Heimlich maneuver: what to do when a baby or child is choking

Seeing a baby or child choke is one of the most frightening situations for parents and caregivers.

In these moments, knowing how to tell whether the child can still breathe and cough is just as important as knowing the first aid maneuvers.

That's because not every choking episode should be handled the same way.

And there is one fundamental difference:

the Heimlich maneuver is not recommended for babies under 1 year old.

For babies, the technique for clearing the airway is different.

What is choking?

Choking happens when food, an object or another substance gets into the airway.

The body normally tries to expel it by coughing.

In some situations, however, the object can partially or completely block the flow of air.

When the obstruction is severe, it is an emergency and you need to act quickly. Brazil's Ministry of Health considers choking a situation that can lead to asphyxia and loss of consciousness.

First: check whether the child can cough or make sounds

Before starting any maneuver, observe the child.

If they can cough forcefully, cry or speak

This shows that air is still getting through.

In this situation:

• keep the child in a comfortable position;
• encourage them to cough;
• watch them closely;
• don't hit them hard on the back;
• don't turn the child upside down;
• don't put your fingers in their mouth looking for the object.

Coughing is an important mechanism for trying to expel the foreign body.

The SBP (Brazilian Society of Pediatrics) advises that, when the cough is effective, airway clearance maneuvers should not be performed.

Watch out if the child:

• can't cough;
• can't speak or cry;
• can't make any sounds;
• has great difficulty breathing;
• makes breathing movements without being able to take in air;
• becomes very agitated;
• starts to turn pale or bluish;
• clutches their neck, if they are old enough to do so.

These signs may indicate severe or complete airway obstruction.

At this point, choking rescue maneuvers should be started.

Baby under 1 year old: do not perform the Heimlich maneuver

In babies under 1 year old, the abdominal thrusts of the Heimlich maneuver should not be performed.

A baby's anatomy is different, and this type of thrust can cause injuries.

For a conscious baby with severe obstruction from food or a solid object, the Brazilian Society of Pediatrics advises alternating back blows with chest thrusts.

1. Place the baby face down

Rest the baby along your forearm.

Hold the head and face securely and keep the head lower than the rest of the body.

You can rest your arm on your own thigh for more stability.

2. Give 5 back blows

With the heel of your hand, give five firm blows between the shoulder blades, in the middle of the back.

3. Turn the baby face up

Keeping the head lower than the chest, carefully turn the baby over onto your other forearm.

4. Give 5 chest thrusts

Perform five thrusts in the center of the chest, just below the imaginary line between the nipples, following the pediatric first aid technique.

until:

• the object is expelled;
• the baby starts breathing again;
• or the baby becomes unconscious.

The SBP's Brazilian guidance currently uses this sequence for babies under 1 year old.

Child over 1 year old: when the Heimlich maneuver comes in

For children over 1 year old with severe obstruction, abdominal thrusts can be performed — the well-known Heimlich maneuver.

The Brazilian Society of Pediatrics advises that the rescuer stand behind the child and adjust to their height, kneeling if necessary.

How to do it

1. Position yourself behind the child.

2. Wrap your arms around their waist.

3. Make a fist with one hand.

4. Place the fist on the abdomen, above the belly button and below the bottom of the breastbone.

5. Cover the fist with your other hand.

6. Make firm movements inward and upward.

Continue until the object is expelled or the child loses consciousness.

The most recent international guidelines also recommend, for conscious children with severe obstruction, alternating 5 back blows with 5 abdominal thrusts.

What if it's milk, water or another liquid?

There is an important difference here.

Young babies may cough or choke during a feed because they are still developing the coordination between sucking, swallowing and breathing.

When the baby is coughing and breathing, the SBP advises:

• sitting them up or semi-upright;
• removing only the excess liquid visible in the mouth;
• letting them cough;
• watching their recovery.

Don't automatically perform the maneuvers for solids just because the baby coughed during a feed.

If they cough, spit up a little and quickly go back to breathing normally, it is usually enough to keep an eye on them.

But if they continue to have difficulty breathing, wheezing or discomfort, seek medical care.

Don't put your finger in their mouth blindly

In a moment of panic, it's common to try putting your fingers in the child's mouth to find the object.

This can push it even further into the airway.

Only try to remove something from the mouth when the object is clearly visible and easily reachable.

Don't do a finger “sweep” without seeing the object.

Don't turn the baby upside down

Holding the baby by the feet or simply shaking them is not an appropriate technique for relieving choking.

Besides not safely resolving the obstruction, these actions can cause other injuries.

Use the techniques recommended for the child's age.

What if the child becomes unconscious?

If the baby or child stops responding, the situation is an emergency.

Carefully place them on a firm, flat surface and call for help immediately.

Call SAMU (Brazil's emergency ambulance service) at 192 and follow the dispatcher's instructions while starting the resuscitation measures you have been trained in. SAMU operates 24 hours a day and can guide whoever is giving first aid while help is on the way.

If someone else is present, ask them to make the call while you stay with the child.

Even after the choking is cleared, do you need to see a doctor?

When choking rescue maneuvers were needed, the SBP recommends a medical evaluation.

This is important because:

• a fragment may have remained in the airway;
• the object may have been inhaled;
• there may be small injuries caused by the foreign body;
• the maneuvers themselves can occasionally cause trauma.

Even if the child seems fine afterward, tell the professional exactly what happened and which maneuvers were performed.

How to reduce the risk of choking

Prevention is just as important as knowing how to give first aid.

Some precautions help:

• keep small objects out of reach;
• check that toys are age-appropriate;
• don't leave coins, bottle caps, batteries, small parts or balloons within reach;
• supervise young children during meals;
• offer foods in shapes and textures appropriate for their age;
• don't let the child eat while running or playing;
• teach older children to chew calmly;
• pay special attention when starting solid foods.

The risk changes as the child grows and begins to explore objects with their hands and mouth.

A first aid course is worth it

Reading about the technique helps, but practicing it with an instructor and a training mannequin makes a big difference.

A real emergency is not the best time to try to remember for the first time where to place your hands.

That's why parents, grandparents, nannies and others who frequently care for the child can benefit from a course in:

• pediatric first aid;
• airway clearance;
• cardiopulmonary resuscitation (CPR).

It's a skill we hope never to need — but one that can save a life.

The essentials to remember

If you only keep a few pieces of information from this article, keep these:

If the child is coughing forcefully: let them cough and watch them.

If there is severe obstruction: act immediately.

Under 1 year old: back blows + chest thrusts.

Over 1 year old: airway clearance technique that includes the Heimlich maneuver.

**Never put your fingers in their mouth without seeing the object.**

If they lose consciousness: call SAMU at 192 immediately and start appropriate first aid.

Knowing these differences makes your response much safer.

Nilu tip: save the number 192 on the phones of the main caregivers and consider taking a hands-on first aid course before starting solid foods. Knowing the technique in advance gives you much more confidence than trying to learn it during an emergency. 💛

Reference sources

• Brazilian Society of Pediatrics — Guide and guidance on choking in children and foreign body aspiration.
• Brazil's Ministry of Health — guidance on choking.
• Brazil's Ministry of Health — Mobile Emergency Care Service (SAMU 192).
• American Heart Association — 2025 Guidelines for CPR and management of airway obstruction.

This content is for educational and informational purposes and does not replace hands-on first aid training or emergency care. In case of severe airway obstruction, loss of consciousness or significant difficulty breathing, call SAMU at 192 immediately.