Baby choking: what to do and how to be ready
Gagging is normal. Choking is an emergency. Know the difference.
One of the most important things you can learn as a new parent is the difference between a baby gagging and a baby choking. They look alarming in different ways, and your response to each is completely different.
Gagging is a normal and protective reflex. A gagging baby is noisy. They cough vigorously, go red in the face, may retch and make dramatic spluttering sounds, and are working the food or object toward the front of their mouth themselves. Their cough is effective and forceful. The right response to gagging is to stay calm, stay close, and wait. Do not pat their back or try to reach into their mouth. The cough reflex is far more effective than any intervention you could make, and interfering can disrupt it.
Choking means the airway is partly or fully blocked and the baby cannot clear it themselves. A choking baby is quiet or nearly silent. Their cry or cough is very weak or non-existent. They cannot make a strong sound. They may go red and then start to turn blue around the lips. Their face may show a panicked or frightened expression. They are not able to breathe effectively. This is the situation where you act immediately.
First aid for a choking baby under 1 year: step by step
If your baby is choking and their cough is ineffective or silent, follow these steps without delay.
Step 1: Shout for help. Call out loudly so another person can call 999 while you act. If you are alone, do the first aid steps before calling 999 unless your baby has already lost consciousness.
Step 2: Give 5 back blows. Hold your baby face-down along your forearm, with their head lower than their bottom. Support their head with your hand. Using the heel of your other hand, give 5 firm blows between the shoulder blades. Each blow should be a distinct, deliberate strike. The goal is to use the force of the blow to dislodge the object.
Step 3: Check the mouth. After 5 back blows, look into your baby's mouth. If you can clearly see an object and you can remove it easily with one finger, do so. Never do a blind finger sweep inside the mouth. If you cannot see anything or cannot reach it easily, do not probe. A blind finger sweep risks pushing the object deeper into the airway.
Step 4: Give 5 chest thrusts. Turn your baby face-up along your forearm, with their head still lower than their body. Place two fingers on the centre of the chest, one finger's width below the nipple line. Give 5 sharp, downward thrusts. These are more forceful than CPR compressions. Each thrust should be a firm push downward aimed at dislodging the object from the airway.
Step 5: Alternate and continue. Continue alternating 5 back blows and 5 chest thrusts until the object comes out and your baby starts breathing and crying effectively, or until your baby loses consciousness.
Step 6: If your baby loses consciousness. Call 999 immediately if you have not already done so. Begin infant CPR. The chest compressions involved in CPR also create airway pressure that can help dislodge an obstruction. The 999 operator will guide you through CPR step by step.
First aid for a choking child over 1 year: step by step
For a child over 1 year old who is choking with an ineffective cough, the approach is slightly different.
Give 5 back blows between the shoulder blades with the child leaning forward. Then give 5 abdominal thrusts, which are also called the Heimlich manoeuvre. Kneel or stand behind the child depending on their height. Make a fist with one hand and place it above their navel and below their breastbone. Cover your fist with your other hand and pull sharply inward and upward 5 times. The goal is a rapid upward movement that pushes air from the lungs and forces the object out.
Continue alternating 5 back blows and 5 abdominal thrusts until the object comes out or the child loses consciousness. If the child loses consciousness, call 999 and begin child CPR.
Never do abdominal thrusts on a baby under 1 year old. The organs at this age are not protected by the rib cage in the way they are in older children, and abdominal thrusts can cause serious internal injury. Always use chest thrusts for babies under 1 year.
Things never to do during a choking episode
Never do a blind finger sweep inside a baby or child's mouth. If you cannot see the object clearly, do not put your finger in to search for it. This is one of the most common mistakes and one of the most dangerous, because it risks pushing the object further down.
Never do abdominal thrusts on a baby under 1 year. Use chest thrusts instead as described above.
Never shake a baby in an attempt to dislodge an object. This is ineffective and dangerous.
Never give water or any liquid to try to wash the object down. If the airway is blocked, liquid will not pass freely and may worsen the situation.
After a choking episode: see a doctor
After any choking episode, take your baby to be seen by a doctor, even if the object came out and your baby seems completely well. There are two reasons for this. First, there may be a remaining fragment of the object still in the airway or oesophagus that is not yet causing symptoms. Second, the airway may have been irritated or bruised during the episode or the first aid manoeuvres, and this warrants assessment.
If your baby was unconscious at any point, go directly to A&E. If the object came out and your baby recovered quickly with no loss of consciousness, call your GP or 111 to arrange a same-day review.
Preventing choking
Choking prevention begins at weaning and continues through the toddler years. The most important food safety rules are these. Always cut grapes into quarters lengthways, never give them whole. Cut cherry tomatoes into quarters. Cut large pieces of raw carrot, apple, and similar hard vegetables into small pieces appropriate for your child's stage. Never give whole nuts to a child under 5 years old. Avoid large marshmallows, thick blobs of nut butter, and large chunks of bread without careful preparation.
Beyond food, keep small objects off the floor and out of reach. Check the age labels on toys, which are based on choking risk assessments. Coins, button batteries, small toy parts, pen caps, and jewellery beads are among the most common choking hazards. Button batteries deserve special mention because they are not only a choking risk but also cause severe internal burns from electrical current if swallowed, within as little as 2 hours. If your child swallows a button battery, call 999.
Learn before you need it
Reading about choking first aid is valuable, but doing a hands-on course is even better. The British Red Cross, St John Ambulance, and Bliss all offer infant and child first aid courses. Many NHS trusts offer free courses for new parents. A short course lets you practise the back blow and chest thrust positions on a manikin so that if you ever face a real situation, your body already knows what to do.
Learning infant first aid before your baby starts weaning is one of the most practical and worthwhile things you can do.
Frequently asked questions
How do I tell if my baby is gagging or choking?
A gagging baby is noisy and working things out themselves. They cough vigorously, go red in the face, and may retch dramatically. Their cough is strong and loud. You do not need to intervene. A choking baby has a partly or fully blocked airway. Their cry or cough is very weak or completely silent, they cannot make a strong sound, their face may go red and then start to turn blue, and they have a look of distress or panic. If the cough is effective, wait and watch. If the cough is ineffective or silent, act immediately.
What are the exact steps for baby choking first aid?
For a baby under 1 year: give 5 firm back blows with the baby face-down along your forearm, head lower than their bottom. Check the mouth for any visible object and remove it only if you can see it clearly. Then give 5 chest thrusts with the baby face-up, using two fingers on the centre of the chest one finger-width below the nipple line. Alternate back blows and chest thrusts until the object comes out or the baby loses consciousness. If the baby loses consciousness, call 999 and start infant CPR.
Why should I not do abdominal thrusts on a baby under 1?
Abdominal thrusts (the Heimlich manoeuvre) use sharp inward and upward pressure above the navel. In a baby under 1 year, this risks causing serious internal injuries to the liver and other organs, which are not yet protected by the rib cage as they are in older children. Chest thrusts press downward on the breastbone and achieve the same effect on the airway without this risk. Always use chest thrusts for babies under 1 year.
Should I try to remove the object with my finger?
Only if you can clearly see the object and can remove it easily with a single finger. Never do a blind finger sweep inside a baby's mouth. If you cannot see the object, a finger sweep is likely to push it deeper into the airway, making the situation significantly worse. Only remove what you can clearly see.
When do I start CPR during a choking episode?
If your baby loses consciousness at any point during a choking episode, call 999 immediately and begin infant CPR. The chest compressions involved in infant CPR also create pressure in the airway that can help dislodge the obstruction. The 999 operator will guide you through each step.
Where can I learn baby first aid?
The British Red Cross, St John Ambulance, and Bliss all offer infant and child first aid courses, in person and online. Many NHS trusts run free courses for new parents. A short practical course is one of the most useful things you can do as a new parent. Learning before you need it means you can act calmly and effectively if you ever do.
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