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First Aid for a Choking Child

Conscious Child

If your child is unable to make a sound, cough, or cry, or her face turns blue, you must act fast to dislodge object.

Under Age 1

1. Place the infant facedown along your forearm, her head and neck well-supported in your hand and lower than her trunk.

2. Brace that arm against your thigh and with the heel of the opposite hand, deliver up to five quick, firm blows between her shoulder blades.

3. If the object doesn't pop out or if she still isn't coughing or crying, carefully turn her face-up on a firm surface, or on your lap or forearm, again supporting her head and neck. Place the middle and ring fingers of your free hand slightly below her nipples and in the center of the breastbone. Give five quick thrusts, pushing downward on the chest.

4. Repeat above steps, alternating back blows and chest thrusts, until the object becomes dislodged or you're able to see the object in her mouth and carefully sweep it out with your fingers.

Ages 1 to 3

1. Place the child on the floor on his back, straddle his thighs, and put the heels of your hands  -- one over the other  -- against his abdomen, above the navel and below the rib cage. Press quickly and firmly upward into the abdomen up to five times. Check the mouth and remove any object you can see.

2. Repeat if necessary.

Over Age 3

1. Perform the Heimlich maneuver: Stand or kneel behind the child, arms around his middle. Place your fist thumb-side against his abdomen just above the navel; grasp the fist with your other hand.

2. Calmly explain what you're about to do. Give up to five quick, firm thrusts, inward and upward, avoiding chest bones.

3. Repeat if necessary.

Unconscious Child

If the child isn't breathing and has lost consciousness, but you can feel a pulse, begin these lifesaving steps immediately:*

1. Place infant or child face-up on floor. Make sure her tongue isn't blocking her airway by lifting the jaw so the tongue comes forward. If you can see an object, sweep it out with your index finger. Tilt her head back.

2. Look, listen, and feel for breathing. If you can't detect any, with a baby under age 1, place your mouth tightly over her mouth and nose. Over age 1, seal your lips around her mouth and pinch her nose shut.

3. Give two slow breaths; check pulse. If her chest doesn't rise but a pulse is present, object may still be blocking the airway. Retilt the head and repeat breathing steps 1 to 3.

4. If chest still doesn't rise, begin back blows and/or chest thrusts (see above) to dislodge object. For all children 1 and over, use steps for ages 1 to 3, above. If chest rises, air is getting through; continue to give one breath every three seconds, checking pulse until help arrives or child is breathing.

*If you can't feel a pulse, take steps above; if air is getting through, begin cycles of five chest compressions to one breath (CPR).

This guide explains the first steps in treating a choking child and is not intended as a substitute for a first aid manual or class.

Source: Steven Shelov, M.D., chairman of pediatrics, Maimonides Medical Center, State University of New York, Brooklyn, and coeditor of the American Academy of Pediatrics' Guide To Your Child's Symptoms.

Common Choking Foods

These are hazards for kids 6 and under. Depending on your child's age, either avoid them or follow the serving advice. Be especially vigilant with kids learning to feed themselves who can't yet thoroughly chew food.

Hot Dogs

Skin holds meat together, making it more likely to be swallowed whole and obstruct the airway. Don't feed to a child under age 3. For older children, remove skin and cut into very tiny pieces, lengthwise and crosswise.

Carrots

Too hard for tiny mouths to chew; pieces can get stuck in airway. Only serve pureed carrots to kids 2 and under. For kids 3 and up, cook carrots until mushy.

Grapes

Can be swallowed whole and get lodged in airway. For children age 4 and under, serve deskinned, quartered, seedless grapes.

Raisins

Young kids can't chew properly; may be inhaled into the airway. Don't give to kids under age 3.

Nuts

Too difficult for small mouths to chew; tiny pieces can be easily inhaled into the airway. Don't give to children age 6 and under.

Popcorn

Kids can swallow unpopped kernels. Don't give to children under age 4. For ages 4 to 5, remove all unpopped kernels.

Apples and Pears

Difficult to chew, especially if not peeled. Don't give to kids under age 4 unless pureed or cooked until soft. For kids 4 to 6, peel and cut into small pieces.

Hard Candy

Hard candy is slippery, so it's easily inhaled into the airway. Never give to children 4 and under.

Celery

Stringy pieces can get caught in the airway. Never give raw to kids 4 and under. For ages 5 to 6, cut raw celery into bite-size pieces. For ages 3 and 4, cook until soft; serve small pieces.

Peanut Butter

Big clumps can become lodged in the airway. Never give to children under age 4. For kids 4 to 6, spread a thin layer on bread; never let them eat spoonfuls.

Play It Safe

Any toy with small, removable parts is a choking hazard for kids under age 3. To determine if a toy has pieces that could be a choking hazard, check the product's packaging for any warning labels (they'll be separate from the information that lists the age at which a child is ready to use it developmentally). A toy may be unsafe if it fits through a 1 3/4-inch diameter toilet-paper tube. Keep older siblings' toys  -- anything small, such as little cars, game pieces, building blocks or bricks, and even large toys with small removable parts  -- out of a toddler's reach. Four common nonfood choking hazards are:

Coins

Their shininess makes them a natural target for small kids' curious hands and mouths. Don't leave loose change or a purse within the reach of kids 3 and younger.

Latex Balloons

An uninflated balloon or pieces of a popped balloon can easily be swallowed or inhaled. Latex balloons are especially lethal because the material completely obstructs airways. Never let kids under age 6 play with balloons, uninflated or inflated, without supervision. Use Mylar balloons instead of latex; should it burst, Mylar breaks into large pieces, whereas latex breaks into small ones. If either type pops, dispose of all the pieces immediately.

Marbles and Small Balls

These are easily popped into little mouths and swallowed. Keep away entirely from any child 3 or younger.

Button-Size Batteries

If ingested, battery acid can damage digestive tract. Never allow kids age 4 or younger to play unsupervised with any toy or device that has small batteries in it.

Source: Jacqueline Jones, M.D., director of pediatric otolaryngology at New York Hospital/Cornell University Medical College, New York, NY.

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