Paediatric First Aid – What to do when your child is choking?


child choking - paediatric first aid

Being able to deal with choking is one of the main areas we cover in our Paediatric First Aid courses in Northern Ireland. Choking in children is extremely commonplace, although however many times it happens to you it never gets any less frightening. However, it is reassuring to know that in the vast majority of choking cases, given the correct help, the child will make a full and speedy recover.

Whilst you shouldn’t be alarmed, you should equip yourself with as much information as possible in order to reduce the chances of choking. You should also learn how to help if your baby does choke. Ensure you are able to recognise the signs of choking, which are different to the signs of gagging.

Before we get into the detail, here are some short tips to help prevent choking in the first place;

  1. Keep small objects out of reach of children. As a rule of thumb, anything that can fit through the centre of a loo roll should be considered a choking hazard.
  2. Cut all meals into small bitesize pieces
  3. Always supervise children while eating
  4. Get into a good habit of making your children eat in a safe and stable environment ie. While strapped into a highchair
  5. Discourage older children from sharing food with infants


Gagging is part of the weaning learning curve for babies. Don’t be alarmed if your baby is gagging, it is a normal reflex as they learn to eat solids and liquids. The physical effect of gagging is to:

  1. Bring the food back into the mouth;
  2. Chew it further;
  3. Consume it once more but in a smaller amount.

Although it may seem alarming, gagging is actually a safety mechanism designed to prevent choking. It happens whether you follow the spoon-fed weaning method or baby-led weaning.

The signs are:

  • Watering eyes
  • Tongue hanging out of the mouth
  • Retching movements or even vomiting.

Gagging can be caused by an overload of food, a dislike of the taste of food, or some babies even gag on their own fingers just to see how far they can put things in their mouths. Babies also gag on liquids as they learn the rhythm of sucking.

Gagging is often a noisy affair. It can be frustrating to see the food you’ve prepared for your baby be spat and retched out, but do remember that this is a normal and healthy part of the weaning process.


Choking occurs when food (or any other object) blocks the airway, rather than going down the oesophagus – it goes down the breathing tube, rather than the food one!

Usually when we eat or drink and swallow – the epiglottis covers the top of the trachea and stops food from entering it. Sometimes, particularly if talking, laughing or crying whilst eating, the flap of the epiglottis is unable to protect the trachea and enables food to enter.

The body’s reflex if this happens is to cough, to eject the food. However, if the airway becomes completely blocked the person is unable to cough and is silent. This is extremely serious and without help, they could die.

How to help a choking child over 1 year

If a child shows signs of choking, stay calm and ask them to cough to help remove the object.

If they are unable to cough:
Bend the child forward, supporting them on their chest with one hand
with the other hand; use the flat of your hand to give a sharp back blow between the shoulder blades.

choking child over parents knees - paediatric first aid

Check to see if the blockage has cleared before giving another blow – give up to 5 back blows checking each time to see if the blockage has cleared.

If the back blows haven’t helped get an ambulance on the way by calling 999


If the blockage hasn’t cleared after five blows, the next stage is to do an abdominal/chest thrusts.

Stand behind the child and place one hand in a fist under their rib cage. Use the other hand to pull up and under in a J shaped motion, to dislodge the obstruction.

Perform abdominal thrusts up to 5 times, checking each time to see if the obstruction has cleared. Anyone who has received abdominal thrusts must be seen by a doctor.

If the child is still choking alternate five back blows and five abdominal thrusts until emergency help arrives. 

If at any point the child becomes unconscious, commence CPR (Also covered in our Paediatric First Aid course)

What to do when a baby under 1 year old is choking

First look in the baby’s mouth and if there is something obvious in the mouth, remove it with finger tips.

DO NOT put your fingers down a baby or child’s throat, or finger sweep the mouth, as this can make matters worse by pushing the obstruction further down or by causing swelling.

Lay the baby downwards on your forearm, across your legs, supporting them under their chin and using the flat of your hand, give a firm back blow between the shoulder blades.

babay back blows - paediatric first aid

Give up to five back blows and check between each blow to see if the blockage has cleared. If the obstruction has not come out – get an ambulance on the way

If the blockage hasn’t cleared, lay the baby on their back, place two fingers in the centre of the chest just below the nipple line and give up to five chest thrusts. (the same place as you push when doing chest compressions on a baby)

Warning: Never do an abdominal thrusts on a baby under a year as you could cause damage.
Check to see if the blockage has cleared between each chest thrust.
If baby is still choking, call 999 and continue alternate five back blows and five chest thrusts until emergency help arrives.

If at any point baby becomes unconscious, commence CPR.

What to do once the obstruction comes out?
If they are unconscious but breathing – put them into the recovery position
If they are unconscious and not breathing start CPR
If they seem absolutely fine – ensure that they don’t have problems swallowing, check there is no pain or bleeding – it is always advisable to have them checked out by a medical professional. If it is not your child, ensure that you have contacted the parents.

If the child has been given abdominal thrusts or chest thrusts, they should always be checked by a medical professional

It is strongly advised that you attend a Paediatric First Aid course to understand what to do in a medical emergency and gain practical knowledge.

If you are interested in attending one of our monthly Paediatric First Aid courses in Belfast, please contact us on 02890 098858, email or use our contact us page for more information about our courses.

Harberry Training provide this information for guidance and it is not in any way a substitute for medical advice. We are not responsible for or liable for any diagnosis made, or actions taken based on this information.

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