First aid for an infant who is choking

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Clinical situation:

You are at home. A frightened neighbor has come running to you for help. She said her 8-month-old son was playing with toys and suddenly began coughing and choking heavily. Arriving at her apartment, you found a pale, lethargic infant with difficulty breathing and unable to cry.

Equipment for the practical skill:

• protective medical gloves;
• СPR simulator “An infant”.

The procedure for performing a practical skill

• Make sure the scene is safe.
• Check the infant condition:
  • take the infant in your arms;
  • call the infant loudly;
  • determine the presence and effectiveness of cough:
    • ineffective cough: inability to vocalize, quiet or silent cough, inability to breathe, cyanosis, loss of consciousness;
    • effective cough: crying or verbal response to treatment, loud crying, ability to inhale before coughing, full consciousness.
• Instruct the person standing nearby (“the infant’s mother”) to call an ambulance and inform the dispatcher about the child’s asphyxia and other circumstances of the incident.
• Sit, kneel or stand to give first aid care to a choking infant, as long as you are able to support the infant on your thigh with the infant’s head lower than his or her chest. If the infant is large or your hands are small, you may find it easiest to sit or kneel.

• Give 5 back blows for the infant:
  • place your forearm along the infant’s back, cradling the back of the infant’s head with your hand;
  • place your other forearm along the infant’s front, supporting the infant’s jaw with your thumb and fingers;
  • turn the infant over so that he or she is face-down along your forearm.
  • lower your arm onto your thigh so that the infant’s head is lower than his or her chest; 
  • continue to support the infant’s jaw with the thumb and fingers of one hand while you firmly strike the infant between the shoulder blades with the heel of your other hand;

• • each back blow should be separate from the others.
• Give 5 chest thrusts for the infant:
  • place one hand along the infant’s back, cradling the back of the infant’s head with your hand;
  • while continuing to support the infant’s jaw with the thumb and fingers of your other hand, support the infant between your forearms and turn the infant over so that he or she is face-up along your forearm;
  • lower your arm onto your thigh so that the infant’s head is lower than his or her chest;
  • place the pads of two fingers in the center of the infant’s chest, on the breastbone just below the nipple line;
  • press down about 1½ inches (4 cm) and then let the chest return to its normal position, keeping your fingers in contact with the breastbone;

• • each chest thrust should be separate from the others.
• Continue sets of 5 back blows and 5 chest thrusts until
  • the infant can cough forcefully, cry or breathe:
    • place the infant in a safe side-lying position;
    • monitor the infant's condition;
    • arrange to take or send the casualty to the hospital, even if he seems to have recovered completely;
  • o   or the infant becomes unresponsive – start CPR:
    • carefully lower him or her to the ground and begin CPR, starting with chest compressions;
    • after each set of chest compressions and before attempting rescue breaths, open the person's mouth and look for the object;
    • if you see an object in the person's mouth, remove it using your finger.