A choking infant's airway may be completely or partially blocked. A complete blockage is an urgent medical emergency. A partial obstruction can quickly become life threatening if the infant loses the ability to breathe in and out sufficiently.

Without oxygen, permanent brain damage can occur in as little as 4 minutes. Rapid first aid for choking can save a life.

Choking in infants is usually caused by inhaling a small object that they have placed in their mouth, such as a button, coin, balloon, or watch battery.

The danger signs of true choking are:

• Inability to cry or make much sound
• Weak, ineffective coughing
• Soft or high-pitched sounds while inhaling
• Difficulty breathing - ribs and chest retract
• Bluish skin color
• Loss of consciousness if blockage is not cleared

1. DO NOT perform these steps if the infant is coughing forcefully or has a strong cry -- either of which can dislodge the object on its own.
2. Lay the infant face down, along your forearm. Use your thigh or lap for support. Hold the infant's chest in your hand and jaw with your fingers. Point the infant's head downward, lower than the body.
3. Give up to 5 quick, forceful blows between the infant's shoulder blades. Use the heel of your free hand.

1. Turn the infant face up. Use your thigh or lap for support. Support the head.
2. Place 2 fingers on the middle of his breastbone just below the nipples.
3. Give up to 5 quick thrusts down, compressing the chest 1/3 to 1/2 the depth of the chest.
4. Continue this series of 5 back blows and 5 chest thrusts until the object is dislodged or the infant loses consciousness.

IF THE INFANT LOSES CONSCIOUSNESS

If the child becomes unresponsive, stops breathing, or turns blue:

• Shout for help.
• Give infant CPR. Call 911 after one minute of CPR.
• If you can SEE the object blocking the airway, try to remove it with your finger. Try to remove an object ONLY if you can see it.

• DO NOT interfere if the infant is coughing forcefully, has a strong cry, or is breathing adequately. However, be ready to act if the symptoms worsen.
• DO NOT try to grasp and pull out the object if the infant is conscious.
• DO NOT perform these steps if the infant stops breathing for other reasons, such as asthma, infection, swelling, or a blow to the head.

If an infant is choking:

• Tell someone to call 911 while you begin first aid.
• If you are alone, shout for help and begin first aid.

• Don't give children under 3 years old balloons or toys with fragile or small parts.
• Keep infants away from buttons, popcorn, coins, grapes, nuts, or similar items.
• Watch infants and toddlers while they are eating. Do not allow a child to crawl around while eating. Childproof your home.
• The earliest safety lesson is "No!"

Murray JF, ed. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: Saunders; 2000:753.

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: London: Mosby; 2002:90-92.