Recognize it
- The universal sign: hands clutching the throat; a panicked, confused, or surprised look.
- Weak cough or no cough; high-pitched squeaking or no sound; can't speak, cry, or cough.
- Skin may look flushed at first, then turn pale or bluish as oxygen drops.
The cough test: if the person can cough forcefully, talk, cry, or laugh, let them keep coughing — a strong cough clears the airway better than anything you can do. Step in only when they can't cough, talk, cry, or laugh forcefully.
What to do
Conscious adult or child
- 1Get 911 called. If someone else is there, have them call while you start care. If you're alone, give care first, then call — don't delay to find a phone.
- 2Give 5 back blows — stand to the side and behind, bend the person forward at the waist, and strike between the shoulder blades with the heel of your hand.
- 3Give 5 abdominal thrusts (the Heimlich) — stand behind, fist just above the navel, grasp it with the other hand, and thrust quick and upward.
- 4Alternate 5 back blows and 5 thrusts until the object comes out or the person becomes unresponsive.
- 5If they become unresponsive, lower them safely and begin CPR. Remove an object only if you can actually see it — never sweep blindly.
Conscious infant (under 1)
- 1Hold the baby facedown along your forearm, head lower than the trunk, supporting the head and jaw; rest your arm on your thigh.
- 2Give 5 back blows between the shoulder blades with the heel of your hand.
- 3Turn the baby faceup, head still lower than the trunk, and give 5 chest thrusts with two fingers on the breastbone — never abdominal thrusts on an infant.
- 4Alternate until the object is out or the baby becomes unresponsive, then begin infant CPR. Get emergency help called.
When to use it
- Mealtime emergencies at camp — the classic scenario is a peer choking on food during a meal.
- Small children on family campouts putting objects in their mouths.
- Any time someone eats fast, talks with a full mouth, or laughs while eating.
Common mistakes & safety
- Don't do abdominal thrusts on a baby. Their organs are fragile — use back blows and chest thrusts instead.
- Don't do a blind finger sweep. You can push the object deeper — only remove one you can actually see.
- Don't interfere with an effective cough. Let a forceful cough continue; stay ready to act the moment it weakens.
- An unresponsive choking person needs CPR immediately, not more thrusts — that transition is the key move.
- Anyone who received abdominal thrusts should be checked by a professional afterward — the thrusts can cause internal injury even when they work.
- The guidance changed in 2025. Adults are now explicitly covered, and the sequence for conscious adults and children is back blows then abdominal thrusts.
Going deeper
- Why they work. Both spike the air pressure behind the object to pop it out — back blows jar it loose, abdominal thrusts drive the diaphragm up like a piston.
- Choking alone. A lone choking adult can do self-abdominal-thrusts against a chair back or a fist to the abdomen.
- Fluid vs. solid. Back blows and thrusts are for a solid blockage; a fluid (vomit, blood, water) is cleared by turning the person on their side to let the airway drain, then rescue breathing or CPR if needed.
Official source
Adult and child choking — American Red Cross →Reflects the 2025 American Heart Association CPR guidelines. This is general information, not a substitute for hands-on training — take a certified first-aid/CPR course.