First aid for the choking child

• Published in: Pediatrics (Evanston) 1993-09, Vol.92 (3), p.477-479
• Main Authors: Weinberg, Joseph A, Foltin, George L, Haller, J Alexander, Hodge, Dee III
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Asphyxia; Biological and medical sciences; Care and treatment; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Heimlich maneuver; Intensive care medicine; Medical sciences; Methods; Pediatrics
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.92.3.477

There are more than 300 annual deaths of children in the United States due to choking.1 Prompt, effective first aid provided by a bystander may and often does prevent morbidity or death. Pediatricians should review the risk of choking with parents during routine health care visits and encourage families to obtain formal training from local agencies such as the American Red Cross and American Heart Association. Toys, food, or other foreign objects find their way into youngsters' airways. Any child who has choked on a foreign body and is coughing, crying, or speaking is best left to his/her own reflexes to relieve the obstruction. If the child or infant is unable to make sounds or if complete obstruction develops, without evidence of respiratory air movement, immediate first aid is required to avoid permanent disability or death. CURRENT TECHNIQUES Abdominal Thrust Technique Most experts agree that the abdominal thrust maneuver (Fig 1), as originally described by Henry Heimlich, MD, is the most effective method of relieving airway obstruction in children more than 1 year of age.2-8 This method utilizes the following concepts: (1) four fifths of normal respiration occurs using the diaphragm; (2) abdominal pressure compresses the diaphragm upward, thereby raising intrathoracic pressure; (3) rapid increase in intrathoracic pressure may expel the obstructing object; and (4) as a patient becomes hypoxic, muscle tone diminishes. Thus, repeated abdominal thrusts that may be ineffective initially become effective minutes later. Controversy exists concerning first aid management for a choking child less than 12 months of age: abdominal thrust technique versus back-blow and chest thrust technique.