First aid for choking child

A year or so ago, we had a sad case in my hospital in the United Kingdom where a two-year-old boy choked on a sweet. His parents could not get the sweet out. By the time they got him to hospital, he had been unconscious for so long that he had become paralysed. How to deal with a choking child is something that every parent should know about.

What to do
You can recognise a choking child, because they will generally start coughing or struggling to breath very suddenly, when they have previously been well that day.

If the child is coughing strongly then this is a good sign. The child will most often cough the object out themself without any help. You should just comfort the child and encourage them to keep coughing.

If the child is choking but only coughing weakly, then you need to help them get the object out. To do this:

Look in the mouth. If you can clearly see the object and can reach it, try to remove it with your fingers.

If you cannot see the object or it is too far away then you need to give the child five ‘back-blows’. These are firm blows to the middle of the child’s back with your hand. These work best if the child is positioned with their head below the rest of the body. For a small child, this can be done by placing them on your lap. For a bigger child, you should get them to lean forward.

If ‘back-blows’ have not worked then you should try five ‘chest-thrusts’. In an older child you should stand or kneel behind them. Place your arms around them as if giving them a hug. Clench your fist between the belly button and ribs and cover with the other hand. Pull sharply upwards and inwards up to five times. In a child less than one simply lie them down and press on their breast-bone sharply five times.

If these have not worked, you can repeat steps two and three whilst arranging to take the child to the nearest hospital.

If the child is unconscious you should give them mouth-to-mouth resuscitation (cover their mouth and nose with yours and breath into it once every second) and get the child to hospital as soon as possible.

What not to do
Don’t stick your fingers into the child’s throat to try and remove the object if you cannot clearly see it. Most often, this will just push the object down further

How to prevent choking from happening
Children under 5 years old like to put small things in their mouth such as coins, keys, rings and plastic bags. You should keep these away from your children at all times. Hard sweets, whole groundnuts and chewing gum should not be given to children less than five years old as they may choke on them. Foods that are around the size of a 500 Shilling coin are the perfect size for a child to choke on, therefore such foods should be cut into smaller portions to reduce this risk.

The writer is a paediatrician