What is choking?

Choking is what happens when something gets stuck in a person's throat or windpipe, partially or totally blocking the flow of air to their lungs.

In adults, choking usually occurs when a piece of food enters the windpipe instead of the food pipe. Babies and young children can choke on anything smaller than a D-size battery.

Sometimes the windpipe is only partially blocked. If the person can still breathe, they will probably be able to push out the object by coughing forcefully. Be careful not to do anything that will push the blockage further into the windpipe, like banging on the person's back while they are upright.

If the object cuts off the airway completely and the person cannot breathe, it's now a medical emergency. The brain can only survive for a few minutes without oxygen.

What are the symptoms of choking?

Someone may be choking if they:

• clutch their throat (universal sign of choking)
• cough, wheeze or gag
• have difficulty breathing, speaking or swallowing
• make a whistling or ‘crowing' noise
• can't make any sound at all
• have no air coming out of their nose and mouth
• have blue lips, face, earlobes or fingernails
• are very agitated
• lose consciousness

What should I do in an emergency?

Choking — adults and children (over 1 year)

If the person becomes blue, limp or unconscious, call triple zero (000) and ask for an ambulance.

1. Try to keep the person calm. Ask them to cough to try to remove the object.
2. If coughing doesn’t work, call triple zero (000) for an ambulance.
3. Bend the person forward and give them up to 5 sharp blows on the back between the shoulder blades with the heel of one hand.
   After each blow, check if the blockage has been cleared.
4. If the blockage still hasn’t cleared after 5 blows, place one hand in the middle of the person’s back for support. Place the heel of the other hand on the lower half of the breastbone (in the central part of the chest). Press hard into the chest with a quick upward thrust, as if you’re trying to lift the person up.
   After each thrust, check if the blockage has been cleared.
5. If the blockage has not cleared after 5 thrusts, continue alternating 5 back blows with 5 chest thrusts until medical help arrives.
6. If the patient becomes blue, limp or unconscious, start CPR immediately.

Choking — Babies under 12 months

If a baby is choking, call triple zero (000) immediately and ask for an ambulance. Stay on the phone.

1. Lay the baby face down on your forearm with their head lower than their body, supporting their head and shoulders on your hand.
2. Hold their mouth open with your fingers. Make sure you keep supporting their head.
3. Give up to 5 sharp blows to the back between the shoulders with the heel of one hand.
   After each blow, check if the blockage has been cleared.
4. Use your little finger to remove the object from their mouth if it has cleared from their airway.
5. If the blockage has not cleared after 5 back blows, place the infant on their back on a firm surface. Place 2 fingers on the lower half of the breastbone and give up to 5 chest thrusts — like CPR compressions, but slower and sharper.
   After each thrust, check if the blockage has been cleared.
6. If the blockage has not cleared after 5 thrusts, continue alternating 5 back blows with 5 chest thrusts until medical help arrives.
7. If the child becomes unconscious, start CPR immediately.

Choking: What not to do

• Don’t ask them if they’re ok. Instead ask them if they are choking, as they may be suffering from something else (such as asthma).
• Don’t attempt to perform the Heimlich manoeuvre (big thrust to the abdominal area) as it can break ribs and damage internal organs.
• Don’t put your fingers in their mouth – they may bite you accidentally and it could further lodge the object in the trachea.
• Don’t pick up a child who is choking and turn them upside down.

If you are choking yourself

If you are alone and you are choking, call triple zero (000) and ask for an ambulance. Try to get someone to help you if at all possible, and keep calm. Try to clear the obstruction with a forceful cough.

You can do chest thrusts on yourself to try to dislodge the object:

1. Place a fist on the lower half of your breastbone (in the central part of the chest).
2. Grasp your fist with the other hand and bend over a hard surface, like a countertop or chair.
3. Press hard into the chest with a quick upward thrust, as if you’re trying to lift a person up.
   After each thrust, check if the blockage has been cleared.

Recovery from choking

After someone has been treated for choking, they may still need medical help if:

• they have a cough that doesn’t go away
• they feel like something is stuck in their throat

Can choking be prevented?

It's important to keep all small objects out of the reach of babies and children, including hard pieces of food like lollies and raw apple, household items like coins and batteries, small parts of toys and pebbles.

To reduce the risk of choking while eating, make sure your child sits to eat rather than lying down or running around. Cut up food into small pieces and encourage them to chew well. Avoid giving your child choking hazards, such as whole nuts, until they are 5.

Check the floor regularly for small objects, and make sure toys aren't broken or damaged. Avoid buying toys with button batteries.

Children and adults with a disability, including cerebral palsy, epilepsy or dementia, are at greater risk of choking. Your doctor can give you extra advice about how to help them avoid choking.

Resources and support

For more information and support, try these resources:

• The best thing you can do is to know first aid. You can find first aid courses at St John Ambulance Australia, the Royal Life Saving Society - Australia and the Australian Red Cross.
• St John has fact sheets that cover choking, both in adults and in infants.
• Product Safety Australia's Choke Check tool can help you identify toys and other objects that pose a choking hazard.