Post-Back Blow Care for Infant Choking
After successful back blows that relieve choking in an infant, you must verify complete airway clearance, check the mouth for visible foreign bodies, attempt rescue breaths, and continue monitoring—if the infant becomes unresponsive at any point, immediately begin CPR starting with chest compressions. 1, 2
Immediate Post-Intervention Assessment
After delivering back blows (and chest compressions if needed), follow this algorithmic sequence:
Step 1: Check the Mouth
- Visually inspect the mouth after each cycle of 5 back blows and 5 chest compressions 1, 2
- Remove any visible foreign bodies you can see 1
- Never perform blind finger sweeps—these can push the object deeper into the larynx or damage the oropharynx 1, 3
Step 2: Reposition and Reassess Airway
- Open the airway using head tilt-chin lift or jaw thrust maneuver 1
- Reassess air entry to determine if obstruction is relieved 1
- Look for signs of effective spontaneous respiration 1
Step 3: Attempt Rescue Breathing
- After checking the mouth and repositioning, attempt 2 rescue breaths 2
- You may be able to ventilate even with partial obstruction, but ensure the infant exhales most of the artificial ventilation after each breath 1
- If breaths do not go in, the airway remains obstructed—repeat the cycle 1
If Obstruction Persists
Continue alternating cycles until the object is expelled or the infant becomes unresponsive: 1, 2
- 5 back blows (infant prone, head lower than chest) 1, 2
- 5 chest compressions (infant supine, head lower than chest, rate ~20/min, more vigorous than CPR compressions) 1, 2
- Check mouth for visible objects 1, 2
- Attempt 2 rescue breaths 2
If Infant Becomes Unresponsive
This is a critical transition point—immediately switch to CPR: 1, 2
- Start with 30 chest compressions (do NOT check for pulse first) 1
- After 30 compressions, open the airway and look for a foreign body 1
- Remove visible objects only 1
- Attempt 2 breaths 1
- Continue cycles of 30 compressions and 2 breaths 1
- After 2 minutes, activate emergency medical services if not already done 1
Post-Resolution Monitoring
Even after successful clearance, the infant requires continued observation:
- Monitor continuously for signs of airway re-obstruction, inadequate breathing, or worsening responsiveness 4
- Watch for persistent coughing, wheezing, or respiratory distress that may indicate retained foreign body fragments 3, 5
- A normal clinical exam does NOT exclude retained foreign body—clinical history of witnessed choking takes precedence 3
When to Seek Emergency Care
Transport to emergency department even if the infant appears asymptomatic after choking if: 3
- The choking episode involved small objects or food particles 3
- There is any persistent respiratory symptom (wheezing, stridor, cough) 3, 5
- The infant had cyanosis or altered consciousness during the event 3
- You are uncertain whether the foreign body was completely expelled 3
Critical Pitfall
Do not be falsely reassured by normal appearance or even normal chest X-ray when history suggests foreign body aspiration—imaging can miss radiolucent objects, and clinical history is paramount 3. Bronchoscopy may be needed for definitive diagnosis 3.
Key Technical Points for Back Blows in Infants
The technique matters for both effectiveness and safety:
- Hold infant prone along your forearm with head lower than chest 1, 2
- Deliver 5 sharp blows to the middle of the back with heel of hand 1
- Never use abdominal thrusts in infants—risk of rupturing abdominal viscera (especially the relatively large, unprotected liver) 1, 2
- Chest compressions for choking should be sharper and more vigorous than CPR compressions, at approximately 20/min rather than 100/min 1, 2
Prevention Counseling
After any choking event, provide anticipatory guidance: 6