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Choking in a conscious child may occur when the upper airway, usually the throat or windpipe, is blocked by an object or irritation. A child, for the purposes of this article, is an individual between one and eight years of age.

What are the signs and symptoms of the injury?

• inability to breathe or cry
• high-pitched voice or gurgling sounds
• ineffective cough
• bluish tint on face, hands, or feet

If the choking episode is left untreated, unconsciousness or death may follow.

What are the causes and risks of the injury?

Choking is usually caused by things that the child has placed in his or her mouth. These include toys, candy, popcorn, nuts, batteries, rocks, and buttons. Things that can wrap around the throat and constrict it, such as string or rope, can also cause choking.

What can be done to prevent the injury?

Some cases of choking can be avoided by:

• giving young children only age-appropriate toys
• avoiding toys that break easily, have small parts, or have batteries
• keeping foods such as popcorn, hot dogs, nuts, and seeds away from very small children
• cutting pieces of food for small children, especially grapes and wieners, into small enough pieces to prevent their lodging in the throat
• keeping buttons, watch batteries, coins, rocks, and any other small household items away from small children
• keeping strings and ropes away from small children. Never tie a pacifier with string to a child's clothing. The string could get wrapped around the child's neck.

How is the injury recognized?

Usually a person will notice that the child is having difficulty breathing. There may be a shocked, anxious look on the child's face, and the child may begin to turn blue.

What are the treatments for the injury?

• Nothing should be done if the child can still cough, breathe, or cry.
• If the child is conscious, do not try to grasp any object lodged in the throat, because this may push it down further.
• No first aid steps should be started until it is certain that the child is actually choking. If the child is actually choking, coughing and crying will be very weak or impossible, and the child's distress will be very obvious.

If the person performing first aid is alone, he or she should shout for help and begin first aid. If another person is there, he or she should contact the emergency medical system immediately.

• Stand behind the child with arms wrapped around the waist.
• Make a fist with one hand.
• Place the thumb side of the fist against the child's abdomen just above the navel but well below the breastbone.
• Grasp the fist with the other hand and press the fist into the child's abdomen with a quick upward thrust.
• Give up to 5 upward thrusts. Repeat until the object pops out or the child becomes unconscious.
• Each thrust should be a separate and distinct movement.

• Place the child face up.
• While kneeling, straddle the child's thighs. Place the heel of one hand against the child's abdomen in the middle, slightly above the navel and well below the breastbone.
• Place the second hand directly on top of the first.
• Press the abdomen with a quick upper thrust.

Do not try to remove an object from a conscious child's mouth. This could push the object further into the throat.

If the child becomes unconscious, begin first aid for choking in the unconscious child.

What are the side effects of the treatments?

The Heimlich maneuver can cause vomiting, injuries to internal organs, or broken ribs. Vomiting can be a problem if the vomited material is caught in the airway and inhaled into the lungs.

What happens after treatment for the injury?

It is important for a child who has choked to obtain medical care from a healthcare professional. Occasionally, an object will enter the lung instead of being expelled. This can cause coughing, wheezing, or aspiration pneumonia.