- gasping for breath
- grabbing the throat
- turning blue
- unable to talk
If a choking person is making noise or coughing forcefully, do not interfere but stay with him until the episode ends and the object is expelled. If he is unable to cough or move in any way, quickly look into his mouth. If you see the object and can easily retrieve it, do so cautiously, being careful not to push the object farther down the throat.
If it is not easily removable, do not attempt to grasp it. Call for emergency help. Then proceed to the following measures. For an infant or small child try the back blow approach:
- Place the child face down across your leg or lap with the head lower than the rest of the body.
- Support the child’s chin with one hand.
- Firmly and deliberately slap the back between the shoulder blades four times. If this technique proves unsuccessful in expelling the foreign object, then proceed with the chest thrust approach:
- Place the child face up across your leg, keeping the head lower than the body.
- Support the head and neck with one hand.
- Place two fingertips for a newborn or the heel of the hand for an older baby on the lower sternum (just above the stomach area) and push in and up four times in rapid succession.
Alternate these approaches until the object is dislodged and the child begins to breathe.
For an older child (over 40 pounds), use the Heimlich maneuver:
- Stand behind the child, wrapping your arms around the child’s waist (between the navel and the rib cage).
- Make a fist with one hand and place your free hand over the fist.
- Thrust your fist in and upward (into the upper abdominal area) in four separate and distinct motions.
Once the object is freed, begin rescue breathing or CPR if the child is not breathing. Remember: CPR is of no value until the object is dislodged. For the older child who is unconscious, the standard upright Heimlich maneuver will not work. In that case, follow these instructions:
- Place the child on his or her back on the floor.
- Kneeling over (or straddling) the child, place the heel of one hand on the child’s abdomen and place the free hand on top of the first hand, fingers interlocking.
- Push the heel of the bottom hand into the child’s upper abdomen with four quick, upward thrusts.
- Keep small, hard objects away from small children. This includes hard candy, nuts, popcorn, hot dogs, chewing gum, and hard fruits and vegetables.
- Cut food into small pieces.
- Remove small toys or hanging mobiles from the crib before the baby is able to reach them. Use only unbreakable toys that have no sharp edges or small parts that can come loose. Do not allow electrical or hanging cords within reach of a crib or a toddler’s play area.
- Do not allow an infant to wear a necklace or a young child to play with any cord or string around the neck.
- Keep plastic bags and balloons out of reach of all children. A popped or deflated balloon in a small child’s mouth, if inhaled, could easily obstruct his airway.
It is not uncommon for children to swallow nonfood objects, either deliberately or accidentally. Toddlers, who are prone to place small items into the mouth, are at particular risk for this type of accident. Fortunately once the object passes through the esophagus (the tube that carries food from the throat to the stomach) it will usually progress through the rest of the intestinal tract without difficulty. As this occurs, the child will not show any signs of distress, except in rare cases where an odd-shaped (and usually pointed) object such as a tooth-pick becomes stuck or perforates the bowel.
Swallowed Objects Treatment
An X-ray may be done to try to confirm the object’s location (although not all objects will be visible on an X-ray), and the child’s stools may be examined for the next few days until the object passes. If it is not found after 4 to 7 days, a second X-ray may be performed. (If the object is metallic, some emergency facilities use a metal detector to track its progress.) Seek immediate medical attention if abdominal pain develops before the object has passed out of the child’s body.
Symptoms of Object Lodged in the Esophagus
A small percentage of swallowed objects become lodged in the esophagus. When this occurs, a mild pain will usually develop in the chest below the sternum (breastbone), along with increased salivation caused by the inability to swallow.
Treatment of Object Lodged in the Esophagus
- The child will be frightened, so keep him as calm as possible.
- DO NOT attempt to force the object into the stomach by giving fluids or food.
- In most cases the object will pass into the stomach within 10 minutes. But if pain or difficulty in swallowing persists, the child will need emergency medical attention.
Swallowed Small Batteries
An X-ray of the chest/abdomen will usually disclose the location of the object. A specialist may be consulted and an endoscopy done. In this procedure a narrow, flexible fiber-optic device, known as an endoscope, is passed into the sedated child’s esophagus in an attempt to dislodge or remove the foreign body.
Swallowed Small Batteries Treatment
If a child swallows a small “button battery’ – the small, round battery used in watches, hearing aids, and other electronic devices – see a doctor immediately. A button battery that does not pass through the esophagus must be removed (usually using an endoscope) because it can cause a serious local erosion or even a perforation within a matter of hours.