STOP CHOCKING

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How to Perform the Heimlich Maneuver: A Step-by-Step Guide

Choking is a life-threatening emergency that occurs when an object, food, or another foreign item becomes lodged in the airway, obstructing normal breathing. If not cleared quickly, choking can result in brain damage or death. The Heimlich maneuver (also called abdominal thrusts) is a first-aid technique used to help clear a blocked airway in a person who is choking.

In this guide, we’ll explain how to perform the Heimlich maneuver on adults and children over 1 year old. We’ll also cover how to help a choking infant, as the technique varies slightly for babies.

Recognizing Choking: Signs and Symptoms

Before performing the Heimlich maneuver, it’s important to identify that someone is actually choking. A person who is choking may exhibit one or more of the following signs:

  • Coughing forcefully (early stages)
  • Inability to speak or breathe
  • Hands clutching the throat (universal sign for choking)
  • Wheezing or gasping for air
  • Turning blue (sign of oxygen deprivation)
  • Loss of consciousness (if the airway remains blocked for too long)

If a person cannot breathe, speak, or cough forcefully, they are likely choking and need immediate help.

How to Perform the Heimlich Maneuver on an Adult or Child Over 1 Year Old

1. Assess the Situation

  • Is the person coughing or speaking? If they are coughing or speaking, encourage them to keep coughing forcefully to clear the airway on their own.
  • Is the person unable to cough, speak, or breathe? If they can’t, or if they are making high-pitched sounds or wheezing, they need help.

2. Call 911

  • If the person is choking and unable to breathe, call 911 or your local emergency number immediately. If possible, have someone else call while you perform the Heimlich maneuver.

3. Position Yourself Behind the Person

  • Stand behind the choking person. For an adult, you’ll need to be tall enough to reach their midsection comfortably.
  • Place your arms around their waist, with your dominant hand in a fist.

4. Make a Fist

  • Form a fist with your dominant hand and place the thumb side of the fist just above the person’s navel (belly button), in the upper abdomen.

5. Grasp Your Fist with Your Other Hand

  • Using your non-dominant hand, grasp your fist to hold it in place securely.

6. Perform Abdominal Thrusts

  • Give quick, inward and upward thrusts: With the force coming from your entire body, press your fist inward and upward into the person’s abdomen. The motion should feel like you’re trying to push the diaphragm upward, which will force air out of the lungs and create enough pressure to expel the object blocking the airway.
    • The thrusts should be quick and forceful, but avoid hitting the person too hard or causing injury.
    • Repeat the thrusts until the object is expelled or the person becomes unconscious.

7. If the Person Becomes Unconscious

  • If the person loses consciousness, lower them to the ground gently and begin CPR immediately (30 chest compressions followed by 2 rescue breaths).
  • If you’re trained in CPR, continue with chest compressions. You may be able to dislodge the object while performing compressions, or you might be able to check the mouth for the obstruction.

8. Continue Until Help Arrives

  • Continue performing the Heimlich maneuver or CPR until medical help arrives or the person starts breathing on their own.

How to Perform the Heimlich Maneuver on a Pregnant Woman

For a pregnant woman or someone with a larger belly, the Heimlich maneuver needs to be modified slightly to avoid putting pressure on the abdomen:

  1. Position yourself behind the person as you would for a non-pregnant adult.
  2. Place your hands just below the ribcage, at the base of the breastbone (sternum), rather than around the abdomen.
  3. Perform chest compressions (instead of abdominal thrusts) by pressing inward and upward, using your hands to apply firm pressure to the chest in the direction of the diaphragm.

These chest compressions should help expel air from the lungs and dislodge the obstruction.

How to Perform the Heimlich Maneuver on a Child (1 Year to Puberty)

Performing the Heimlich maneuver on a child requires a few modifications to account for their smaller size:

  1. Position Yourself Behind the Child
    • For a child, position yourself behind them, kneeling if necessary to be at their level.
  2. Place Your Hands
    • Make a fist with your dominant hand and place the thumb side of the fist against the child’s upper abdomen, above the navel.
  3. Give Abdominal Thrusts
    • Grasp your fist with your other hand and give quick, inward, and upward thrusts. The thrust should be strong enough to expel the object but gentle enough to avoid injury.
  4. If the Child Becomes Unconscious
    • If the child loses consciousness, lower them to the ground and begin CPR (30 chest compressions, then 2 rescue breaths).

How to Perform the Heimlich Maneuver on an Infant (Under 1 Year)

For infants, the Heimlich maneuver is different from that used for older children and adults, as their bodies are much smaller and more fragile. For infants, use back blows and chest thrusts instead of abdominal thrusts.

1. Position the Infant

  • Hold the infant face down on your forearm, supporting the head and neck with your hand. The infant should be lying across your forearm, with their head lower than their chest to allow gravity to help with expulsion of the object.
  • Keep the infant’s head and neck stable, making sure the airway is open.

2. Give Back Blows

  • Using the heel of your hand, give five firm back blows between the infant’s shoulder blades.
    • Hold the infant securely with one arm and use the heel of your hand to deliver the back blows. These should be forceful enough to help expel the object but gentle enough to avoid injury.

3. Chest Thrusts (if back blows don’t work)

  • If the object does not come out after the back blows, turn the infant face up while supporting their head and neck.
  • Place two fingers in the center of the infant’s chest just below the nipple line and give five quick chest thrusts.
    • Thrust downward, using enough pressure to force air from the lungs, which might dislodge the object.

4. Repeat if Necessary

  • Alternate between back blows and chest thrusts until the object is expelled or the infant starts breathing.
  • If the infant becomes unconscious, begin infant CPR (30 chest compressions and 2 rescue breaths) and call 911 immediately.

Additional Considerations and Safety Tips

  • Don’t perform abdominal thrusts on babies, small children, or anyone under 1 year of age. Always use back blows and chest thrusts for infants.
  • Be aware of choking hazards: Encourage children to eat slowly, chew food properly, and avoid foods that are likely to cause choking (e.g., whole grapes, nuts, popcorn).
  • Know when to call 911: If the person is not able to breathe, loses consciousness, or the object is not expelled after performing the Heimlich maneuver, call 911 immediately. Emergency medical professionals will be able to assist further.
  • Training: While this guide provides a basic overview, it’s highly recommended to take a certified first-aid and CPR course from organizations like the American Red Cross or American Heart Association. These courses will teach you the Heimlich maneuver in more detail and give you the opportunity to practice these techniques on dummies in a safe environment.

Conclusion

The Heimlich maneuver is a vital first-aid skill that can help save the life of someone who is choking. Knowing when and how to apply this technique—whether for an adult, child, or infant—can make all the difference in an emergency. With the proper knowledge and quick action, you can help clear the airway and restore breathing to someone who is in serious danger.

Always remember to stay calm, act quickly, and call for professional medical help as soon as possible.