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Gabby are you alright? Are you choking? Here lift up your elbows. I'm gonna push on your stomach, okay? Are you okay? Can you breathe now? Man, that was close. Now let's break down the skills for child conscious choking. When we approach a choking child there's a couple things we wanna do to evaluate whether or not they're truly choking or not. One is ask them if they're choking. If they are able to respond to you verbally they may have something stuck but it's probably not in the airway or at least it's not fully obstructed because they're actually able to move enough air past their larynx to be able to formulate a word. But if they're able to only nod or kinda that gagging, high pitch squeaking noise chances are there's an obstruction and it's fully occluding their airway. Another universal sign, if they've been trained to do so, or sometimes even naturally, is them to grasp around their throat as if they are choking. It's at that point that I'm gonna say "Are you alright? Are you choking?" They nod yes, they have the universal sign with their hands around their throat, I'm then going to instruct the child to lift their elbows up as I lower myself to their level. The reason we want to get to the level of the size of the child is so we don't put unnecessary pressure on their rib cage. We'd rather not break any ribs or cause any further harm if at all possible. It's at that point that we wanna find an important landmark. We're gonna find the belly button. Once we find the belly button we're gonna ball up the other fist with our thumb tucked in and place that tucked up thumb against their abdomen just above the belly button. Then we grab that fist hand and go inward and upward into their diaphragm. We're gonna do that inward upward thrust as many times as it requires until the object actually comes out, they're able to breathe and cough again or the patient becomes unconscious as we lower them to the floor to help protect them from further harm. It's important that we continue to allow EMS to come into the home or the location of the child if we've already called 911 so they can do an evaluation and ensure that we've not caused any abdominal injury, that there's no pieces of obstruction still remaining in the airway. And if there's not an EMS department on the way it's always a good idea to bring the child into an urgent care center, a doctor's office or the hospital so that evaluation can be performed there. If you follow these steps the majority of the time you'll be able to easily get an obstructed airway clear and get this little one back on track.
This conscious child choking lesson is for situations where you can see that a child is choking and he or she is conscious. The choking victim will usually be exhibiting some unmistakable signs, including:
- They cannot cough
- They cannot breathe
- They cannot speak
Another sign to look for is the universal sign for choking – when the victim places both of their hands around their throat.
Remember to only worry about calling 911 and activating EMS if doing so is quick and easy, or there is another person nearby that can call. Otherwise, don't waste time calling 911 and go right into assessing the victim.
How to Provide Care
The first thing you want to do is face the child and look them in the eyes. You want confirmation that the victim is choking, and you want to receive permission to help the child.
"Are you choking?"
The child will probably nod yes.
"May I help you?"
You'll likely get another nod. Don't wait too long to receive permission, as children may be a little more flustered than adults.
Pro Tip #1: With children, they may not have the same level of awareness as adults. If they're only nodding or making gagging, high-pitched squeaking sounds, these are good indications that the airway is fully obstructed.
Pro Tip #2: If the child can respond verbally, that means that they are able to move enough air past the larynx to speak. This is a good indication that something may be stuck but that the airway isn't obstructed. Or it could indicate a partial obstruction of the airway.
If there is a parent or legal guardian present, make sure to get permission before beginning the following procedure.
Abdominal Thrust Technique for Children
- Elevate the victim's arms and elbows so you have clear access to the abdominal area.
- Locate the belly button using the index finger on your dominant hand and hold it there. This is the landmark you'll use to find the correct abdominal point.
Warning: It's important that when helping a choking victim who's shorter than yourself, that you lower yourself to their height. This will limit unnecessary pressure on the rib cage and prevent broken ribs or other possible harm while you perform the abdominal thrusts.
- On your non-dominant hand, tuck in your thumb and place your fist thumb-first above the finger that's on the belly button, essentially stacking one on top of the other vertically.
Remember to stay below the xyphoid process and above the belly button. This is the diaphragmatic region where you'll be performing the abdominal thrusts.
- Take your index finger off the belly button and wrap that dominant hand over your other hand that's positioned on the victim's diaphragm.
- Lower yourself to the height of the child.
- Keep your elbows out so they're resting on the victim's ribs as little as possible.
- Thrust up and in and turn your hands upward as you perform each thrust.
- Perform the abdominal thrusts until the object comes out or the child becomes unresponsive.
Remember to turn your hands upward as you perform each thrust, as this will bring the diaphragm up and in and compress the lower lobes of the lungs, forcing air to shoot up the trachea and pop the obstruction out. This works in the majority of choking situations.
- Once the object comes out, the child will begin coughing to help clear the airway and should begin breathing normally again in a matter of seconds.
- Encourage the victim and let the child know that he or she is OK now and have them sit down if necessary. Children may experience more confusion and fear than adults, so letting them know that they'll be fine is important.
If you called 911, let them come anyway, so the child can be examined. EMS responders can check the choking victim's airway and listen to their lungs to make certain that there are no partial obstructions remaining. And they can do a quick assessment for internal bleeding or other damage.
Pro Tip #3: If you did not call 911, it's always a good idea for you or someone else to take the child into an urgent care center, hospital, or to see their physician. With children, don't leave it up to them to determine if more care is necessary.
If you weren't able to remove the obstruction using the abdominal thrust technique, the child will go unconscious pretty quickly. Help lower them to the ground, so they don't fall and injure themselves. Call 911 immediately and activate EMS or call in a code if in a healthcare setting. Then begin performing the unconscious child choking procedure.
A Word About Airway Adjuncts
As the tongue is one of the most common causes of airway obstruction in unconscious patients, keeping the tongue free from blocking the airway passage will be a high priority. There are two types of mechanical airway adjuncts that can be used if needed – oral (oropharyngeal) airway (OPA) and nasal (nasopharyngeal) airway (NPA).
Both of these devices are designed to keep the tongue free of blocking the throat. The OPA is inserted into the mouth before reaching the throat, while the NPA is inserted into the nostrils.
Both devices come in a variety of sizes and are curved to fit the natural contours of the mouth and throat. Once they are in place, you can continue with the use your BVM (Bag Valve Mask) or mask with a one-way valve as you normally would.