Infant CPR: What to Do When Baby Is Choking
September 12, 2016
Babies have a long, adorable list of skills to learn: how to crawl, how to stand, how to turn those babblings into fluent conversation, how to not drop a spoon on the floor for the fifth (or sixth!) time. Safely chewing and swallowing are on that list too—which means while infants are born ready to eat, they’re not totally primed to avoid choking. Here’s what you need to know about preventing baby from choking and how to perform infant CPR in the event of a worst-case scenario.
“Infants have a relatively limited repertoire of things they can do for themselves,” says Joan E. Shook, MD, FAAP, FACEP, a member of the American Red Cross Scientific Advisory Council and Texas Children’s Hospital in Houston. “From birth to about 4 months, their choking hazards typically are the things you’re putting in their mouth.” That means a newborn may choke on breast milk or saliva—and, later, baby food or, less often, mucus (from having a respiratory illness) or something they’ve regurgitated. For a baby choking on liquid, typically all you need to do is prop open the infant’s mouth and suck out the offending substance with a bulb syringe.
Once baby begins crawling, however, the game changes significantly, since babies use their mouths to explore their environment. “When you have an older child putting foreign objects in his or her mouth, that can be a completely different kind of choking event,” Shook says. The most common causes of baby choking include small items that block the airway (think: toys, buttons, chunks of solid food or coins), as well as behaviors like eating too much in one bite. “Babies don’t have the cognitive ability to think, ‘If I put this one Cheerio in my mouth, I should swallow it before I take the next 50,’” Shook says. “They’ll cram their little mouths full of whatever, and then they don’t know how to navigate it.”
Before you even get to this worst-case scenario, the smartest thing you can do is take a class on baby choking and infant CPR. “In the heat of the moment, it’s hard to know how to do it correctly,” Shook says. “Although 911 can walk you through it, if you’ve never done it, it’s very difficult.” To find a class near you, go to the American Red Cross website and enter your zip code. You’ll see options for in-person training (Shook’s preferred choice) as well as online classes.
Here’s a run-through of how to tell if baby is choking, and what to do if baby chokes:
If baby is gagging or coughing, has difficulty breathing or is turning red or blue, something is probably blocking the windpipe and she’s choking. Your first move is to quickly assess: Is the blockage partial or complete?
With a partial blockage, some air is still getting in and out of baby’s lungs around the foreign object, and baby is probably gagging or coughing. The best thing to do is not intervene and let baby cough it out—it’s the best way to dislodge a blockage. Never perform a finger sweep (sticking your finger in baby’s mouth to try to grab whatever’s in there) because it could push the object further down baby’s throat.
You’ll need to take action if baby can’t successfully cough up the object, or if baby has a complete blockage (meaning no air is getting in or out of baby’s lungs). In that case, you might see his ribs and chest pull inward, his face will turn red, and he won’t be able to cry or make noise. Ask someone to call 911 and then try to dislodge the object with back blows and chest thrusts—steps designed to remove the object without harming baby’s body. (The Heimlich maneuver, while safe on adults, could damage organs in baby’s delicate torso, so you never want to attempt that.) If you’re alone with baby, first deliver back blows and chest thrusts for two minutes, then call 911 and follow their directions for care.
• To perform back blows: Lay baby face down on your forearm with her head supported by your hand and her chest higher than her head. Using the heel of one hand, give five firm back blows between her shoulder blades.
• To perform chest thrusts: Lay baby face-up on your forearm with his skull supported by your hand and his head lower than his chest. Place two or three fingers in the center of his chest just below the nipple line, and compress the breastbone about 1.5 inches. That’s one chest thrust; perform five.
Alternate between doing five back blows and five chest thrusts, rolling baby from her back to her front until the object is ejected or baby forcefully coughs, cries or breathes. If baby becomes unconscious with the object still lodged in the throat, carefully lower him or her onto a flat, firm surface and begin giving infant CPR.
Check if baby is unconscious by flicking his feet. His face may also turn blue from lack of oxygen. If baby is unresponsive, you’ll need to perform infant CPR by following these steps:
1. Lay baby on a flat, firm surface (like the floor) and start with two rescue breaths. Tilt the head back and lift the chin up. Make a complete seal over baby’s nose and mouth with your mouth, and blow in for about one second. That’s one rescue breath; do two, in quick succession. If baby doesn’t revive after two rescue breaths, begin chest compressions.
2. Do 30 chest compressions. Position the pads of two to three fingers in the middle of baby’s chest. Push about one and a half inches deep—this is a lighter pressure than you’d use on an adult. Push fast: The ideal infant CPR ratio is 100 compressions per minute. To help keep the right pace, the American Heart Association recommends timing your pumps to the beat of the Bee Gees song “Staying Alive,” which has 100 to 120 beats per minute.
3. After 30 compressions, open baby’s mouth and look for the object. If you can see it and can remove it without pushing it in further, fish it out. If baby is still unconscious, repeat the pattern (two rescue breaths, 30 chest thrusts) until rescue personnel arrive. Stop infant CPR the second you find an obvious sign of life, such as breathing.
Lastly, any and all of baby’s caregivers (nanny, grandparents and so on) should know how to perform infant CPR in case of a baby choking emergency. The American Red Cross offers a First Aid mobile app, free for both iOS and Adroid users, that gives step-by-step instructions for how to perform back blows, chest thrusts and baby CPR (as well as CPR for children and adults.) These measures could very well save baby’s life.
Luckily, a baby choking incident is usually preventable, thanks to parental oversight. The first step is to keep small toys, such as marbles, deflated balloons and bouncy balls, out of your child’s reach, as well as tiny household items, including button batteries, marker caps and loose change. “If an object can fit through a toilet paper tube, an infant can put it in his mouth and choke on it,” Shook says.
Supervising mealtime is also a must. Use these guidelines to prevent baby choking:
Mash baby’s food or cut it into pea-size bites to make sure baby can swallow foods safely. Remember, babies don’t actually chew until they get their molars in, which usually happens at about 13 to 19 months. Until then, they mash food between their gums.
Don’t introduce solid foods before baby is ready (typically around 4 to 6 months). She will need to be able to hold her neck steady, draw in her lower lip when you pull out a spoon, and swallow food rather than pushing it out onto her chin before getting her first taste of solid food.
Avoid high-risk foods such as hot dogs, nuts, hard veggies, seeds, popcorn and grapes. Use this litmus test: If the food requires molars (could you crunch up that carrot without any back teeth?), it’s too tough for baby. And if it’s soft and round, like a grape or hot dog, it needs to be sliced into very small pieces before baby gets his chubby fingers on it.