Jacob Shaw

Choking First Aid for babies and children

Written by Jacob Shaw ·

Choking is every parent’s and educator’s worst fear, and it’s one of the topics people ask about most in our courses. Young children explore the world with their mouths, and their airways are small, so food and small objects can block them easily. The good news is that the First Aid for choking is simple, and knowing it can make all the difference.

This guide follows the Australian and New Zealand Committee on Resuscitation (ANZCOR) guidelines. It's not a substitute for hands-on training. In an emergency, always call Triple Zero (000).

Is the child choking?

First, work out whether the airway is partly or completely blocked.

Mild airway obstruction (effective cough). The child is coughing loudly, crying or talking, and can breathe in between coughs. Their cough is doing the job.

Severe airway obstruction (ineffective cough). The child can’t cough effectively, cry or speak. They might be silent, making high-pitched noises or wheezing, clutching at their throat, struggling to breathe, or turning blue around the lips. Older children may not be able to tell you what’s wrong.

Mild obstruction: encourage coughing

If the child is coughing effectively:

  • Encourage them to keep coughing. Coughing is the most effective way to clear the airway.
  • Don’t slap their back, give them a drink or put your fingers in their mouth. These can push the object further down, or turn a partial blockage into a complete one.
  • Stay with them and watch closely. If the cough becomes weak or ineffective, or they start to struggle, act immediately.
  • Call Triple Zero (000) if the obstruction doesn’t clear quickly.

Severe obstruction in a baby (under 1 year)

1. Call Triple Zero (000). If you’re on your own, put the phone on speaker and start First Aid straight away.

2. Give up to 5 back blows.

  • Lay the baby face down across your lap, with their head lower than their chest. Support their head and jaw with your hand, without covering their mouth or pressing on their throat.
  • Give up to 5 firm back blows between the shoulder blades with the heel of your other hand.
  • Check after each back blow to see whether the blockage has cleared.

3. If that doesn’t work, give up to 5 chest thrusts.

  • Turn the baby over onto their back across your thigh, still with their head lower than their chest, supporting their head.
  • Place two fingers in the centre of the chest, on the lower half of the breastbone, just below the nipple line.
  • Give up to 5 chest thrusts. They’re similar to CPR compressions, but sharper and slower.
  • Check after each thrust to see whether the blockage has cleared.

4. Keep alternating. If the blockage still hasn’t cleared, keep alternating 5 back blows with 5 chest thrusts until help arrives.

5. If the baby becomes unresponsive, start CPR straight away. Before giving breaths, look in the mouth and remove anything you can see, but don’t do blind finger sweeps.

Severe obstruction in a child (over 1 year)

1. Call Triple Zero (000).

2. Give up to 5 back blows.

  • For a small child, lay them face down across your lap, with their head lower than their chest.
  • For a bigger child, have them stand or sit and lean forward, supporting their chest with one hand.
  • Give up to 5 firm back blows between the shoulder blades with the heel of your hand, checking after each one.

3. If that doesn’t work, give up to 5 chest thrusts.

  • Lie the child on their back, or keep them standing or sitting.
  • Place the heel of one hand on the lower half of the breastbone, in the centre of the chest.
  • Give up to 5 chest thrusts, sharper and slower than CPR compressions, checking after each one.

4. Keep alternating back blows and chest thrusts until the object comes out or help arrives.

5. If the child becomes unresponsive, start CPR. Remove any visible object from the mouth, but don’t do blind finger sweeps.

What about the Heimlich manoeuvre?

You might have seen abdominal thrusts, or the “Heimlich manoeuvre”, on TV. In Australia and New Zealand, ANZCOR recommends back blows and chest thrusts instead, because abdominal thrusts can cause internal injuries, especially in children. Stick to back blows and chest thrusts.

After a choking episode

Even if the object comes out and the child seems fine, have them checked by a doctor. A small part of the object may still be in the airway, and back blows and chest thrusts can occasionally cause injury. Seek medical help straight away if they have a persistent cough, wheezing, difficulty breathing or swallowing, or pain.

In a childcare service, you’ll also need to record the incident, tell the parents and, depending on the outcome, notify the regulator. This is covered in our ACECQA approved Childcare First Aid course.

Preventing choking

Most choking incidents in young children involve food. A few simple habits help:

  • Supervise children while they eat, and make sure they sit down. No eating while walking, running, playing or in the car.
  • Cut food into small pieces. Quarter grapes and cherry tomatoes lengthways, and cut sausages lengthways before slicing.
  • Avoid small, hard foods for young children, such as whole nuts, popcorn, hard lollies and raw carrot or apple pieces. Grate, steam or mash hard fruit and vegetables instead.
  • Keep small objects out of reach, including coins, marbles, small toy parts, balloons, magnets and pen lids. A handy rule of thumb: if an object fits through a toilet roll tube, it’s too small for a child under three.
  • Check toys are age-appropriate and look for small parts that can come loose.

Button batteries

Button batteries aren’t just a choking risk. If swallowed, they can burn through the oesophagus in as little as two hours. If you think a child has swallowed a button battery, call Triple Zero (000) or go to the nearest emergency department immediately. Don’t wait for symptoms, don’t give them anything to eat or drink, and don’t make them vomit. For advice, call the Poisons Information Centre on 13 11 26. Keep remotes, key fobs, kitchen scales and other devices with button batteries secured and out of reach.

Learn it hands-on

Choking First Aid is easier to remember once you’ve practised it. In our Childcare First Aid course you’ll practise choking management and CPR on infant and child manikins, alongside asthma, anaphylaxis and other childhood emergencies. It’s the course for childcare educators, nannies and parents alike, and it’s ACECQA approved. Courses run every week in Brisbane and on the Gold Coast for $119.

If you’re short on time, our 1.5-hour CPR course covers infant and child CPR.