Choking First Aid: What to Do for an Adult, Child or Baby

Choking is one of the few emergencies where the right action in the first minute usually decides the outcome, and where the wrong action can cause real injury. It is also the emergency where Australian guidance differs from what most people have absorbed from American television.

The Australian and New Zealand Committee on Resuscitation (ANZCOR) sets the standard here, and it is clear: back blows and chest thrusts, not abdominal thrusts. This guide follows that guidance for adults, children and babies under one.

How to tell if someone is choking

ANZCOR asks you to judge one thing first: how effective is their cough? That single question decides what you do next, and it is the step people skip.

Mild blockage — an effective cough

• They can speak, cry, cough or breathe
• The cough is loud and forceful
• They are still able to answer you

What to do: stay with them and encourage them to keep coughing. A forceful cough moves more air than anything you can do for them. Do not slap their back, do not put your fingers in their mouth, and do not give them water. Watch them closely in case it turns severe.

Severe blockage — an ineffective cough

• The cough is weak, silent or absent
• They cannot speak, cry or breathe, or only make a high-pitched noise on breathing in
• They may clutch at their throat, look panicked, or go blue around the lips and face
• They may become limp or unresponsive

What to do: this is a life-threatening emergency. Call Triple Zero (000) for an ambulance, or have someone else call while you start. Then begin back blows.

Choking first aid for an adult or a child over 1

You can do all of this with the person sitting or standing — whichever lets you reach their back and support their chest.

1. Call 000, or send someone to call. Stay on the line.
2. Give up to five sharp back blows. Support their upper body with one hand and, with the heel of your other hand, strike firmly in the middle of the back between the shoulder blades. Check after each blow to see whether the blockage has cleared — stop as soon as it has.
3. If five back blows have not worked, give up to five chest thrusts. Place one hand on the same spot on the chest you would use for CPR compressions — the lower half of the breastbone. Each thrust should be sharper than a CPR compression and given more slowly. Check after each thrust.
4. Keep alternating five back blows and five chest thrusts for as long as they remain responsive and the blockage has not cleared.
5. If they stop responding, lower them to the ground and start CPR immediately.

Choking first aid for a baby under 1

The sequence is the same — five back blows, then five chest thrusts — but the handling is different, because a baby needs their head and neck supported throughout.

1. Call 000.
2. Position the baby face down along your forearm, head lower than their chest, supporting their head and shoulders on your hand. Keep their mouth open with your fingers so anything that comes loose can fall out.
3. Give up to five back blows between the shoulder blades with the heel of one hand. Use less force than you would for an adult. Check after each blow.
4. If that has not cleared it, turn the baby onto their back — on a firm surface, or head-downwards across your thigh.
5. Give up to five chest thrusts using two fingers on the lower half of the breastbone. Check after each thrust.
6. Keep alternating five back blows and five chest thrusts until the blockage clears or help arrives.
7. If the baby becomes blue, limp or unresponsive, follow DRSABCD and begin CPR.

Never shake a baby, and never hold them upside down by the ankles. Support the head and neck at all times.

Why Australia does not teach abdominal thrusts

The abdominal thrust — the Heimlich manoeuvre, the upward squeeze under the ribs that everyone has seen in films — is not part of Australian first aid guidance.

ANZCOR's position is explicit: “The use of abdominal thrusts in the management of FBAO is not recommended and, instead back blows and chest thrusts should be used.” The reason is harm. Reviewing the evidence, ANZCOR found life-threatening complications reported across 52 observational studies of abdominal thrusts — including damage to internal organs. Back blows and chest thrusts carry far fewer reported injuries while working just as well.

So if you have been taught the Heimlich, or you have only ever seen it on screen, this is the one thing worth updating. Back blows first, then chest thrusts.

If they become unresponsive

A blockage that is not cleared will eventually stop someone breathing. If the person stops responding to you:

1. Lower them to the floor and make sure 000 has been called.
2. Look in the mouth. Remove any object you can clearly see. No blind sweeps.
3. Start CPR if they are not breathing normally — 30 chest compressions to 2 rescue breaths. Chest compressions can themselves generate enough pressure to shift a blockage.
4. Keep going until they recover, paramedics take over, or an AED is available and tells you otherwise.

If they start breathing normally again, roll them into the recovery position and monitor them until the ambulance arrives.

After the blockage clears

Getting the object out is not always the end of it. Have the person assessed by a doctor if any of the following applies:

• They received back blows or chest thrusts — these can cause injury that is not obvious straight away
• They have a persistent cough, difficulty swallowing, or a feeling that something is still stuck
• They had a partial blockage that cleared itself but their breathing still sounds different
• It was a baby or young child
• You think part of the object may still be in the airway or may have been inhaled

Reducing the risk, especially for children

• Cut food small and encourage slow eating. Sit children down to eat — not running, not in the car.
• Avoid the known high-risk foods for under-3s: whole nuts, popcorn, raw carrot and apple chunks, hard lollies, and grapes or cherry tomatoes served whole. Quarter them lengthways.
• Keep small objects out of reach — coins, button batteries, marbles, small toy parts, balloons.
• Button batteries are a separate emergency. If you think a child has swallowed one, call the Poisons Information Centre on 13 11 26 immediately — and Triple Zero (000) if they are bleeding or having trouble breathing. A swallowed button battery can burn through a child’s oesophagus in less than two hours. Do not wait for symptoms, do not give food or drink, and do not try to make them vomit.
• For adults, the risk rises with alcohol, eating in a hurry, ill-fitting dentures, and conditions affecting swallowing.

Related reading: what to say when you call an ambulance, the full DRSABCD action plan, and anaphylaxis first aid — a swollen airway can look like choking but needs adrenaline, not back blows. If someone in your household has a condition a responder should know about, you can create your emergency profile in a few minutes.

Choking first aid FAQs

Sources

• ANZCOR Guideline 4 — Airway — assessing cough effectiveness, back blows, chest thrusts, infant positioning, and the recommendation against abdominal thrusts and blind finger sweeps.
• St John Ambulance Australia — Choking infant (under 1 year) — step-by-step infant technique and when to call Triple Zero.
• Better Health Channel — Choking — recognition, high-risk foods for young children and prevention.
• Triple Zero (000) — when and how to call Australia’s emergency number.
• Poisons Information Centre, 13 11 26 — for swallowed button batteries and other ingestions.

Disclaimer: This article is general first aid information, not medical advice or a substitute for accredited first aid training. In an emergency, always call Triple Zero (000). For non-urgent health advice, call healthdirect on 1800 022 222 (NURSE-ON-CALL 1300 60 60 24 in Victoria, 13 HEALTH 13 43 25 84 in Queensland) or speak with your GP. MedibandPlus stores and provides access to a member’s own medical information; it does not assess, diagnose or treat any condition.

More first aid guides

• DRSABCD: the first aid action plan explained
• How to do CPR: a beginner’s guide
• The recovery position, step by step
• How to use a defibrillator (AED)
• Anaphylaxis first aid
• Asthma first aid
• Calling an ambulance in Australia