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Choking First Aid: Back Blows and Abdominal Thrusts, Step by Step

Choking can escalate in seconds. Here is the general sequence of first-aid steps commonly taught for a conscious adult or child — this is general information, not a substitute for certified first-aid training.

Recognizing true choking

A person who is genuinely choking often cannot speak, cough forcefully, or breathe, and may grip their throat with one or both hands (the universal choking sign). This is different from someone who can still cough or speak, which usually means the airway is only partially blocked.

If the airway is only partially blocked, encourage coughing

If the person can still cough forcefully or speak, encourage them to keep coughing on their own rather than intervening physically, since a forceful natural cough is often effective at clearing a partial obstruction, and physical intervention carries its own risks.

Back blows: the first step for complete blockage

Standing slightly behind and to the side of the person, lean them forward and deliver up to five firm blows between the shoulder blades with the heel of your hand, checking after each blow whether the object has been dislodged.

Abdominal thrusts (the Heimlich maneuver)

If back blows do not clear the blockage, stand behind the person, wrap your arms around their waist, make a fist and place it just above the navel, grasp it with your other hand, and pull sharply inward and upward in a quick thrust. This is generally alternated with back blows (five and five) until the object is expelled or the person becomes unresponsive.

If you are choking and alone

You can perform abdominal thrusts on yourself using your own fist and hand in the same inward-and-upward motion, or lean firmly over a sturdy, fixed object like the back of a chair or a countertop edge to create a similar thrusting force against your abdomen.

Infants under 1 year need a different technique

Standard abdominal thrusts should never be used on infants under 1 year old. Instead, the typically taught approach alternates back blows with chest thrusts (using two fingers on the center of the breastbone), with the infant positioned face-down along your forearm for back blows and face-up for chest thrusts, supporting the head and neck throughout.

Why back blows and abdominal thrusts work

Back blows use a sharp, direct mechanical force to try to dislodge an object by shock and gravity. Abdominal thrusts work differently: the sudden inward-and-upward force compresses the diaphragm and pushes trapped air out of the lungs in a burst, functioning like an artificial, forceful cough that can eject an object the person’s own airway could not clear.

What changes for infants and other special cases

Because an infant’s abdominal organs are more vulnerable to injury from a forceful thrust, standard abdominal thrusts are replaced with chest thrusts for infants under 1 year old. For someone who is pregnant or has a significantly larger body, chest thrusts (rather than abdominal thrusts) are also commonly taught as an alternative, since correctly reaching around the abdomen may not be practical or safe.

Frequently Asked Questions

What emergency number should I call if someone is choking?

This depends on where you are — emergency numbers differ by country (for example, 911 in the US, 999 in the UK, 112 across much of the EU, and 119 in South Korea). Know your local emergency number in advance. This is general information, not a substitute for certified first-aid training — consider taking an accredited first-aid or CPR course to learn and practice these techniques properly.

If the object comes out and the person seems fine, do I still need to call emergency services?

It is still generally recommended to have the person evaluated by a medical professional afterward, since forceful abdominal or chest thrusts can occasionally cause internal injury, and there is a small risk that part of the obstruction remains or that the airway was otherwise affected. When in doubt, seek medical attention.