Choking, suffocation and swallowed objects

Choking happens when an object or fluid partially or fully blocks the airway and stops the flow of air into the lungs. When this happens, a person is at risk of injury and death from choking or suffocation.

When a child's airway is partially blocked, they may have noisy breathing and find it harder than normal to breathe. When their airway is fully blocked and they are choking, they may try to breathe but can't.

Children are more at risk of choking because their airway is not yet fully developed, and they are unable to cough up items which are stuck. Coughing, gagging and becoming unresponsive are the result of choking.

Small items such as food, toys and household objects can cause choking. As a general rule, items smaller than a 20-cent piece can choke a child aged less than 3 years.

Your responses will depend on whether your child has an effective cough and are still able to cry, talk and breathe. Encourage your child to stay calm and to cough, this may help the object to come out.

If your child has an ineffective cough, is conscious and is making a harsh noise when they're breathing in, or is having trouble breathing, call triple zero (000) for an ambulance.

Babies under 12 months

If your baby is conscious:

1. Give up to 5 sharp back blows:
• Position them so their head and shoulders are on your hand and forearm and they're facing downwards.
• Hold your baby's mouth open with your fingers.
• Give up to 5 sharp blows between their shoulders with the heel of one hand.
• Look to see if the obstruction has been cleared after each back blow and remove any foreign material that may have loosened.
2. If unsuccessful, give up to 5 chest thrusts:
• Place your baby on their back on a firm surface.
• Place 2 fingers (index and middle) over the lower half of their breastbone.
• Give 5 chest thrusts. These are similar to CPR compressions but sharper and delivered at a slower rate.
• Look to see if the obstruction has been cleared after each chest thrust.
3. If the obstruction has cleared, position your baby with their head pointing downwards on your forearm, and remove any foreign material carefully with your little finger.
4. If the obstruction does not clear, continue alternating with 5 back blows and 5 chest thrusts until medical help arrives.
5. If your baby loses consciousness, start cardiopulmonary resuscitation (CPR).

Children over 12 months

1. Try to keep your child calm.
2. Ask your child to cough. If this doesn't clear the blockage, phone triple zero (000) for an ambulance.
3. Bend the child forward and give them up to 5 sharp blows on the back, between their shoulder blades.
4. After each blow, check to see if the blockage has cleared.
5. If it hasn't, give up to 5 chest thrusts. Place one hand in the middle of their back for support and place the heel of the other hand on the lower half of their breastbone. Press hard into their chest with a quick thrust. After each thrust, check to see if the blockage has cleared.
6. If the blockage hasn't cleared after 5 chest thrusts, continue alternating 5 back blows with 5 chest thrusts until medical help arrives.
7. If the child becomes blue or loses consciousness, start CPR immediately.

If your child is struggling to clear the object themselves, start giving up to 5 back blows and then chest thrusts. Chest thrusts are given in the same way as chest compressions when giving CPR (cardio pulmonary resuscitation), but more slowly at a rate of 1 per second.

Suffocation happens when something blocks the mouth or nose, or compresses the chest. This prevents the person breathing.

Plastic bags, plastic wrap and dry-cleaning bags are particularly dangerous for children because they can pull them over their heads. Plastic covers for cot and bassinet mattresses need to be removed before using. It's also important to always follow the safe sleeping recommendations to help keep your baby safe.

Immediately remove the object covering their face or head. Check to see if your baby is breathing normally as you may need to start CPR if they have stopped breathing and are unresponsive. Call an ambulance immediately.

Babies who have suffocated need admission to hospital so they can be checked and monitored. You will need to check your baby's environment and remove the object which caused them to stop breathing.

A swallowed object, also called a 'suspected foreign body', is any item which should not have been swallowed.

Examples of typical objects that aren't food include:

• needles, pins or safety pins
• coins, small magnets and small batteries
• buttons, beads, marbles, pen tops and polystyrene beads, water beads and other small items
• small stones or pebbles, pips or seeds from fruit
• teeth that have been knocked out

Once the object has been cleared from the child's airway, it's important to check that it looks whole. If small pieces are left, the airway can still be obstructed. Small, pointy objects can cause problems in the bowel a couple of days after being swallowed. This is why it's important to have the child checked by a doctor.

Objects that are swallowed and go into the oesophagus (food tract) can become stuck. Symptoms can include drooling, pain in the chest or neck and trouble swallowing food. Medical investigations include taking a careful history of what was swallowed and how the child appears. Sometimes an x-ray helps to identify where exactly the object is positioned. Often, objects are passed in the child's poo in a day or so. However, if they're having problems breathing, eating or drinking, the object needs to be removed. Button batteries and magnets need to be removed immediately.

Foods that commonly cause choking risks are the type which need a reasonable amount of chewing and small, hard, solid foods. Nuts, uncooked raw vegetables, hot dogs/sausages, lollies, and marshmallows and stringy food like celery and pineapple, pose choking risks.

Household choking risks:

• coins
• jewellery
• stationery items, for example, paper clips, pen or marker lids, erasers and magnets
• tablets
• chewing gum and lollies
• stickers from fruit
• garden objects, for example, stones and pebbles

Children are naturally inquisitive and place objects in their mouth as a means of exploring the world around them. This is why it's important to supervise them at all times. It's also useful to regularly check areas where they play and can get to small objects.

Keep all small objects out of reach. Get into the habit of scanning your child's environment for small objects. Only buy toys that are suitable for your baby's age, and check toys regularly to make sure they're not broken.

For more information on product safety and recalls, visit Product Safety Australia.

First aid courses

You can learn CPR through a short course. Try St John Ambulance, Australian Red Cross or Royal Life Saving Australia. Look for a course covering first aid for babies and children.

Information and apps to download

Read the St John Ambulance fact sheet on CPR for infants and fact sheet on CPR for adults or children over 1 year.

St John Ambulance Australia has First Aid fact sheets in multiple languages.

Download the free Australian Red Cross First Aid app. This resource gives you access to the most up-to-date CPR advice, wherever you are.