Infant First Aid for Choking and CPR:
An Illustrated Guide

Article and photos by The Baby Center
Copyright © BabyCenter.com.
All rights reserved.
Used with permission.

It may seem scary, but babies choke all the time. They're constantly putting objects in their mouths, and they have trouble swallowing certain foods until they're over a year old. Babies can lose consciousness within a matter of minutes once they start choking , so it's important to learn how to clear a blocked airway and to administer CPR (cardiopulmonary resuscitation) if necessary. We've compiled this basic step-by-step guide to show you what to do in an emergency, but please don't rely on it as your sole source of CPR information. Set aside a day to take an infant/child CPR course — it's one of the most important things you can do to protect your baby from harm. Airway obstruction injuries (choking, suffocation, and strangulation) are a leading cause of accidental death in children under age 14. You can find a class in your area by calling your local chapter of the American Red Cross (check the white pages).

The following instructions are for children under age 1. To find out what to do when a toddler chokes, see our illustrated guide to toddler CPR.

Enter the amount of food under intake, if nursing perhaps enter the length of time, record the naps and sleeping, enter when the child vomits/spits under emesis and try to estimate the amount, but remember that it always looks like it's more than it is.  To get a feel for quantities, try spilling an ounce or two of plain water on counter or bare floor, this will give you a good idea of what it looks like and help you get used to how much your child might be spitting.  Mark any urination and bowel movements the child has under voids and BM's and finally record your comments for the day, any of the feeds, bm's etc.

Infant Choking

Step 1: Figure out what's causing the problem

If your baby is suddenly unable to cry or cough she probably has something blocking her airway, and you will need to help her get it out. She may make odd noises or no sound at all while opening her mouth, and her skin may turn bright red or blue. If she is coughing or gagging, her airway is only partially blocked, most likely because some food or liquid has gone down her windpipe instead of her esophagus, the tube that leads to the stomach. In this case, let her continue to cough; this is the most effective way of dislodging the blockage. (If you suspect that an allergic reaction or an infection, such as croup, has closed off your baby's airway by causing her throat to swell up, call 911 immediately. You will not be able to clear her airway yourself.) If your baby cannot clear her airway on her own and you believe something is trapped there, ask someone to call 911 immediately, and begin Step 2.

Step 2: Give back blows and chest thrusts

If your baby can't clear her airway on her own and you believe something is trapped there, carefully position her face down on your forearm, with your hand supporting her head and neck, and rest the arm holding the baby on your thigh. Support her so that her head is lower than the rest of her body. Then give her five back blows between her shoulder blades with the heel of your hand to try to dislodge the object. Next, place your free hand (the one that had been delivering the back blows) on the back of her head and along her spine and carefully turn her over supporting the head and neck. Support her face-up, with your forearm resting on your thigh, keeping her head lower than the rest of her body. Place two or four fingers in the center of your baby's breastbone and give five chest thrusts, each about 1/2 to 1 inch deep. Continue the series of back blows and chest thrusts until the object is forced out, she begins to breathe on her own, she becomes unconscious, or advanced medical help arrives and takes over.

Stop if your baby starts to cough and let her try to cough up the obstruction; coughing is the most effective way of dislodging the blockage. If the object comes out but your baby is still not breathing, check her pulse, and start rescue breathing or CPR.

Rescue Breathing and CPR

Step 1: Check your baby's breathing and pulse

Swiftly but gently place your baby on her back on a firm surface. Make sure her airway is open by lifting her chin gently, tipping her head back slowly. For at least five seconds, look, listen, and feel for signs of breathing. To check for a pulse, lift your baby's arm above her head. Place your index and middle fingers firmly on the inside of her arm, halfway between the shoulder and elbow. Feel for a pulse for at least five seconds.

Step 2: If your baby is not breathing but has a pulse, begin rescue breathing

Cover her nose and mouth with your mouth and exhale into her lungs until you see her chest rise. Remember that a baby's lungs are much smaller than yours, so it will take much less than a full breath to fill them; for example, newborns only require a mouthful of air. Exhaling too much air into a baby's lungs could damage them. (If her chest doesn't rise, her airway is blocked. Resume the back blows and chest thrusts.) Give one slow breath every three seconds. Stop every 20 breaths and check her pulse. Continue rescue breathing until she starts breathing on her own or until you can no longer find a pulse. If you can't feel a pulse, begin Step 3 below.

Step 3: If your baby is not breathing and has no pulse, begin CPR

With your baby still lying on her back, locate her sternum again: Imagine a line between her nipples, and measure one finger-width down from the middle of that line. Position two fingers on that spot, and depress the chest between 1/2 and 1 inch. Repeat five times within about three seconds. (Count "one and two and three.") With your baby's head still tilted, cover her nose and mouth with your mouth, and give one slow, gentle breath. Repeat the cycle of compressions and breathing about 10 times, then stop and check for a pulse. Call 911 now if no one has done so for you. Resume CPR, checking for a pulse every few minutes, until help arrives or your baby resumes breathing.

Once your baby does resume breathing, get her to an emergency room as soon as possible. Even if she seems fully recovered, a doctor needs to make sure that her airway is completely clear and that she has not sustained any internal injuries.

Article and photos by The Baby Center
Copyright © BabyCenter.com. All rights reserved.
Used with permission