Lesson 5 of 6 · 3 min read
Choking
A person who can cough should keep coughing. A person who can't cough, speak or breathe needs back blows and thrusts right away.
Video lessons don't replace hands-on training. Practice these skills in a supervised class with a qualified instructor before you rely on them at work.
Mild or severe?
- Mild: they can cough forcefully, talk or cry. Let them keep coughing, stay with them and watch for it getting worse.
- Severe: a weak cough or none, can't speak (or an infant can't cry), color changing, or not breathing. Act now, and have someone call 911.
Adults and children (changed in 2025)
The 2025 guidelines now start with back blows for adults and children:
- 5 back blows. Stand to the side and slightly behind them, support their chest with one arm and lean them forward. Strike firmly between the shoulder blades with the heel of your hand, 5 times.
- 5 abdominal thrusts. Stand behind them, make a fist just above the belly button, cover it with your other hand, and pull in and up quickly, 5 times.
- Repeat 5 and 5 until the object comes out or the person stops responding.
If you can't get your arms around their belly, or they are late in pregnancy, give chest thrusts instead of abdominal thrusts. For a small child you may need to kneel behind them.
Infants
For an infant with severe choking, repeat 5 back blows and 5 chest thrusts. Hold the baby face down along your forearm with the head lower than the body, and give 5 firm back blows between the shoulder blades. Turn the baby face up, head still low, and give 5 quick chest thrusts in the center of the chest. The 2025 guidelines recommend the heel of one hand for these thrusts. Never give abdominal thrusts to an infant.
If they stop responding
Lower them to the floor, make sure 911 has been called, and start CPR beginning with compressions. Each time you open the mouth to give a breath, look for the object and take it out only if you can see it. No blind finger sweeps.
Anyone who needed back blows or thrusts should be checked by a medical professional afterward.
Key points
- Can cough or talk: let them keep coughing and watch closely.
- Can't cough, speak or breathe: 5 back blows, then 5 abdominal thrusts, repeated.
- Can't reach around them, or late pregnancy: chest thrusts instead.
- Infants: 5 back blows and 5 chest thrusts, never abdominal thrusts. No blind finger sweeps.
Picture it
An employee break room. A coworker stands up suddenly, hands at his throat. You ask "Are you choking?" He nods but can't make a sound.
You tell someone to call 911, step to his side, lean him forward and give 5 firm back blows. Nothing. You move behind him for 5 abdominal thrusts. On the next round of back blows the food comes out and he starts coughing. You stay with him until he's checked out.
Resources
- American Heart Association: 2025 Guidelines for CPR and ECC
The current national CPR guidelines this course follows, published October 2025.
- American Red Cross: Adult and child choking
How to give back blows and abdominal thrusts, with special cases such as pregnancy and wheelchairs.