Although children under age four are most at risk for choking on food and small objects, youngsters in their middle years can choke too. A number of foods or other items (for instance, hot dogs, poorly chewed pieces of meat, grapes, raw carrots, hard candy, balloons, small toy parts) can become lodged in the child's airway (or trachea), keeping oxygen from reaching the lungs and the rest of the body as well. When the brain does not receive oxygen for more than four minutes, permanent brain damage and death can result. If your child is having some breathing difficulties—but is still able to speak or has a strong cough—do nothing yourself; the child's cough is better than any back blows or abdominal thrusts (Heimlich maneuver) you can administer. But call 911 so that she can be transported to an emergency department, since a partial blockage of the airway could turn into a complete one.
However, if your youngster cannot breathe at all, or if she appears pale or her cough is very weak, then she needs immediate attention. First, have someone call 911 for emergency services. Perform the Heimlich maneuver on your youngster. For the middle-years child, this technique can be used while the youngster is lying down, sitting, or standing.
For a conscious child who is sitting or standing, position yourself behind her and wrap your arms around her waist. Place the thumb side of your fist on the middle of her abdomen, well below the lower tip of the breastbone. Then grab that fist with your free hand, press inward with rapid, upward thrusts. Repeat the thrusts until the object is coughed up or the youngster begins to breathe or cough.
If the child is unconscious, lower her to the floor on her back and try using the tongue-jaw lift. Open the youngster's mouth, with your thumb held over her tongue, and your fingers wrapped around the lower jaw; as this draws the tongue away from the back of the throat, you may be able to clear the airway. If you can see the foreign object, try removing it with a sideways sweep of a finger; use this approach carefully, however, since it could push the object even farther down the airway, causing additional blockage.
If breathing still has not resumed, tilt the child's head back gently and lift her chin. Then place your own mouth over her mouth and, pinching her nose shut, give two slow breaths, each lasting one and a half to two seconds. If this technique is not successful, return to the Heimlich maneuver. Kneeling at the child's feet, place the heel of one of your hands in the midline between the navel and rib cage. Then place your other hand on top of the first one. Next, press firmly but gently into the abdomen, using six to ten rapid inward and upward thrusts.
Repeat the steps above—the finger sweep, the slow breaths, and the abdominal thrusts—until the child begins breathing or emergency help arrives.
Cardiopulmonary resuscitation (CPR) is another first-aid procedure, to be used only when a youngster has no pulse, indicating that his heart has stopped beating. CPR involves compression of the chest, using the heel of the hand applied to the lower half of the breastbone. These compressions should be administered over an approximately four-second period in groups of five, followed by a gentle mouth-to-mouth breath, after which the cycle is repeated. This technique can keep a child breathing and his blood circulating until emergency help arrives. It should be performed by an individual who has received specific training in this approach. CPR is even more important if you have a swimming pool or a hot tub at home, or live near a lake or other body of water. Prevention, of course, is the first line of defense against drownings: No matter what their age, children should never be left unsupervised in or near a pool or body of water, even if they appear to be good swimmers. Swimming pools should be completely fenced in to prevent unsupervised access and use.
If a youngster is drowning, her breathing must be restored promptly to prevent asphyxia (lack of oxygen). Here are some guidelines to keep in mind:
Remove your child from the water as soon as possible. Unless you are a strong swimmer yourself, try to avoid jumping into the water to pull out a drowning youngster. Instead, attempt to grab her with an outstretched arm, a long pole, or a life ring.
Call 911 for emergency assistance.
If the youngster has stopped breathing, administer mouth-to-mouth resuscitation, using about fifteen slow, steady breaths per minute. If she also has no pulse, then chest compressions and full CPR must be performed.
Although this article's descriptions of life-saving techniques can familiarize you with standard procedures, they are NOT a substitute for your completion of a certified first-aid course in which you learn mouth-to-mouth resuscitation and CPR. All parents should have this training. Contact your local American Red Cross or American Heart Association office for information on where these classes are offered in your community.