First Aid for Choking: How to Perform the Heimlich Maneuver

Choking is one of the leading causes of accidental death in the United States, with more than 5,000 choking-related deaths reported annually. This makes rapid first aid knowledge a potentially lifesaving skill. As we all know, a suddenly blocked airway can cut off oxygen within minutes. This is why recognizing choking early and knowing how to perform the Heimlich maneuver can make all the difference before professional medical help arrives.

Anyone can choke at any age. Food, a small object, or another item can block the airway. A strong cough may clear a partial blockage. If the person cannot breathe or cough, act immediately to restore airflow and call for emergency help. 

This guide explains the signs of choking, when to use the Heimlich maneuver, and the steps to help someone safely. 

What Is Choking? – Let’s Have a Zoomed-In Look!

Choking happens when food or another object blocks the airway. The blockage may be partial or complete. Even a small toy or another item can also cause choking. This eventually prevents air from reaching the lungs. And, without enough oxygen, the body and brain can quickly become deprived of the oxygen that they need to perform functions. Although mild airway blockages may clear on their own through forceful coughing, remember, choking is a medical emergency and it requires immediate intervention.

Partial vs. Complete Airway Obstruction

The first step in helping someone who is choking is knowing how serious the blockage is. This quick chart will help you recognize the difference between partial and complete airway obstruction and understand what to do next.

Signs of Mild Choking

A person with mild choking may still be able to move some air through their airway. In many cases, encourage them to continue coughing as it is the safest first step.

• Strong or forceful coughing
• Difficulty swallowing
• Gagging or wheezing
• Able to speak between coughs
• Mild breathing difficulty
• Visible signs of distress while remaining conscious

Signs of Severe Choking

Severe choking occurs when the airway is almost or completely blocked, which prevents enough oxygen from reaching the lungs. Immediate first aid is essential.

• Inability to speak or cry out
• Silent or ineffective coughing
• Difficulty or inability to breathe
• Clutching the throat (the universal choking sign)
• Blue or gray lips, face, or fingernails
• Panicked facial expression
• Weakness or loss of consciousness if the blockage is not removed

What Is Heimlich Maneuver & When Should You Perform It?

The Heimlich maneuver, also known as abdominal thrusts, is a first-aid technique used to help dislodge an object blocking a person’s airway during severe choking. However, it should only be performed when there are clear signs of a complete airway obstruction. Before acting upon the Heimlich maneuver, quickly assess the person’s condition to determine if it is mild or severe choking.

Perform the Heimlich Maneuver If:

The Heimlich maneuver is appropriate when a conscious adult or child over one year of age shows signs of severe choking, like:

• Unable to speak or answer questions
• Unable to cough effectively
• Unable to breathe or making only weak breathing sounds
• Clutching the throat (the universal choking sign)
• Lips, face, or fingertips turning blue due to lack of oxygen
• Obvious signs of panic or distress caused by a blocked airway

Do Not Perform the Heimlich Maneuver If:

Not every choking incident requires abdominal thrusts. Avoid performing the Heimlich maneuver if the person:

• Is coughing forcefully, as coughing is often the most effective way to clear the airway.
• Can still speak or breathe, even if they are uncomfortable.
• Is an infant under one year old, as infants require a different first-aid technique involving back blows and chest thrusts.
• Has become unconscious. In this situation, carefully lower the person to the ground, call emergency services, and begin CPR if you are trained to do so.

Featured Article: How to Move from a CNA to a Certified Medication Aide

How to Perform the Heimlich Maneuver Safely (Step-by-Step)

If you know the correct technique to do a choking first aid Heimlich maneuver, it can make a lifesaving difference during a choking emergency. Follow these steps carefully to help remove the obstruction while minimizing the risk of injury.

For Adults and Children Over One Year

If an adult or a child over one year old has severe choking, act quickly and follow these steps to help clear the airway.

Step 1: Confirm Severe Choking

Make sure the person cannot cough, speak, or breathe. If they can only nod or are unable to respond to any question, prepare to provide first aid immediately.

Step 2: Position Yourself Correctly

Stand behind the person and wrap your arms around their waist. If needed, help them lean slightly forward to make it easier for the object to move out of the airway.

Step 3: Place Your Hands Correctly

Make a fist with one hand and place the thumb side just above the person’s navel and below the breastbone. Grasp your fist firmly with your other hand.

Step 4: Deliver Abdominal Thrusts

Give quick, firm inward and upward thrusts into the abdomen. Each thrust should be controlled and forceful enough to create pressure that may dislodge the obstruction.

Step 5: Continue Until the Airway Clears

Repeat the abdominal thrusts until:

• The object is expelled.
• The person can breathe or speak again.
• The person becomes unconscious, at which point CPR should be started while emergency responders are on their way.

How to Help in Special Choking Situations

The first aid choking Heimlich maneuver is effective for many choking emergencies. However, the technique should be adjusted for certain individuals to reduce the risk of injury and improve its effectiveness. Here’s how to respond in special situations.

• Pregnant Individuals

For someone who is pregnant, avoid performing abdominal thrusts, especially during the later stages of pregnancy, as they may cause harm. Instead:

1. Stand behind the person.
2. Place your arms under their armpits and around their chest.
3. Position your hands at the center of the breastbone.
4. Deliver quick, firm chest thrusts until the object is expelled or emergency responders arrive.

If the person becomes unconscious, call emergency services immediately and begin CPR if you are trained to do so.

Learn More: How Long Does CPR Training Take? What You Need to Know Before Enrolling

• People with Obesity

If you cannot safely wrap your arms around the person’s abdomen, chest thrusts may be more effective than abdominal thrusts. Follow these steps:

• Stand behind the person.
• Place your hands on the center of the chest, over the lower half of the breastbone.
• Deliver quick inward thrusts until the airway is cleared.
• Continue until the person can breathe or professional medical help arrives.

• Children Over One Year

The Heimlich maneuver can be performed on children over one year of age, but extra care is needed because their bodies are smaller and more delicate. When assisting a child:

• Kneel or stand at the child’s height.
• Use gentle but firm abdominal thrusts.
• Avoid using excessive force.
• Continue until the object is expelled or the child becomes unconscious.

Always seek medical evaluation afterward, even if the child appears to recover fully.

Infants Under One Year

Do not perform the Heimlich maneuver on infants younger than one year. Instead, use a combination of back blows and chest thrusts.

Step 1: Give Five Back Blows

• Support the infant face-down along your forearm.
• Keep the head lower than the chest.
• Deliver five firm back blows between the shoulder blades using the heel of your hand.

Step 2: Give Five Chest Thrusts

• Turn the infant face-up while continuing to support the head and neck.
• Place two fingers in the center of the chest, just below the nipple line.
• Deliver five quick chest thrusts.

Repeat this cycle until:

• The object is removed.
• The infant begins breathing normally.
• Emergency medical personnel take over.

What If You’re Choking Alone?

If you choke when no one is nearby, act quickly to try to clear the airway before you lose consciousness. If you cannot breathe or speak, make a fist and place it just above your navel. Grasp your fist with your other hand and deliver quick inward and upward abdominal thrusts. Repeat the thrusts until the object comes out. If possible, call emergency services or use your phone’s emergency calling feature before you begin.

If abdominal thrusts do not work, use a firm object such as the back of a sturdy chair, the edge of a countertop, a solid table, or a railing. Lean your upper abdomen against the edge and press downward forcefully to create enough pressure to dislodge the object. 

If you cannot continue, lose consciousness, or the object remains stuck, seek emergency medical assistance immediately.

Featured Article: How to Choose the Right Healthcare Training Center Near You

Common Mistakes to Avoid During a Choking Emergency

In a choking emergency, acting quickly and correctly is critical. Avoiding these common mistakes can help prevent further injury and improve the chances of clearing the airway safely.

Performing the Heimlich Maneuver Too Soon

If the person is still coughing forcefully or able to speak, encourage them to continue coughing. Performing abdominal thrusts unnecessarily may interfere with their body’s natural attempt to expel the obstruction.

Using Incorrect Hand Placement

Your fist should be placed just above the navel and below the breastbone. Positioning your hands too high or too low can reduce the effectiveness of the thrusts and increase the risk of injury.

Applying Excessive Force

While abdominal thrusts should be firm, using unnecessary force can cause injuries such as bruising or damage to internal organs, particularly in children and older adults.

Attempting a Blind Finger Sweep

Never insert your fingers into someone’s mouth unless you can clearly see and easily remove the object. Blind finger sweeps often push the obstruction deeper into the airway.

Delaying Emergency Medical Assistance

If the obstruction doesn’t clear quickly or the person loses consciousness, call emergency services immediately. Early medical intervention can be lifesaving.

Final Thoughts

A choking emergency can happen without warning, but an individual must know how to respond to make a lifesaving difference. If you learn first aid, it turns out as an investment in the safety of your family, friends, coworkers, and community. Build your confidence and keep these techniques of heimlich maneuver in mind; you will definitely be better prepared to respond effectively if a choking emergency ever occurs.

Frequently Asked Questions

1. What is the Heimlich maneuver?

The Heimlich maneuver is a first-aid technique that uses abdominal thrusts to help remove an object blocking the airway of a conscious person experiencing severe choking. It should only be performed when the person cannot breathe, speak, or cough effectively.

2. When should you call emergency services for choking?

Call emergency services immediately if the person:

• Cannot breathe, speak, or cough.
• Remains blocked after first aid.
• Becomes unconscious.
• Does not breathe normally after the object is removed.
• Choked on a battery or sharp object.
• Has ongoing chest pain, persistent coughing, or trouble swallowing after the incident.

3. Is the Heimlich maneuver safe for children?

Yes, it can be performed on children over one year of age using controlled abdominal thrusts appropriate for their size. However, infants younger than one year require a different technique involving back blows and chest thrusts.

4. What should I do if the person becomes unconscious?

Call emergency services immediately. Carefully lower the person to the ground and begin CPR if you are trained to do so. Continue until professional medical help arrives or the person starts breathing again.

5. What should you do after the object is removed?

After the airway is clear:

• Encourage slow, steady breathing.
• Make sure the person can speak comfortably.
• Watch for persistent coughing or wheezing.
• Check for chest or abdominal pain.
• Seek medical care if symptoms continue or worsen.
• Watch for trouble swallowing or breathing later.

Even if the person feels fine, consider a medical evaluation after a severe choking episode, especially if multiple abdominal or chest thrusts were needed.