What is the American Heart Association's recommended first aid procedure for a choking child?

American Heart Association Protocol for Choking Child Management

For a choking child with severe airway obstruction (unable to cough or make sounds), perform continuous abdominal thrusts (Heimlich maneuver) until the object is expelled or the child becomes unresponsive. 1

Initial Assessment: Distinguish Mild from Severe Obstruction

Mild obstruction occurs when the child can still cough and make sounds—in this scenario, do not interfere and allow the child to clear the airway by coughing while you observe for progression to severe obstruction. 1

Severe obstruction occurs when the child cannot cough or make any sound—this requires immediate intervention. 1

Key Recognition Features:

• Sudden onset of respiratory distress with coughing, gagging, stridor, or wheezing 1
• Absence of fever or antecedent respiratory symptoms (distinguishes from croup or infection) 1
• Most common culprits in children include balloons, small objects, and foods such as hot dogs, round candies, nuts, and grapes 1

Treatment Algorithm for Severe Obstruction

For Children (Age >1 Year):

Perform subdiaphragmatic abdominal thrusts (Heimlich maneuver) repeatedly until the object is expelled or the victim becomes unresponsive. 1

For Infants (Age <1 Year):

Deliver repeated cycles of 5 back blows (slaps) followed by 5 chest compressions until the object is expelled or the victim becomes unresponsive. 1

• Abdominal thrusts are contraindicated in infants because they may damage the infant's relatively large and unprotected liver 1

If the Child Becomes Unresponsive

Immediately start CPR with chest compressions—do not perform a pulse check. 1

Modified CPR Protocol for Choking:

1. After 30 chest compressions, open the airway and look for a visible foreign body 1
2. If you see the foreign body, remove it—but never perform blind finger sweeps as they may push the object deeper into the pharynx or damage the oropharynx 1
3. Attempt to give 2 breaths 1
4. Continue cycles of 30 compressions and 2 breaths (or 15:2 if two rescuers are present) 1
5. After 2 minutes of CPR, if no one has already done so, activate the emergency response system 1

Critical Pitfalls to Avoid

• Never interfere with a child who can still cough effectively—this represents mild obstruction and the child's own cough is more effective than any intervention 1
• Never perform blind finger sweeps—this can push the foreign body deeper or cause oropharyngeal injury 1
• Do not use abdominal thrusts in infants—use only back blows and chest compressions to avoid liver injury 1
• Do not check for a pulse when the child becomes unresponsive—immediately begin CPR with chest compressions 1

Age-Specific Technique Details

Infant Back Blows and Chest Compressions:

• Hold the infant face down with the head lower than the trunk, supporting the head and jaw 1
• Deliver 5 back blows with the heel of your hand between the infant's shoulder blades 1
• Turn the infant face up and deliver 5 chest compressions in the same location as CPR compressions 1
• Repeat this cycle until the object is expelled or the infant becomes unresponsive 1

Child Abdominal Thrusts:

• Stand or kneel behind the child 1
• Make a fist with one hand and place it just above the navel, well below the breastbone 1
• Grasp the fist with your other hand and deliver quick, upward thrusts 1
• Continue until the object is expelled or the child becomes unresponsive 1