Choking first aid starts with coughing, back blows and thrusts

The International Federation of Red Cross and Red Crescent Societies (IFRC) advised an escalating response to choking in its 2025 first-aid guidelines: encourage an effective cough, then use back blows and thrusts if the person cannot cough, speak or breathe. The technique changes for infants younger than one, who receive chest thrusts rather than abdominal thrusts.

The term “Heimlich maneuver” usually refers to abdominal thrusts, but those thrusts are only one part of the current sequence for adults and children. Starting with them in every choking incident can interrupt a cough that may clear a partial blockage without further intervention.

Silence, weak coughing or loss of response requires emergency help

Ask whether the person is choking. A person who can speak, breathe and cough forcefully has a partial airway obstruction. Encourage continued coughing, keep watching and be ready to act if the cough weakens or the person can no longer speak or breathe.

Call the local emergency medical service when the person cannot cough, speak, cry or breathe, or when the cough becomes weak and ineffective. Other warning signs include high-pitched breathing, clutching the throat, pale or bluish skin, sudden weakness and loss of responsiveness. Use a phone's speaker function if possible so care can continue while the dispatcher gives instructions.

If the person becomes unresponsive, lower them carefully onto a firm, flat surface and start cardiopulmonary resuscitation (CPR). The IFRC advises standard CPR with chest compressions and rescue breaths if possible, and says only a clearly visible object should be removed from the mouth. Do not sweep a finger through the mouth when no object is visible because that can push material deeper into the airway.

Adults and children over one need back blows before abdominal thrusts

For a responsive adult or child older than one whose cough is ineffective, stand to the side and slightly behind the person. Support the chest, lean the person forward and give up to five firm blows between the shoulder blades with the heel of the hand. Check after each blow and stop if the obstruction clears.

If five back blows do not work, move behind the person and place a clenched fist between the navel and the lower end of the breastbone. Grasp the fist with the other hand and pull sharply inward and upward up to five times. Use force appropriate to the person's size and stop as soon as effective coughing, speech or breathing returns.

If the obstruction remains, alternate up to five back blows with up to five abdominal thrusts while emergency help is being summoned. Resuscitation Council UK's 2025 adult guideline uses this cough, back-blow and abdominal-thrust sequence and calls for CPR if the person becomes unresponsive.

Infants need back blows and chest thrusts

Do not use abdominal thrusts on an infant younger than one. If the infant can cough or cry forcefully, allow that response to continue while watching closely. If the infant cannot cough, cry or breathe, call emergency services and begin the infant sequence.

Sit or kneel, support the infant's head and jaw, and place the infant face down along the forearm or lap with the head lower than the chest. Give up to five firm blows between the shoulder blades, checking after each one. If the blockage remains, turn the infant face up while continuing to support the head and neck.

Give up to five sharp chest thrusts over the lower half of the breastbone, then repeat the back-blow and chest-thrust cycle if necessary. Resuscitation Council UK's 2025 pediatric guideline specifies up to five back blows followed by up to five chest thrusts for infants and abdominal thrusts for children older than one.

Start CPR if the infant becomes unresponsive. The IFRC notes that regional protocols differ on whether infant CPR after choking begins with rescue breaths or compressions. Follow the emergency dispatcher's directions and the sequence taught in an accredited local infant-CPR course.

Pregnancy and body size change the thrust location

Back blows remain the first intervention when a responsive person has an ineffective cough. When pregnancy is apparent, or when the rescuer cannot encircle the abdomen, use chest thrusts instead of abdominal thrusts. Place the hands on the breastbone rather than the abdomen and pull straight inward.

The American Red Cross directs rescuers to use chest thrusts for a pregnant person or a person whose body is too large to encircle for abdominal thrusts. This adaptation comes from US training guidance; readers elsewhere should follow their local dispatcher and accredited first-aid curriculum if its technique differs.

Do not use blind finger sweeps or unproven suction devices

Look in the mouth only when the person is unresponsive and the airway is opened during CPR. Remove an object only when it is clearly visible and can be reached safely. Repeated blind sweeps can drive an object farther down the airway or injure the mouth.

The IFRC does not recommend routine use of suction-based anti-choking devices. Its 2025 guideline says evidence is insufficient to support these devices and warns that reaching for equipment can delay established steps. Back blows, abdominal or chest thrusts, emergency activation and CPR remain the cited sequence.

Medical assessment may be needed after the object comes out

Continue watching the person's breathing and responsiveness after the obstruction clears. The IFRC advises access to emergency medical services for a complete airway obstruction because thrusts can cause internal injury and part of the object may remain in the airway or lungs. Resuscitation Council UK also advises clinical evaluation after successful treatment with abdominal thrusts or chest compressions.

A person with a partial obstruction should obtain medical care if coughing persists, swallowing remains difficult or it still feels as though something is stuck. Ongoing chest or abdominal pain after thrusts also warrants assessment.

Children, chronic illness and regular medicines require separate judgment

Infants and children

Age determines the intervention: infants younger than one receive back blows and chest thrusts, while children older than one receive back blows and abdominal thrusts. A smaller child may require the rescuer to kneel, and the force must be adjusted to body size without turning the intervention into a gentle tap that cannot move the obstruction.

Pregnancy

Use chest thrusts when pregnancy makes abdominal thrusts unsuitable. If the pregnant person becomes unresponsive, begin CPR and follow the emergency dispatcher's instructions; do not continue standing thrusts.

Chronic illness, disability and regular medicines

The cited international guideline does not provide a separate immediate sequence based on medicine use alone. Neurological conditions that impair swallowing or coughing can raise choking risk, while limited mobility may change positioning. Use the same recognition steps, call emergency services early and follow the dispatcher when disability or body position makes the standard technique difficult.

Frequently asked questions

What is the first action when someone is choking?
Check whether the person can cough, speak and breathe. Encourage a forceful cough and monitor it; call emergency services and begin back blows if the cough becomes ineffective or speech and breathing fail.

Do abdominal thrusts come first?
No. The IFRC and Resuscitation Council UK sequence starts with up to five back blows for an adult or child whose cough is ineffective, followed by up to five abdominal thrusts if the back blows fail.

Can abdominal thrusts be used on an infant?
No. An infant younger than one receives up to five back blows followed by up to five chest thrusts. Repeat the cycle while help is being summoned and start CPR if the infant becomes unresponsive.

Should a rescuer reach into the mouth?
Only remove an object that is clearly visible and reachable. Do not perform a blind finger sweep.

What happens after the blockage clears?
Check breathing and responsiveness. Medical assessment is needed after a complete obstruction or the use of abdominal thrusts, and also when coughing, swallowing difficulty or a stuck sensation continues.