Choking Dr Trisha Macnair Choking is when a child struggles to breathe because of a blockage in the airway.

In this article

What causes it? Who's affected?

What are the symptoms? What's the treatment?

Usually, choking in small children is caused by a small foreign object blocking one of the major airways. This may be a small toy they've put in their mouth and inadvertently swallowed, or a small piece of food they haven't chewed properly.

If children run or play with objects in their mouth, there's an increased risk that the object will accidentally get into the trachea (windpipe) or airways.

Some infections that cause swelling of the airways or produce excessive or thick secretions (for example, epiglottitis and severe tonsillitis) can lead to choking.

Children under three years are particularly vulnerable to choking caused by a foreign object in their airways because their trachea and bronchi are small and they've not yet developed full control of the muscles of their mouth and throat.

Choking often begins with small coughs or gasps as the child tries to draw in breath around the obstruction or clear it out. This may be followed by a struggling sound or raspy squeaking whispers as the child tries to communicate their distress.

The child may thrash around and drool and their eyes may water. They may flush red and then turn blue. However, some children - particularly babies - can be remarkably silent as they choke.

The diagnosis becomes obvious as the symptoms develop. Treatment consists of trying to remove the obstruction and helping the child re-establish normal breathing.

• Remove the object carefully only if you can see it - don't dig around in the hope of finding it.

If this isn't successful:

• Give five back slaps, with a baby lying along your arm, head low and chin supported, or an older child leaning forwards.

If this doesn't work:

• Give five chest thrusts with two fingers placed on their breastbone with the baby lying on its back; for older children, give downward thrusts with the heel of the hand on their breastbone.

If this doesn't work:

• Older children may be given abdominal thrusts using the heel of the hand just below the ribs. The child can then be rolled on to their side and the back slaps repeated.

These steps should be repeated until successful.

NB: This is just a simple outline of what should be done and is not a substitute for practical experience. All parents are advised to learn how to resuscitate a child. Contact your local St John Ambulance service or doctor's surgery for details of classes.

If the child is unconscious or efforts to remove the obstruction are unsuccessful, call for an ambulance immediately.

If you have small children in the house, always check that tiny objects are out of their reach. Use a standard measuring device (available from a chemist or nursery shop) to check the safety of small toys.

This article was last medically reviewed by Dr Rob Hicks in December 2007