If a child cannot breathe, speak or cough, treat it as severe choking and act immediately.

Recognise choking

  • Mild (effective) cough: They can cough/cry and draw breath. Encourage coughing, stay close, and be ready to act.
  • Severe (ineffective) cough: Silent or very weak cough, struggling or unable to breathe, possible colour change, panicked look, clutching at throat. Start first aid straight away.

Step-by-step first aid (severe choking)

1) Give up to 5 back blows

  • Stand or kneel to the side and slightly behind the child.
  • Support their chest with one hand and lean them forward so the object can come out of the mouth.
  • With the heel of your other hand, deliver up to five sharp blows between the shoulder blades.
  • Check after each blow to see if the obstruction is cleared.

2) Give up to 5 abdominal thrusts

  • If back blows don’t work, stand behind the child and place your arms around their waist.
  • Make a fist and place it just above the belly button (well away from the lower end of the breastbone).
  • Grasp your fist with your other hand and pull inwards and upwards sharply.
  • Give up to five abdominal thrusts, checking after each thrust.

Do not use abdominal thrusts on babies under 1 year. Use back blows and chest thrusts for infants.

3) Call 999 and keep alternating

  • If the blockage hasn’t cleared, call 999 (use speakerphone if you’re alone).
  • Continue cycles of up to 5 back blows and up to 5 abdominal thrusts until the object comes out, the child breathes normally, or help arrives.

If the child becomes unresponsive

  • Call 999/112 immediately (speakerphone if alone).
  • Start CPR:
    • Open the airway and remove any visible obstruction (no blind finger sweeps).
    • Give 5 rescue breaths, then 30 chest compressions.
    • Continue 30:2 (compressions:breaths) and follow call-handler prompts.
  • Check the mouth between cycles; remove any object you can see easily.

Aftercare (once breathing again)

  • Even if the object is expelled and the child seems fine, seek medical assessment as abdominal thrusts and severe choking can cause internal injury.
  • Monitor for ongoing breathing difficulty, coughing, chest pain, or voice changes.

Important points

  • Do not give food or drink during choking.
  • Do not do blind finger sweeps.
  • Do not hold the child upside down.
  • Use child-appropriate force, firm, controlled blows/thrusts.

Learn with Med Learn Training

This guidance supports, not replaces, formal training. We deliver regulated paediatric first aid across the UK, including choking management and child CPR/AED. Tell us about your setting and we’ll recommend the right course.