs choking to tell them apart.

Call emergency services (911 in the US, 112 in Europe) right away. Shout for help and have someone else call while you start. If you are alone, put the phone on speaker and start first aid at once.

BABIES UNDER 1 YEAR

Back blows and chest thrusts

No Heimlich for babies. Never use abdominal thrusts on a baby under 1. Use back blows and chest thrusts instead.

  1. Spot it

    Baby is silent, can’t cry, cough or breathe, and may turn blue. A noisy cough or gag means air is moving: let baby cough.

    A baby in a high chair looks frightened and can’t cry while a parent reaches in, a phone on the table nearby.

  2. Call for help

    Shout for help and have someone call emergency services. If you’re alone, put the phone on speaker and start straight away.

    A parent holds a frightened baby who can’t cry and turns to shout for help, a phone on speaker on the table.

  3. Lay baby face down

    Sit or kneel. Lay baby face down along your forearm, resting your arm on your thigh. Hold the jaw (not the throat) with your thumb and fingers, and keep the head lower than the chest.

    A parent sits on the edge of a chair with a baby face down along her forearm on her thigh, the baby’s head lower than the chest, her fingers holding the jaw.

  4. Give 5 back blows

    Firm, separate blows between the shoulder blades with the heel of your hand. Not gentle pats.

    The parent raises the heel of her hand to give a firm blow between the shoulder blades of a baby held face down, head lower than the chest.

  5. Turn baby face up

    Sandwich baby between your forearms, support the back of the head, and turn baby onto your other arm resting on your thigh. Head still lower than the chest.

    The parent turns the baby over between both forearms, supporting the head, which stays lower than the chest.

  6. Give 5 chest thrusts

    Heel of one hand on the center of the chest, just below the nipple line. Push straight down about 1.5 inches (4 cm), 5 times, letting the chest come back up. Never two fingers, never abdominal thrusts.

    The baby lies face up along the parent’s forearm with the head lowest and supported, while her other hand pushes down on the center of the chest.

  7. Repeat until it comes out

    Keep alternating 5 back blows and 5 chest thrusts until the object comes out, baby cries or coughs strongly, or baby stops responding.

  8. If baby stops responding

    Lay baby on a firm, flat surface, make sure help is on the way and start infant CPR. Look in the mouth before each set of breaths and remove the object only if you can see it. See the full steps in infant CPR.

    A baby lies limp on its back on the floor while a parent kneels beside, one hand on the forehead and the heel of the other on the center of the chest, a phone on speaker nearby.
Updated in 2025. The American Heart Association and AAP now teach infant chest thrusts with the heel of one hand, not two fingers. For full infant CPR, see infant first aid: choking and CPR.
  • No abdominal thrusts (Heimlich) under 1 year
  • Don’t hold baby upside down by the ankles or shake them
  • Don’t give water or food to “wash it down”
  • Don’t sweep a finger in the mouth for an object you can’t see

CHILDREN 1 YEAR AND OLDER

Back blows and the Heimlich maneuver

From their first birthday, children get the same cycle as adults: 5 back blows, then 5 abdominal thrusts, repeated. Kneel behind a small child so you are at their height.

  1. Spot it

    Ask “Are you choking?” A child who can cough hard, cry or talk has air moving: let them cough and stay close. Act if they can’t cough, speak or breathe, or hold their throat.

    A toddler clutches their throat with both hands, unable to cough, as a parent rushes over.

  2. Call for help

    Shout for help and have someone call emergency services. If you’re alone, put the phone on speaker and start straight away.

    A toddler holds their throat while a parent kneels beside them and shouts for help, a phone on speaker on the floor.

  3. Give 5 back blows

    Kneel beside or behind them. Support the chest with one hand and lean them well forward. Give 5 firm blows between the shoulder blades with the heel of your other hand.

    The kneeling parent supports the toddler’s chest with one hand, leans them forward and gives a back blow between the shoulder blades.

  4. Find the spot

    Kneel behind them and wrap your arms around their waist. Make a fist and put the thumb side just above the belly button, well below the breastbone. Grasp the fist with your other hand.

    A parent kneels behind a toddler with a fist on the tummy just above the belly button, the other hand ready to grasp it.

  5. Give 5 abdominal thrusts

    Pull quickly in and up, 5 times. This is the Heimlich maneuver. Scale the force to the child’s size.

    A parent kneeling behind a toddler grasps her fist above the belly button and thrusts in and up, shown by an arrow.

  6. Repeat until it comes out

    Keep alternating 5 back blows and 5 abdominal thrusts until the object comes out, they cough or cry strongly, or they stop responding.

  7. If they stop responding

    Lower them onto their back on the floor, make sure help is on the way and start CPR. See CPR steps below.

    The parent kneels beside the unresponsive toddler lying on their back on the floor, with a phone on speaker calling emergency services.
Use enough force to move the object, but scale it to the child’s size. For a very small child, you can lay them face down across your lap for back blows.

FOR YOU, YOUR PARTNER AND GROWN-UP KIDS

When an adult is choking: the Heimlich maneuver

Choking isn’t only a baby problem. A rushed bite of steak at dinner, a piece of candy while laughing, a vitamin swallowed the wrong way: as a parent, the person who needs help might be you, your partner, a grandparent at the table, or one day your teenager or grown-up child. The good news is that you only need to learn one more pattern.

For teens and adults, the steps are the same as for children over 1: 5 back blows, then 5 abdominal thrusts, repeated. The only real difference is size: stand behind them instead of kneeling, with one foot between their feet so you can take their weight if they collapse.

And it works both ways. If you and your partner both know these steps, whoever is free can help whoever is choking, including the adult who was just helping the baby.

  1. Spot it

    Hands at the throat, can’t speak, cough or breathe. Ask “Are you choking?” If they can cough hard, let them cough and stay with them.

    A man clutches his throat with both hands, unable to breathe, while a woman hurries toward him.

  2. Call for help

    Have someone call emergency services while you start. Alone with them? Put the phone on speaker.

    A woman supports a choking man with a hand on his back and shouts for help, a phone on speaker on the table.

  3. Give 5 back blows

    Stand slightly behind them, support the chest with one hand and lean them well forward. Give 5 firm blows between the shoulder blades with the heel of your hand.

    A woman supports a choking man’s chest with one arm as he leans forward and raises her other hand to strike between his shoulder blades.

  4. Get into position

    Stand directly behind them with one foot between their feet, so you can take their weight if they collapse. Wrap your arms around their waist.

    A woman stands behind a choking man with her arms around his waist and a fist just above his belly button.

  5. Give 5 abdominal thrusts

    Fist just above the belly button, thumb side in, grasped by your other hand. Pull sharply in and up, 5 times. Pregnant or can’t reach around? Use chest thrusts instead (see below).

    A woman behind a choking man grasps her fist above his belly button and pulls in and up, shown by an arrow.

  6. Repeat until it comes out

    Keep alternating 5 back blows and 5 abdominal thrusts until the object comes out or they stop responding.

  7. If they stop responding

    Lower them carefully to the floor, make sure help is on the way and start CPR. See CPR steps below.

    A rescuer kneels beside an unresponsive man on the floor and gives chest compressions with both hands in the center of the chest, phone on speaker beside them.

Pregnant or larger adults

If you can’t reach around the waist, or the person is visibly pregnant, use chest thrusts instead of abdominal thrusts: put your fist on the center of the breastbone and pull straight back.

If you are alone with the kids and choking

Call emergency services even if you can’t speak, and leave the line open so the dispatcher can hear you and try to locate you. Give yourself abdominal thrusts with your own fist, or press your upper belly hard against the back of a chair or a counter edge.

Once your children are old enough, teach them how to call emergency services and say your address. A school-age child can’t do the Heimlich on an adult, but they can call for help and unlock the door.

IF THEY STOP RESPONDING

Start CPR straight away

  1. 1Lower them onto their back on a firm, flat surface. Make sure emergency services are on the way, and send someone for an AED.
  2. 2Start CPR with chest compressions: 30 compressions, then 2 breaths, at 100 to 120 compressions a minute. Babies: about 1.5 inches (4 cm). Children: about 2 inches (5 cm). Adults: at least 2 inches (5 cm).
  3. 3Check the mouth before breaths. Each time you open the airway, look for the object and remove it only if you can see it.
  4. 4Keep going until they start breathing normally, help takes over, or an AED tells you to stop.

For a baby, follow the full steps in infant CPR: two thumbs with your hands around the chest, or the heel of one hand, just below the nipple line.

WHY IT MATTERS

Why babies never get the Heimlich

“Heimlich maneuver” is the everyday name for abdominal thrusts. In a baby under 1, the liver and other organs sit low and unprotected below a soft rib cage, so a thrust into the belly can cause serious internal injury.

That’s why babies get chest thrusts instead, after back blows, with the head lower than the chest so gravity helps. Once a child turns 1, abdominal thrusts are the recommended technique.

CHEAT SHEET

Choking first aid by age

AgeRepeat this cycleHandKey detail
Baby under 15 back blows + 5 chest thrustsHeel of one handHead lower than chest. Never abdominal thrusts
Child 1 and older5 back blows + 5 abdominal thrustsHeel of hand; fist for thrustsKneel to their height; fist just above belly button
Adult5 back blows + 5 abdominal thrustsHeel of hand; fist for thrustsPregnant or larger: chest thrusts instead
Anyone unresponsiveCPR: 30 compressions + 2 breathsSee CPR stepsLook in the mouth before breaths; no blind sweeps
Take a hands-on class. Practising on a manikin with an instructor from the American Red Cross, the American Heart Association or your hospital makes it far easier to act calmly. Bring grandparents and sitters too.

AVOID THESE

Common mistakes in a choking emergency

  • Slapping the back of someone who is still coughing hard. A strong cough clears the airway best; stay close and be ready
  • Using abdominal thrusts (the Heimlich) on a baby under 1. Babies get back blows and chest thrusts only
  • Doing only abdominal thrusts on a child or adult. The 2025 guidelines start with 5 back blows, then 5 abdominal thrusts, and repeat
  • A blind finger sweep. Reaching for an object you can’t see can push it deeper; remove it only if you can see it
  • Holding a baby upside down by the ankles or shaking them
  • Gentle pats instead of firm back blows. Back blows need to be strong and quick, with the heel of the hand
  • Placing the fist too high. For abdominal thrusts it goes just above the belly button, well below the breastbone
  • Giving water or bread to “push it down”. Never give food or drink to someone who is choking
  • Waiting to call for help. If they can’t breathe, cough or speak, call emergency services straight away
  • Stopping when they go limp. If they stop responding, lower them to the floor and start CPR
  • Skipping the doctor afterwards because they seem fine

AFTERWARDS

When to see a doctor

Anyone who needed back blows, chest thrusts, abdominal thrusts or CPR should be checked by a doctor the same day, even if they seem fine. Thrusts can cause internal injury, and a small piece may still be in the airway.

  • A cough, wheeze or noisy breathing that doesn’t settle
  • Trouble swallowing, drooling or pain in the throat or chest
  • A fever in the days after, which can mean a piece of food was inhaled

To lower the risk at meals, see foods to avoid for babies and how to cut food by age.

Choking first aid: questions parents ask

What is the Heimlich maneuver?

The Heimlich maneuver is the old name for abdominal thrusts: standing behind a choking person, you wrap your arms around their waist, put a fist just above the belly button and pull sharply in and up. The 2025 American Heart Association guidelines pair it with back blows: give 5 back blows, then 5 abdominal thrusts, and repeat.

Can you do the Heimlich maneuver on a baby?

No. Never use abdominal thrusts on a baby under 1 year, because they can injure the liver and other organs. For babies, repeat cycles of 5 back blows and 5 chest thrusts with the heel of one hand, keeping baby’s head lower than the chest.

What changed in the 2025 choking guidelines?

The 2025 American Heart Association and AAP guidelines now teach the same pattern for children and adults: 5 back blows followed by 5 abdominal thrusts, repeated until the object comes out or the person stops responding. For infants, chest thrusts are now given with the heel of one hand instead of two fingers.

What do I do if my toddler is choking?

If your child over 1 can’t cough, cry, speak or breathe, have someone call emergency services (911 in the US). Kneel behind them, lean them forward and give 5 firm back blows between the shoulder blades, then 5 quick abdominal thrusts just above the belly button. Repeat until the object comes out or they stop responding.

What if the person becomes unresponsive while choking?

Lower them to the floor, make sure emergency services are called and start CPR, beginning with chest compressions. Each time you open the airway to give breaths, look in the mouth and remove the object only if you can see it. Never do a blind finger sweep.

Should I slap the back of someone who is coughing?

No. If they can cough forcefully, cry or talk, air is moving. Encourage them to keep coughing and stay with them. Start back blows only if the cough becomes silent or weak, or they can’t breathe or speak.

Does someone need a doctor after the Heimlich maneuver?

Yes. Anyone who needed back blows, chest thrusts or abdominal thrusts should be checked by a doctor, even if they seem fine, because the thrusts can cause internal injury and a small piece may still be in the airway.

How do I do the Heimlich maneuver on a pregnant person?

Don’t press on the belly. Give 5 back blows, then 5 chest thrusts instead of abdominal thrusts: stand behind them, put your fist on the center of the breastbone and pull straight back. The same applies to someone too large to reach around.

Keep reading

Infant CPR and choking first aid Gagging vs choking: how to tell Foods to avoid for babies

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Based on the 2025 American Heart Association and AAP guidelines and American Red Cross guidance. This guide is educational and doesn’t replace a hands-on first aid class or emergency services.

Sources
  1. American Heart Association — 2025 Guidelines for CPR and ECC
  2. AAP (HealthyChildren.org) — AHA and AAP release updated CPR guidelines (2025)
  3. American Red Cross — Choking first aid for adults and children
  4. American Red Cross — Infant CPR and choking
  5. AAP (HealthyChildren.org) — Choking prevention for children