We all hope that we will never be put in a situation where we have to save a child’s life, but it could happen. Children test their physical limits and get into all kinds of dangerous situations. They choke on food, fall off bikes and play equipment, and wade into water unattended.

This step-by-step guide explains the basics of first aid for choking and CPR, but don’t rely on it as your only source of information. Take a few hours to take an infant and child CPR course to learn and practice the proper techniques. These techniques differ depending on the age of the child, and performing them incorrectly can be harmful.

If you would like to attend an in-person class in your area, please visit Red Cross websiteOpens a new window or call 800-733-2767 (800-RED CROSS). Or, if you prefer an online offering, BabyCenter Courses offers self-paced CPR course for babies and childrenOpens a new window which you can take home.

Be prepared for worst case scenarios

Learn how to deal with an emergency directly from an emergency physician in our CPR and Choking Course

The following instructions are for children aged 1 to 12 years. To learn what to do when a baby under 12 months is choking or needs CPR, see our visual guide to infant CPR.

What to do if your child is choking

Step 1: Quickly assess the situation

If the child suddenly cannot cry, cough or speak, there is probably something blocking their airway and you will need to help them out. They may make strange sounds or make no sound at all when they open their mouths. Their skin may turn bright red or blue.

If they cough or grunt, it means their airways are only partially blocked. If this is the case, let them continue to cough. Coughing is the most effective way to clear the blockage.

Call 911 or your local 911 number if:

• The child is unable to cough up the object. Ask someone else to call 911 or your local emergency number while you begin back thrusts and abdominal thrusts (see step 2 below). If you are alone with your child, give two minutes of care and then call 911.
• You suspect that the child’s airway is closed because his throat is swollen. They may have an allergic reaction – to food or insect bites, for example – or they may have an illness, such as croup.
• You witnessed a child suddenly collapse.

Step 2: Try to move the object with back kicks and abdominal crunches

First do the back kicks.

If the child is conscious but cannot cough, speak or breathe or is turning blue, stand or kneel slightly behind them. Provide support by placing one arm diagonally across their chest and leaning them forward.

With the heel of your other hand, hit the child hard between the shoulder blades. Each blow to the back should be a distinct and clear attempt to remove the obstruction.

Take five of these backstabs.

Then do abdominal thrusts.

Stand with one foot in front of the other, or kneel behind the child and wrap your arms around the child’s waist.

Locate their belly button with one or two fingers. Make a fist with your other hand and place your thumb in the middle of the child’s abdomen, just above the navel and well below the lower tip of the sternum.

Grasp the fist with the other hand and give five quick upward punches to the stomach. Each abdominal thrust should be a separate and distinct attempt to dislodge the obstruction.

Repeat back kicks and abdominal thrusts.

Continue alternating five back and five abdominal thrusts until the object is dislodged or the child begins to cough violently, talk, cry, breathe, or become unresponsive. If they cough, encourage them to cough up the object.

If the child does not respond:

If the choking child is unresponsive, you will need to perform a modified version of CPR:

1. Place the child on his back on a firm, flat surface. Kneel next to your upper chest. Place the heel of one hand on their sternum (breastbone), in the center of their chest. Place the other hand directly on top of the first hand. Try to keep your fingers away from your chest by interlacing them or holding them up.
2. Give 30 compressions by pushing the baby’s sternum down about 2 inches. Allow the chest to return to its normal position before starting the next compression.
3. Open the child’s mouth and look for a blockage. Never put your finger in their mouth unless you can actually see the blockage. If you can’t see them and put your finger in their mouth, you could accidentally push the object further down their throat. If you see anything, remove it with your fingers.
4. If you cannot clear the blockage and the child is still unresponsive, give two rescue breaths. Tilt the child’s head with one hand and gently lift the chin with the other. This will open their airways. Plug your child’s nose, place your mouth over theirs, and breathe into their lungs until you see their chest rise.
5. If you do not see the chest rising, repeat the cycle of 30 compressions, checking for the object and attempting two rescue breaths until the object is removed and the child is breathing on their own or help arrives.

After the incident, have the child examined by a medical professional.

How to perform CPR on a child

CPR stands for cardiopulmonary resuscitation. This is a lifesaving measure you can take to save someone who is not showing signs of life, meaning they are unconscious and not breathing.

CPR uses chest compressions and rescue breathing to keep oxygen-rich blood circulating through the brain and other vital organs until the child is revived or emergency medical personnel arrive. Keeping the oxygen-enriched blood circulating helps prevent brain damage—which can happen within minutes—and death.

If you haven’t been trained in CPR (which includes chest compressions and rescue breathing), you should just try doing chest compressions.

Follow these steps:

Step 1: Check the child’s condition

Touch the child’s shoulder and call his name. If they are unresponsive, have someone call 911 or your local emergency number. If you are alone with your child, give two minutes of care as described below, then call 911 yourself.

Place the child on his back on a firm, flat surface. Kneel beside them.

Make sure they are not bleeding profusely. If they are, take measures to stop the bleeding by applying pressure to the area. Do not give CPR until the bleeding is under control.

Step 2: Do 30 chest compressions

Place the heel of one hand in the center of the child’s chest and the other hand on top. Try to keep your fingers off their chest by interlacing them or holding them up. Position your body so that your shoulders are directly over your hands. (For a small child, you can use the one-handed CPR technique: Place the heel of one hand in the center of the child’s chest.)

Keeping your arms straight, push straight down about 2 inches, then let your chest return to its normal position. Push hard and fast. Compressions should be smooth, not jerky.

Do 30 chest compressions at a rate of two per second. Count out loud: “One and two and three and…”, pushing as you say the number and lifting as you say “i”. (The song “Stayin’ Alive” has a beat to boot, as does Adele’s recent hit “Set Fire to the Rain.”)

“When giving chest compressions, it’s important to push down hard and quickly using your upper body weight,” says Liz Donner, MD, a pediatric hospitalist and member of BabyCenter’s medical advisory board. “Keep your arms straight, but release all pressure briefly to allow the heart to fill with blood between each compression. Practicing on a manikin is extremely helpful to get the feel for this.”

Continue giving compressions until:

• You notice an obvious sign of life.
• The AED (Automated External Defibrillator) is ready for use.
• You have performed approximately 2 minutes of CPR and another person is available to take over.
• You have performed approximately 2 minutes of CPR, you are alone with your child, and you need to call 911 or the designated emergency number.
• EMS (emergency medical services) personnel take over.
• You are too tired to continue.
• The scene becomes uncertain.

Even if the child appears to be fine until help arrives, a medical professional will need to check the child to make sure the airway is completely clear and that no internal injuries have occurred.

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