$Unique_ID{PAR00037}
$Pretitle{}
$Title{Medical Advice:  Choking}
$Subtitle{}
$Author{
Editors of Consumer Guide
Chasnoff, Ira J}
$Subject{choke chokes Choking Emergency breathing breathe cry out speak
speaking blue Skin blocked air passage convulsive limp unconscious peanut
popcorn hard candies tablets glass eyes beads toys vomiting croup tracheotomy}
$Log{}

Your Child:  A Medical Guide


Choking


     Emergency Quick Reference

     SYMPTOMS
     - Inability to breathe
     - Inability to cry out or speak
     - Skin turns blue

     IMPORTANT
     - If an object completely blocks the air passage, you have only a few
       minutes to reestablish an airway before brain damage or death occurs.

     EMERGENCY TREATMENT FOR AN INFANT
     1. Immediately call the police or paramedic squad for help.
     2. Give the infant one minute to cough up the object.  If
        unsuccessful . . .
     3. Lay the baby face down on your forearm, with your hand supporting his
        head.  The baby's head should be lower than his chest.
     4. Using the heel of your hand, give four quick blows to the baby's back
        between the shoulder blades. (See Figure 1.)
     5. Place your free hand on the back of his head and, holding him between
        your forearms, turn him face up, with his head still lower than his
        body. (See Figure 2.)
     6. Put two fingertips on the baby's chest between the nipples.  Press
        quickly and fairly hard four times. (See Figure 3.)
     7. Repeat the cycle of four blows and four presses for as long as the
        baby is still choking.  Don't give up.
     8. If breathing stops, begin mouth-to-mouth resuscitation once the airway
        is clear.

     EMERGENCY TREATMENT FOR AN OLDER CHILD
     1. Immediately call the police or paramedic squad for help.
     2. Give the child one minute to cough up the object.  If
        unsuccessful . . .
     3. Stand behind the child.
     4. Reach around the child, lock your hands together, and place them just
        below his breastbone.
     5. Use a quick upward motion while pulling his abdomen in.
     6. Repeat if necessary.
     7. If breathing stops, begin mouth-to-mouth resuscitation once the airway
        is clear.

     PRECAUTIONS
     - Do not abandon your efforts to help a choking child until medical help
       arrives.  The obstructing object may be only partially blocking the
       airway, even though you may not think so.
     - Do not give mouth-to-mouth resuscitation until the object has been
       removed.
     - Do not try to reach into the throat to remove the object unless all
       other, safer methods have failed.
     - Prevent choking.  Examine all toys for loose eyes, beads, and small
       parts.  Keep tablets under lock and key.  Do not give peanuts, popcorn,
       or hard candies to toddlers, and keep such foods out of their reach.
     - A baby who has been vomiting should be placed on his stomach to lessen
       the chance of choking on the vomit.


     Choking is one of the few true emergencies of childhood--minutes may
determine life or death.  Choking is caused when the airway becomes
obstructed, resulting in inability to breathe.  A swallowed object is the most
common cause of choking.
     Choking is easily identified by two key signs:  the child frantically
tries to breathe, and the child is not able to cry out or to speak.  If
choking continues, the child quickly becomes blue, convulsive, limp, and
unconscious.  If an object completely blocks the air passage, you have only a
few minutes to reestablish an airway before brain damage or death can occur.
     Objects that present a particular danger of choking if a child puts them
in his or her mouth are peanuts, tablets, glass eyes of toy animals, hard or
hard-coated candies, beads, popcorn, and tiny toys or small parts from toys.
Solid particles of food from the stomach may choke a child who breathes in
while vomiting.  A baby who has been vomiting is safest from choking when
lying on his or her stomach.
     Choking may also occur in a child who has croup.  However, it is easy to
tell choking from croup from other choking by one important distinction--a
child choking on a foreign object cannot speak or cry out, while a child with
croup can do both.  Choking caused by croup is treated differently from other
choking (see the article on Croup for treatment of that form of choking).

SIGNS AND SYMPTOMS

     Choking on an object is easily identified by two major signs:  frantic,
unsuccessful efforts to breathe and inability to talk or cry out.

HOME CARE

     Seconds count!  Scream for help.  A second adult on the scene should
phone the police or paramedic squad for help.  (Police are usually more
quickly available in most communities than an ambulance, the fire department,
or a doctor.)
     Give the child one minute to cough up the object.  If the child's efforts
are unsuccessful, perform the following maneuvers.
     If the child is an infant:  Lay the baby face down on your forearm, with
your hand supporting his head.  The baby's head should be lower than his
chest.  Using the heel of your hand, give four quick blows to the baby's back
between the shoulder blades.  Then place your free hand on the back of the
baby's head and, holding him between your forearms, turn him face up, with his
head still lower than his body.  Put two fingertips on the baby's chest
between the nipples.  Press quickly and fairly hard four times.  (You are
trying to squeeze the upper abdomen and lower chest, which will force up the
diaphragm so that air is pushed out of the lungs.  The rush of air out of the
lungs may pop the object out of the airway.) Repeat the cycle of four blows
and four presses for as long as the baby is still choking.  Don't give up.
     If the child is a toddler or an older child:  Stand behind the child.
Reach around the child, lock your hands together, and place them just below
his breastbone.  Use a quick upward motion while pulling his stomach in.  (You
are trying to squeeze the upper abdomen and lower chest, which will force up
the diaphragm so that air is pushed out of the lungs.  The rush of air out of
the lungs may pop the object out of the airway.)  Repeat if necessary.
     Only if these efforts are unsuccessful should you attempt to get the
object out with your fingers or tweezers (there is a danger of pushing the
object farther into the airway).
     If breathing stops, begin resuscitation once the airway is clear.
Continue until trained help arrives.

PRECAUTIONS

  -  When an object completely blocks the air passage, the child seldom
     reaches a doctor in time.  However, the object may be only partially
     blocking the airway, even though you may not think so.  Do not abandon
     your efforts to help a choking child until medical help arrives.
  -  Never give mouth-to-mouth resuscitation until the obstructing object
     has been removed.  To do so may force the object farther down the
     throat.
  -  A baby who has been vomiting should be placed on his stomach to lessen
     the chance of choking on the vomit.
  -  Prevention of choking is most important.  Examine all toys for loose eyes
     or other small parts.  Keep tablets under lock and key.  Do not give
     peanuts, popcorn, or hard candies to toddlers, and be sure to clean up
     after adult parties before children can wander unattended into a room and
     find such hazardous treats.

MEDICAL TREATMENT

     The doctor may need to perform a tracheotomy (make an opening through the
neck into the windpipe) on the spot.  Then oxygen, artificial respiration, and
intravenous fluids will be administered.

RELATED TOPICS:  Convulsions with fever; Convulsions without fever; Croup;
Swallowed objects.