Choking

Choking (also called “foreign body airway obstruction”) is when something gets stuck in your airway. This prevents you from breathing normally.

Choking most commonly occurs while eating. Food can easily get lodged in your windpipe (trachea) or voice box (larynx), especially if you’re laughing, talking or eating quickly. Certain medical conditions also raise your risk for choking. Young kids might choke on anything from food to small toys or coins.

Choking can quickly turn into a medical emergency. Call 911 or call emergency services (and do first aid if you’re able) if:

• Someone has signs of severe choking, like they can’t cough, speak or breathe, AND/OR
• They lose consciousness

Types of choking

Healthcare providers classify choking into two main types:

• Complete (or severe) airway obstruction
• Partial (or mild) airway obstruction

Complete airway obstruction means the object fully blocks your airway. Air (and oxygen) can’t get through to your lungs. This is a medical emergency that requires immediate first aid. After four minutes without oxygen, you’re at risk for brain injury and possibly death.

Partial airway obstruction means the object only partly blocks your airway. This is what happens to most of us from time to time. You feel something “go down the wrong pipe,” and you start coughing intensely until it comes out. Partial choking is still serious because the object could shift and fully block your airway. But usually, you can cough up the object without anyone stepping in to help. 

Symptoms of choking

Most people who are choking will cough (noisily or silently), grab at their neck and look scared. But the signs can sometimes be subtle, especially in babies or kids. The signs also depend on whether their airway is partly or fully blocked.

Partial choking symptoms

Someone who’s partially choking can still take in a little air. So, they may:

• Cough a lot — probably loudly
• Sound hoarse when they try to talk (but words can still come out)
• Turn reddish or darker in color

Stay with them, encourage them to cough and be ready for first aid if needed.

Complete choking symptoms

Someone whose airway is completely blocked may:

• Be unable to speak
• Clutch or point to their neck
• Develop blue skin, nails or lips (cyanosis)
• Have a weak or silent cough
• Make a high-pitched noise (stridor)
• Nod when asked, “Are you choking?”
• Pass out (lose consciousness)
• Seem surprised, panicked or confused

Blue skin tone (signaling a lack of oxygen) is obvious in people who have light skin. But you may not notice a change in people with darker skin. Check their gums, the inner sides of their lips and their fingernails.

Seek emergency care and, if you’re able, start first aid.

What is the main cause of choking?

Food causes most episodes of choking. You can choke on any food that’s large enough to get stuck in your airway, especially if you don’t chew it fully. Common culprits include:

• Candy, especially hard candy
• Grapes
• Gum
• Hot dogs sliced into rings
• Marshmallows
• Meat
• Nuts
• Popcorn

Besides food, other objects that can cause choking — especially in children — include:

• Balloons
• Beads
• Button batteries
• Coins
• Small toys or toy parts

Larger objects — like big chunks of food or coins — are more likely to get stuck above your vocal cords. This typically causes a complete obstruction. Small, thin or sharp objects — like fish bones — are more likely to get stuck between or below your vocal cords, causing a partial obstruction.

Risk factors

Not chewing your food well enough is a major risk factor for choking. There are many reasons why you might not chew thoroughly — and many of these are out of your control. For example, you might:

• Have loose or missing teeth
• Wear dentures, which can make it hard to tell if your food is chewed well
• Have TMJ dysfunction, which limits how well you can chew
• Eat quickly because you don’t have time to spare

Eating in bed with your head lowered can also raise your risk.

You also may be more likely to choke if you have a medical condition that causes trouble swallowing (dysphagia). Examples include Alzheimer’s disease, Parkinson’s disease, myasthenia gravis and multiple sclerosis.

Complications of choking

Choking limits how much oxygen reaches your brain (cerebral hypoxia). This can quickly lead to cerebral anoxia, which means no oxygen can reach your brain. Dangerous arrhythmias, brain injury and death can result.

What should you do if someone is choking?

If someone around you starts choking, try to stay calm. Of course, that can be easier said than done. But staying calm can help you make the best and safest decisions. If you’re trained in first aid, be prepared to use it if necessary. Here are some general tips:

• Assess the situation. If someone is coughing (with sound), don’t attempt first aid. It’s likely they can cough up the object on their own. Trying to intervene might make matters worse. Instead, watch and see what happens. Encourage the person to cough. Don’t leave them alone until you know they’re OK.
• Don’t automatically try to remove the object. You might think you need to reach into the person’s mouth to remove the object. But you should only do this if you can clearly see the object. If so, make a hooking motion with your index finger to grab the object and pull it out. Don’t sweep your fingers around their mouth. This might push the object farther down.
• Know when to call for emergency help. If the person shows signs of complete choking, you or someone else should call 911 or your local emergency services number. Immediately begin first aid that’s appropriate to the person’s age (see below).

Choking first aid for adults and children

If an adult or child (over age 1) shows signs of complete choking, tell someone else to call emergency services. If no one else is around, call yourself, but put the phone on speaker and don’t delay first aid. Follow these steps:

1. Stand to the side and a bit behind the person. Kneel if it’s a small child.
2. Lean the person slightly forward.
3. Use your nondominant hand to gently support the person’s chest. This means if you’re right-handed, use your left hand for support.
4. Use the heel of your dominant hand to strike the area between their shoulder blades. This is called a back blow or back slap. Do up to five of these. Between each one, pause to see if the object has come out.
5. If five back blows aren’t enough, do up to five abdominal thrusts. This is also called the Heimlich maneuver. You make a fist with one hand and clasp your other hand around it. Place your hands between the person’s belly button and ribcage and push inward and upward. (Don’t attempt this unless you’re trained.)
6. If the person is still choking, repeat this sequence of five back blows and five abdominal thrusts until the object comes out or medical help arrives.
7. If the person goes unconscious at any point before help arrives, begin CPR if you’re able.

Choking first aid for infants (babies under 1 year)

If an infant shows signs of complete choking, have someone call 911 and begin first aid:

1. Turn the infant over so they’re lying face-down across your nondominant arm.
2. Use your nondominant hand to support the infant’s head and neck.
3. Do five back slaps. This means you use the heel of your dominant hand to slap the area between the infant’s shoulder blades. Use firm pressure, but use your best judgment to avoid being too forceful.
4. Turn the infant over so they’re face up.
5. Do five chest thrusts. This means you use the heel of your hand or just a couple of fingers to press down on the infant’s breastbone (sternum). Their sternum should go down by one-half inch to one inch per thrust. Avoid pressing on the sternum’s lower tip.
6. Do this same sequence again — five back slaps and then five chest thrusts — until the object comes out or medical help arrives.
7. If the infant goes unconscious, begin CPR if you’re able.

Hospital treatments for choking

Usually, first aid is enough to manage choking. But some people need extra treatments at a hospital. This might involve one or more of the following:

• A procedure (like laryngoscopy) to remove the object that’s stuck
• Support for breathing
• Treatment for any complications that arise

When should I see a healthcare provider?

See a provider if you had a serious choking episode that required first aid. Back blows and abdominal thrusts are lifesaving. But they can also cause complications, including damage to organs and bones in your torso (trunk). A provider will check for signs of complications and make sure you get any needed treatments.

Along similar lines, seek medical care for your child if they received first aid for choking. This is important even if your child seems fine. They may not know something is wrong or be able to tell you if something hurts.

See a provider after a partial choking episode if you:

• Feel like there’s something stuck in your throat
• Have trouble swallowing
• Keep coughing

When should I go to the ER?

Seek emergency care for yourself or anyone around you who’s severely choking. This means they can’t speak, breathe or cough effectively to dislodge the object that’s stuck in their airway. Every second matters and could make the difference between life and death.

What questions should I ask my healthcare provider?

Healthcare providers are your best source of information about ways to prevent choking or respond when it happens. If you have a child or are planning a family, talk to a provider about pediatric first aid training. They can recommend a program and make sure you get the resources you need. The more confident you feel in your ability to respond to a medical emergency, the less anxious you’ll feel in the moment.

Specific questions you may want to ask include:

• Should I do first aid training? If so, what courses do you recommend?
• Do I have any risk factors for choking?
• How can I lower my risk of choking?
• Are there any reasons why I shouldn’t receive abdominal thrusts (the Heimlich maneuver)?
• What should I do if I choke when alone?

If you have a loved one at risk for choking, ask their healthcare provider what you can do to help them stay safe. Be sure to get your loved one’s thoughts and preferences, too. You may want to do first-aid training regularly. Or maybe you can arrange for someone to always be with them when they’re eating. Having a plan in place can give you both some peace of mind.

How can I prevent choking?

Here are some tips to keep in mind:

• Cut your food into smaller pieces and take smaller bites.
• Don’t talk or laugh while chewing.
• Pay attention when you chew, and chew thoroughly.
• Make sure all dental prostheses (like implants, dentures and crowns) fit and work well.
• Try to slow down when you eat.
• Avoid eating while lying down. If you’re in bed, aim to sit up at a 90-degree angle (back straight up).

There’s a lot you can do to prevent choking in your child. For example, cut their food into small pieces and teach your child to spit out anything that doesn’t belong in their food — like bones, gristle or pits.

How do I know if my baby is choking or gagging?

In general, gagging is noisy (and generally harmless), while choking is mostly quiet (and dangerous). Gagging is a normal reflex that keeps your baby from choking. They gag when they’re still learning how to chew and swallow foods of different textures.

If your baby is gagging, they’ll:

• Make loud coughing noises
• Stick their tongue out
• Vomit

If your baby is choking, they’ll:

• Cough silently
• Make a high-pitched whistling sound (stridor)
• Turn a bluish color

Your pediatrician can tell you more about these differences and when to seek medical care.

What is a choking device?

A choking device is a tool that removes an object that’s stuck in your throat. DeChoker® and LifeVac® are two brand names. These devices are a bit like the plungers you use for your sink. They create a tight seal around your mouth and use suction force to dislodge the object from your airway.

But proceed with caution. We need more research to know when these devices are most effective. Healthcare providers still recommend traditional first aid (back blows and abdominal thrusts) as the tried-and-true response to choking.

Choking devices may have value as:

• A backup to keep on hand if all else fails and paramedics haven’t arrived yet
• An option for people who might more easily get injured by abdominal thrusts (for example, people with frailty)
• An option for people who are pregnant or have a body shape that makes traditional first aid more challenging or dangerous

Talk to a healthcare provider before you invest in a choking device for yourself or a loved one. Get their opinion on whether to buy one and when to use it.