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What to Do if Someone Is Choking

Contributor: Melisa Lai-Becker, MD
5 minute read
A woman choking with her left hand on her chest after eating a doughnut that she's holding in her right hand

Choking is an all-too-common emergency situation that can arise during a meal at home, while out at a restaurant, or even on the go. Choking episodes often occur in the elderly, but can happen to people of any age.

Choking causes nearly 5,000 deaths in the United States every year, but if you recognize the signs, you can help a choking person quickly.

Melisa Lai-Becker, MD, an emergency medicine doctor at Mass General Brigham, provides crucial advice on how to help someone who’s choking. Learn the emergency steps to follow in real time, including when to call 9-1-1.

Step 1: Assess choking symptoms and be ready to call 9-1-1.

Ask yourself if the person is:

  • Unable to make a sound
  • Holding their neck or pointing to their throat
  • Turning color in the face

If the answer to any of these questions is yes, a person may be choking. Tell them to cough. If they are unable to, or they aren’t able make any sound, it’s time to act quickly. Follow the steps below and be ready to call 9-1-1.

Step 2: Give sharp blows to the back.

If an adult is choking and unable to clear a blockage on their own, try several quick blows to the back:

  • Use the heel of your hand.
  • Hit firmly and sharply on the upper back between the shoulder blades.
  • Repeat up to 5 times.

Step 3: Perform the Heimlich maneuver (abdominal thrusts).

If sharp blows to the upper back don’t clear a blockage, try 5 abdominal thrusts:

  • Wrap your arms around the person’s torso, from the back.
  • Make a fist with one hand and grasp it with the other hand.
  • Place your joined fists just above the person’s belly button.
  • Pull quickly with both hands inwards and upwards to force air up and out of the lungs.
  • Repeat up to 5 times if needed.

Forcing air out of the lungs with a sudden thrust will often propel any blockage out from where it has lodged. If using back blows and abdominal thrusts fails to clear a blockage, call 9-1-1 immediately.

Choking in pregnant or obese people

Give 5 chest thrusts to the breastbone (middle of the chest) instead of the abdomen when trying to clear the airway of a pregnant or obese person.

Choking when alone

If you’re choking and alone, give yourself abdominal thrusts:

  • Place your fist above your belly button.
  • Grasp your fist with your other hand.
  • Shove your fist inward and upward.

You also can bend over a hard surface, such as a chair or a countertop, and thrust it above your belly button in place of a fist.

If you’re choking, alone, and can’t talk or easily reach another person:

  • Text-to-911 is available in many states.
  • Type the numbers “9-1-1” into the “to” or “recipient” field.
  • Text your location and the nature of your emergency right away.

Infant and toddler choking first aid

The steps you take to help a choking baby or child may differ depending on their age. Abdominal thrusts as described above are not recommended for use on infants 12 months or younger. 

Signs of infant choking

Infants and very young toddlers may not know how to signal that they’re choking. Observation is key to assessing a choking situation.

An infant is truly considered to be choking if:

  • They can’t cry or make sound.
  • They have a bluish tinge to their skin color.
  • They make soft or high-pitched sounds while inhaling.
  • They can’t cough, or display other signs of difficulty breathing.
  • They lose consciousness.

Help a choking infant or baby less than 1 year old

To clear a blockage:

  • Hold the baby face down along the length of your thigh.
  • Keep their head lower than their bottom.
  • Hit them sharply on the back up to 5 times to dislodge the blockage. Hit firmly but not hard enough to cause injury.
  • Check the baby’s mouth and remove any visible objects with a finger.

If the airway is still blocked, try chest thrusts:

  • Place 2 to 3 fingers on the baby’s chest.
  • Press downward sharply up to 5 times.

Hopefully these actions clear the blockage in a choking baby. If they don’t, call 9-1-1.

Choking toddler or older child

You can help a choking baby or child in the same way as an adult.

Choking prevention and education

Small children are at especially high risk for choking. To prevent your child from choking, follow these simple steps:

  • Cut your child’s food into small pieces.
  • Beware of foods like nuts, grapes, hot dogs, and hard candies that are easy to choke on.
  • Keep small objects, high-risk foods, and other choking hazards out of children’s reach.
  • Watch your child while they eat and supervise playing.

Choking can happen almost anywhere, at any time. Typically, it occurs in a place where emergency response personnel are not close by. If you stay calm and follow these basic steps, you may potentially save a life.

Melisa Lai-Becker, MD


Emergency Medicine Doctor