Infant first aid for choking and CPR: An illustrated guide

We all hope we'll never be put in the position of having to save a baby's life, but it could happen. Babies can and do choke on food and toys, slip under the water in the tub or a pool, and get caught in drawstrings and curtain cords.

This step-by-step guide explains the basics of first aid for choking and CPR, but please don't rely on it as your sole source of information. Set aside a few hours to take an infant and child CPR course to learn and practice the proper techniques. These techniques differ depending on the age of the child, and doing them improperly can be harmful.

If you'd like to take an in-person class in your area, visit the Red Cross websiteOpens a new window or call 800-733-2767 (800-RED-CROSS). Or, if you prefer an online offering, BabyCenter Courses offers a self-paced infant CPR and first aid courseOpens a new window you can take at home.

The following instructions are for babies younger than 12 months old. To find out what to do when an older child is choking or needs CPR, see our illustrated guide to CPR for children age 12 months and older.

Choking

Step 1: Assess the situation quickly.

If a baby is suddenly unable to cry or cough, something is probably blocking their airway, and you'll need to help them get it out. They may make odd noises or no sound at all while opening their mouth. Their skin may turn red or blue.

If they're coughing or gagging, it means their airway is only partially blocked. If that's the case, let them continue to cough. Coughing is the most effective way to dislodge a blockage.

Call 911 or your local emergency number if:

• The baby isn't able to cough up the object. (Ask someone to call 911 or the local emergency number while you begin back blows and chest thrusts (see step 2, below). If you're alone with the baby, give two minutes of care, then call 911.
• You suspect that the baby's airway is closed because their throat has swollen shut. They may be having an allergic reaction – to food or to an insect bite, for example – or they may have an illness, such as croup.
• The baby is at high risk for heart problems
• You witnessed the baby suddenly collapse.

Step 2: Try to dislodge the object with back blows and chest thrusts.

First do back blows

If a baby is conscious but can't cough, cry, or breathe and you believe something is trapped in their airway, carefully position them face-up on one forearm, cradling the back of their head with that hand.

Place the other hand and forearm on their front. They are now sandwiched between your forearms.

Use your thumb and fingers to hold their jaw and turn them over so that they're facedown along your forearm. Lower your arm onto your thigh so that the baby's head is lower than their chest.

Using the heel of your hand, deliver five firm and distinct back blows between the baby's shoulder blades to try to dislodge the object. Maintain support of their head and neck by firmly holding their jaw between your thumb and forefinger.

If the object does not come out, place your free hand (the one that had been delivering the back blows) on the back of the baby's head with your arm along their spine. Carefully turn them over while keeping your other hand and forearm on their front.

Then do chest thrusts

Use your thumb and fingers to hold the baby's jaw while sandwiching them between your forearms to support their head and neck. Lower your arm that is supporting their back onto your thigh, still keeping the baby's head lower than the rest of their body.

Place the pads of two or three fingers in the center of the baby's chest, just below an imaginary line running between their nipples. To do a chest thrust, push straight down on the chest about 1 1/2 inches. Then allow the chest to come back to its normal position.

Do five chest thrusts. Keep your fingers in contact with the baby's breastbone. The chest thrusts should be smooth, not jerky.

Repeat back blows and chest thrusts

Continue alternating five back blows and five chest thrusts until the object is forced out or the baby starts to cough forcefully, cry, breathe, or becomes unresponsive. If they're coughing, let them try to cough up the object.

If the baby becomes unresponsive

If a baby who is choking on something becomes unconscious, lower the baby to the ground and start CPR (see below). After each set of compressions and before attempting rescue breaths, open the baby's mouth, look for the blockage, and remove it if you can.

Never put your finger in the baby's mouth unless you actually see a blockage. If you can't see it and you put your finger in their mouth, you might accidentally push the blockage deeper into their throat. If you can see a blockage, remove it with your little finger.

Continue the sequence until the child revives or help arrives.

How to perform CPR

What is CPR?

CPR stands for cardiopulmonary resuscitation. This is the lifesaving measure you can take to save a baby who shows no signs of life, meaning they are unconscious and not breathing.

CPR uses chest compressions and rescue breaths to make oxygen-rich blood circulate through the brain and other vital organs until the child revives or emergency medical personnel arrive. Keeping oxygenated blood circulating helps prevent brain damage – which can occur within a few minutes – and death.

Infant CPR isn't hard to do. Follow these steps:

Step 1: Verify that the infant is unresponsive and not breathing.

Shout to get the infant's attention, using their name. If they don't respond, tap the bottom of their foot and shout again while checking for normal breathing. (Look to see whether their chest is rising, and listen for breathing sounds.)

If the infant doesn't respond and isn't breathing or is gasping, have someone call 911 or the local emergency number. (If you're alone with the baby, give two minutes of care as described below, then call 911 yourself.)

Swiftly but gently place the baby on their back on a firm, flat surface. Stand or kneel next to them.

Make sure they aren't bleeding severely. If they are, take measures to stop the bleeding by applying pressure to the area. Don't administer CPR until the bleeding is under control.

Step 2: Give 30 chest compressions.

Place one hand on the infant's forehead. Place the pads of two fingers in the center of their chest, just below the nipple line. Compress the chest by pushing straight down about 1 1/2 inches, and then let the chest return to its normal position. Push hard and push fast. Compressions should be smooth, not jerky.

Give compressions at the rate of two per second. Count out loud: "One and two and three and...", pushing down as you say the number and coming up as you say "and." (The song Staying Alive has the rhythm you're shooting for.)

Step 3: Give two rescue breaths.

Note: If you're uncomfortable giving rescue breaths, giving chest compressions only is better than nothing.

Open the airway by putting one hand on the baby's forehead and two fingers on their chin and tilting their head back to a neutral position. Make a complete seal over the baby's nose and mouth with your mouth.

Take a normal breath and blow into the baby's nose and mouth for about one second, looking to see if the chest rises. If the chest doesn't rise, retilt the head and ensure a proper seal before giving a second rescue breath.

If the baby's chest doesn't rise, their airway is blocked. Open the baby's mouth, look for the blockage, and remove it if you can. Continue to check the mouth for an object after each set of compressions until the baby's chest rises as rescue breaths go in.

Continue giving sets of 30 compressions and two rescue breaths until:

• You notice an obvious sign of life.
• An AED (automated external defibrillator) is ready to use
• You have performed approximately 2 minutes of CPR (5 sets of compressions and rescue breaths) and another person is available to take over compressions.
• You have performed approximately 2 minutes of CPR (5 sets of compressions and rescue breaths), you are alone with the baby, and you need to call 911 or the designated emergency number.
• EMS personnel take over.
• You are too tired to continue.
• The scene becomes unsafe.

Even if the baby seems fine by the time help arrives, a doctor will need to check them to make sure that their airway is completely clear and they haven't sustained any internal injuries.

Emergency care for an older child is different than for an infant. You might also want to read over our first aid for choking and CPR illustrated guide for children 12 months and older.

Learn more:

• When to call 911
• Choking hazards for children
• First-aid kit checklist