Choking first aid for babies and toddlers

Read this before you need it

Choking is frightening, and it happens fast. The AAP says choking is a leading cause of death for babies and young children, and being without oxygen for more than 4 minutes can cause brain damage. Knowing the steps ahead of time is what lets you act straight away.

This page sets out the steps the way the American Red Cross, the American Heart Association (AHA) with the AAP, and the NHS describe them. It doesn’t replace a hands-on course. Practicing on a training doll is the best way to learn how firm a back blow should be and where your hands go. See “Take a course” below.

Is it choking, or gagging?

Gagging is noisy and common when babies learn to eat. Choking is often quiet. The Red Cross lists these signs of choking:

• weak or no cough
• high-pitched squeaking, or no sound at all
• can’t cough, cry or speak
• pale or blue skin
• a panicked, confused or surprised look, or hands at the throat

If your child is coughing loudly, encourage them to keep coughing and don’t leave them (NHS, Red Cross). Coughing is the best way to clear the airway. The AAP says a cough after choking often settles within about 15 minutes, whether or not the object comes out. Keep watching closely. If the cough turns weak or silent, or they struggle to breathe, start the steps below. Get medical help afterwards even if they seem fine (NHS).

If the cough is silent, or they can’t breathe in properly, act now. For more on telling the two apart, see gagging vs. choking.

Call for help

Shout for help and have someone call 911 straight away. If you’re alone and your phone is with you, put it on speaker, call, and start back blows at once. Don’t leave your child to find a phone.Shout for help and start back blows and thrusts straight away. If someone is with you, ask them to call 999 now. If you’re alone, call 999 (on speaker) if the blockage hasn’t cleared after one round of back blows and thrusts, and keep going until help arrives.Shout for help and have someone call your local emergency number (such as 112 in Europe or 000 in Australia) straight away. If you’re alone and your phone is with you, put it on speaker, call, and start back blows at once.

Baby under 1 year

1. Up to 5 back blows

• Sit or kneel. Lay your baby face down along your forearm, resting on your thigh, with their head lower than their body.
• Support their head and jaw with your hand, holding the jaw with your thumb and fingers. Keep your fingers off the soft part of the throat.
• Give up to 5 firm back blows between the shoulder blades with the heel of your hand. Check after each one whether the object has come out.

2. Up to 5 chest thrusts

• Turn your baby face up along your forearm or thighs, supporting their head, with their head lower than their body.
• Place the heel of one hand in the middle of the chest, just below the nipple line. The 2025 AHA and AAP guidelines recommend the heel of one hand for choking babies, because it pushes deeper than 2 fingers.Place 2 fingers in the middle of the chest, just below the nipple line (NHS).Place 2 fingers (NHS) or the heel of one hand (2025 AHA and AAP guidelines) in the middle of the chest, just below the nipple line, as your local first aid course teaches.
• Give up to 5 quick chest thrusts, about 1½ inches (4 cm) deep (Red Cross). Check after each one.

3. Keep repeating back blows and chest thrusts until the object comes out, your baby can cough or cry, or help arrives. The 2025 AHA and AAP guidelines recommend repeated cycles of 5 back blows and 5 chest thrusts for babies. Never give abdominal thrusts to a baby under 1.

Child over 1 year

1. Up to 5 back blows

• Lay a small child face down across your lap, as you would a baby. If that isn’t possible, kneel or stand behind them, slightly to one side, and support them leaning forward.
• Give up to 5 firm back blows between the shoulder blades with the heel of your hand. Check after each one.

2. Up to 5 abdominal thrusts

• Kneel or stand behind your child and put your arms under their arms, around their upper tummy.
• Make a fist and place it between their belly button and their ribs. Grasp it with your other hand.
• Pull sharply inwards and upwards, up to 5 times. Check after each one.
• Don’t press on the lower ribcage: it can cause injury (NHS).

3. Keep repeating back blows and abdominal thrusts until the object comes out, your child can cough, cry or speak, or help arrives. The 2025 AHA and AAP guidelines changed US advice to these alternating cycles for children; earlier US guidance used abdominal thrusts alone.

If your child becomes unresponsive

• Lay them on a firm, flat surface and shout for help.
• Make sure the emergency call has been made, on speaker so your hands are free (NHS). Don’t leave your child.
• Open their mouth. Only remove an object if you can clearly see it and easily grab it.
• Start CPR as you were taught. US guidance (Red Cross, AHA and AAP) begins with chest compressions. Look in the mouth again before giving breaths.The NHS begins with 5 rescue breaths, then gives 30 chest compressions to every 2 breaths. For a baby under 1, the NHS describes compressions with the tips of 2 fingers.Follow the method your local first aid course teaches. Look in the mouth again before giving breaths.

What not to do

• No blind finger sweeps. If you can clearly see the object and can easily grab it, take it out. Don’t poke blindly or repeatedly into the mouth: you can push the object further in (NHS). The Red Cross says never sweep unless you can actually see the object, and the 2025 AHA and AAP guidelines say blind finger sweeps should not be done.
• Don’t hang a child upside down by their feet. The Red Cross says it doesn’t work and they could be hurt if dropped.
• Don’t leave your child alone, even if the coughing settles.

After a choking episode

Get medical help even if the object comes out (NHS). Part of it may still be stuck, or your child may have been hurt by the back blows or thrusts. Keep watching them closely while any coughing settles (AAP). If they struggle to breathe at any point, or turn pale or blue, start the steps again and call 911999your local emergency number.

Take a course

The AAP advises every parent to take a certified first aid and CPR class, and suggests contacting the American Red Cross or the AHA to find one near you. The NHS also highly recommends a first aid course for every parent or carer, because it makes the steps much easier to understand and remember.

The American Red Cross runs child and baby first aid and CPR classes, online and in person, and many local hospitals offer infant CPR sessions.St John Ambulance and the British Red Cross run baby and child first aid courses, including online, and the NHS links to their CPR videos.Your national Red Cross or Red Crescent society, or a local hospital, may run an infant and child first aid course near you.

Courses also teach CPR, which this page only outlines. In the US, the 2025 AHA and AAP guidelines dropped the 2-finger method for babies, both for chest thrusts when choking and for CPR compressions. The NHS still describes 2 fingers. A recent course where you live teaches the method your emergency services use. We strongly recommend one, and encourage grandparents, babysitters and anyone else who feeds your child to take one too.

Lowering the risk

First aid is the backup. Most choking can be prevented:

• Sit your child upright to eat, and watch them the whole time (CDC).
• No eating while walking, playing, lying down or in the car (CDC, AAP).
• Serve food soft and in safe shapes: see safe food sizes and shapes and the full choking hazards list.
• Keep small objects like coins, button batteries and toy parts out of reach (AAP).

Where US and UK advice differs

• When to call. US advice (Red Cross) is to call 911 straight away, or have someone call, as soon as you see signs of choking. The NHS says to call 999 if back blows and thrusts haven’t cleared the blockage, and straight away if your child is unconscious. If someone is with you, having them call at once fits both.
• Order of steps. The Red Cross and the AHA and AAP describe 5 back blows, then 5 thrusts, repeated. The NHS says the order doesn’t matter: if one method doesn’t work, try the other, and keep going until the object comes out.
• Children over 1. Since 2025, US guidelines match UK advice: back blows alternating with abdominal thrusts.
• Chest thrusts for a baby. The 2025 AHA and AAP guidelines recommend the heel of one hand on the middle of the chest, because it reaches the needed depth more reliably than 2 fingers. The NHS (and, for now, the American Red Cross page) describe 2 fingers just below the nipple line. Both press on the same spot. Use the method you were taught.
• CPR if your child becomes unresponsive. US guidance (Red Cross, AHA and AAP) starts with chest compressions, and since 2025 no longer uses 2 fingers for a baby (1 hand, or 2 thumbs with your hands around the chest). The NHS starts with 5 rescue breaths, then 30 compressions to 2 breaths, and describes 2 fingertips for a baby. Both say to call for help and keep going until help arrives.