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Choking – what to do in the next sixty seconds

A person who can cough should be left to cough. A person who cannot make a sound needs back blows now. The difference decides everything.

Mild or severe — this is the whole decision

Everything depends on one question: can they cough, speak or breathe at all?

  • MILD — coughing forcefully, able to make sounds, able to breathe between coughs. Encourage them to keep coughing. Do not hit them on the back and do not put fingers in their mouth. Coughing is more effective than anything you can do, and interfering can dislodge the object into a worse position.
  • SEVERE — silent, unable to speak or cough, clutching the throat, face going red then blue, panicking. Act immediately.

An adult or child who cannot cough

  1. Get someone to call an ambulance while you start.
  2. Stand to the side and slightly behind. Support their chest with one hand and lean them well forward, so anything dislodged comes out rather than going further down.
  3. Give up to five sharp back blows between the shoulder blades with the heel of your hand. Check after each one.
  4. If that fails, give up to five abdominal thrusts: stand behind, arms around the waist, fist just above the navel, grasp with the other hand, pull sharply inwards and upwards.
  5. Alternate five back blows and five abdominal thrusts until it clears or they become unresponsive.
  6. If they become unresponsive, lower them to the floor, call for an ambulance if not already done, and start CPR.

Anyone who has received abdominal thrusts should be checked by a doctor afterwards, because they can cause internal injury that is not immediately obvious.

Babies under one year

  1. Lay the baby face down along your forearm, head lower than the body, supporting the head and jaw.
  2. Five sharp back blows between the shoulder blades with the heel of your hand.
  3. Turn the baby face up along your other forearm, still head-down.
  4. Five chest thrusts: two fingers on the breastbone, just below the nipple line, sharper and slower than compressions.
  5. Repeat, checking the mouth between cycles — remove anything you can clearly see, but never sweep blindly with a finger.
  6. If the baby becomes unresponsive, start infant CPR and get emergency help.

Preventing it in children

  • Avoid whole nuts, popcorn, hard sweets, chunks of raw carrot or apple and whole grapes under about five. Cut round food lengthways.
  • Children should sit still while eating — not walking, running, playing or lying down.
  • Keep small objects, coins, button batteries and small toy parts away from small children.
  • A swallowed button battery is a separate emergency and needs a hospital immediately, even with no symptoms — it burns through tissue within hours.
  • Do not let an adult throw food for a child to catch in their mouth.

Common questions

Should I slap someone on the back if they are coughing?
No. If they are coughing effectively, coughing is doing a better job than you can. Back blows are for someone who cannot cough, speak or breathe.
Can I do abdominal thrusts on myself?
Yes, if alone — press your own fist above the navel and thrust inwards and upwards, or lean your upper abdomen sharply over the back of a chair. Call for help first if you can.
What about a pregnant or very large person?
Use chest thrusts instead of abdominal thrusts — hands on the breastbone rather than the abdomen, pulling sharply backwards.

Sources

Last reviewed 4 August 2026.