How to care for an infant (baby) who is choking

Infants (babies under the age of 1) experiencing choking need to be approached differently. Using the same techniques applied to older children and adults may cause further harm to little ones.

As with an adult or older child, you must obtain consent before administering any first aid. In the case of a minor, if a parent or guardian is present, seek consent from them quickly.

Small babies (new-born to 1 year) who are conscious will display a fair amount of distress and may show signs of ‘stranger anxiety’ (clinginess to a parent or guardian who is familiar to them), especially if they are older than 6 months.

1. Assisting an infant

Artificial coughing methods will also form the main objective in handling a smaller individual who is choking, but the process requires you to provide a little more support to the fragile body of an infant.

You can choose to kneel, sit or stand in order to provide consented care. Choose your own body position according to what makes you feel most stable, also taking into consideration the size of the baby and the level of strength you have, in order to handle them safely.

As with a choking adult or older child, the obstruction causing breathing problems must be expelled first. You will need to alternate between sets of back slaps / blows and chest compressions / thrusts.

Back slaps / blows:

You will need to raise one leg with the knee positioned at a 90-degree angle, atop a step or hard object (while standing) which can support you, or alternatively sit or kneel. You will then need to position a child safely in order to assist them.

Place the length of your forearm along the baby’s back (with the child facing upwards). Cradle the baby’s head in your hand, providing support to the neck. Support the frontside of the baby with your other forearm, using your thumb and fingers to hold the jaw (taking care not to cover your hand over the baby’s mouth).

Carefully use your positioned arms to turn the baby over (facing downwards), resting on the length of your thigh (and positioned arm) for support. A baby’s head (positioned just off the knee) should be at a lower level than his or her chest (or torso). Leave your thumb and fingers in place along the baby’s jawline to provide support and stability.

With the other hand (i.e. the arm that you used to hold the baby at the back), strike the baby between the shoulder blades with the heel of the hand. Again, a set of at least 5 separate blows can be given, while ensuring that your hand is open, and fingers are long and pointing upwards so as not to collide with the baby’s neck and head in the process.

Chest compressions / thrusts:

Once one set of back blows is complete, place the hand used back along the baby’s back, cradling the base of his or her head. Carefully turn the baby over, still supporting his or her jaw with the other hand, resting on your thigh.

With the baby now facing upwards, lower the baby and your hand / arm position onto the length of your thigh. The baby’s head should still be at a lower angle than his or her chest. With your top hand, find the baby’s breastbone (sternum) in the chest area. With two fingers in the centre of the chest (normally just beneath the nipple line), press down firmly for a set of at least 5 compressions.

Between each thrust / compression, watch that the chest returns to its normal position. Take care not to move your fingers away from the breastbone in the process. ⁽⁵⁾ 

Alternate between the two until the obstruction is dislodged and the infant is able to cry, or cough forcefully and breathe (or loses consciousness and becomes unresponsive).

If an infant is not conscious or falls unconscious after expelling the obstruction:

• Open the baby’s airways by lifting his or her jaw upwards and tilting the head backwards.
• Open the baby’s mouth (using a tongue-jaw lift technique – place your thumb inside the mouth and your fingers in a holding position along the baby’s chin) ⁽⁶⁾ to see if a loose foreign object is able to be removed with a finger sweep. If there is something that can be safely removed (i.e. it can be seen and is loose), do so with the index finger of the other hand. Generally, though, a blind finger sweep is not encouraged for children under the age of 8. EMS professionals typically prefer using a suction device for young children and babies.
• If a baby is not conscious and you are aware that it is due to choking, begin first aid by alternating back blows and chest thrusts to dislodge the foreign object.
• Once dislodged, check the baby’s breathing and pulse. If the baby is not breathing, begin CPR / rescue breathing, followed by alternate chest compressions until EMS professionals arrive to take over and provide trained life support. Don’t forget to keep checking for any dislodged foreign objects or pieces thereof in between sets.

As with adults and children, an infant that is no longer choking or struggling to breathe must be evaluated by a physician as soon as possible to ensure no internal injuries have occurred during the emergency assistance process, or the choking incident.

References:

^{5. MedlinePlus. December 2017. Choking - infant under 1 year: https://medlineplus.gov/ency/article/000048.htm [Accessed 01.12.2017]}

^{6. Introduction to Clinical Allied Healthcare (second edtion) By Debra Garber. 1996. Chapter Eighteen - Basic First Aid: https://books.google.co.za/books?id=Sunbj6DJbccC&pg=SA18-PA11&lpg=SA18-PA11&dq#v=onepage&q&f=true  [Accessed 01.12.2017]}