Choking can happen suddenly: during dinner, at a family gathering, in a restaurant, or while a child is playing. In a few seconds, a normal moment can become a medical emergency.
The Heimlich maneuver, also called abdominal thrusts, is one of the best-known first-aid responses for choking. Today, major first-aid guidance often teaches it together with back blows, because a complete airway blockage may require fast, repeated action.
The most important rule is simple: if someone cannot breathe, speak, cough effectively, or make sounds, treat it as a choking emergency and call for emergency medical help.
What Is the Heimlich Maneuver?
The Heimlich maneuver is a first-aid technique designed to help remove an object blocking a person’s airway.
It uses quick inward and upward pressure below the ribs and above the navel. This pressure can force air from the lungs and help push the object out.
The technique became widely known in the 1970s and is still commonly associated with choking rescue. However, modern first-aid guidance does not always teach abdominal thrusts alone.
The 2025 American Heart Association guidance recommends that rescuers use alternating cycles of five back blows followed by five abdominal thrusts for conscious adults and children with severe foreign-body airway obstruction, starting with back blows.
How to Recognize Serious Choking
Not every cough means the person needs the Heimlich maneuver.
If someone is coughing strongly, breathing, or able to speak, encourage them to keep coughing. A strong cough may clear the airway naturally.
Serious choking is different.
Warning signs may include:
- Inability to speak
- Weak or silent coughing
- Trouble breathing
- Hands clutching the throat
- Blue or pale skin
- Panic or sudden silence
- Loss of consciousness
The American Red Cross describes choking as a partial or complete airway blockage caused by food, small objects, swelling, or fluids, and emphasizes quick first-aid response when the airway is severely blocked.
What to Do for a Choking Adult or Child Over One Year Old
For a conscious adult or child older than one year who cannot cough, speak, cry, or breathe effectively, current major guidance supports a sequence of back blows and abdominal thrusts.
A practical response looks like this:
First, call emergency services or ask someone nearby to call.
Then give five firm back blows between the shoulder blades.
If the object does not come out, give five abdominal thrusts.
Repeat the cycle until the object comes out or the person becomes unresponsive.
The American Heart Association’s 2025 guidance and Mayo Clinic’s first-aid materials both describe using back blows and abdominal thrusts for adults and children older than one year.
How Abdominal Thrusts Are Performed
Stand behind the choking person.
Wrap your arms around their waist.
Make a fist with one hand and place it above the navel, but below the breastbone.
Grab your fist with your other hand.
Pull sharply inward and upward.
Each thrust should be quick and purposeful, not slow or gentle.
The goal is not to squeeze the person. The goal is to create a strong burst of pressure that may help eject the blockage.
If the person is too large to wrap your arms around, the American Red Cross advises giving chest thrusts instead of abdominal thrusts.
What to Do if the Person Becomes Unresponsive
If the choking person collapses or becomes unresponsive, begin CPR and make sure emergency services have been called.
Do not continue standing abdominal thrusts on someone who is unconscious.
For children with severe foreign-body airway obstruction, the 2025 American Heart Association and American Academy of Pediatrics guidance states that cycles of back blows and abdominal thrusts should continue until the object is expelled or the child becomes unresponsive; once unresponsive, CPR should begin.
A certified CPR course is the safest way to learn the correct technique, hand placement, compression depth, and rescue-breath sequence.
What About Babies Under One Year Old?
Infants are different.
Do not use abdominal thrusts on a baby under one year old.
For infants with severe choking, updated 2025 American Heart Association guidance recommends alternating five back blows and five chest thrusts until the object is expelled or the infant becomes unresponsive.
The NHS gives similar practical advice: babies under one year should receive back blows and chest thrusts, while children over one year may receive back blows and abdominal thrusts.
This distinction matters because infants have smaller bodies and more vulnerable internal organs.
Common Mistakes to Avoid
One dangerous mistake is doing nothing because you are unsure.
Another mistake is trying to pull the object out blindly with your fingers. Blind finger sweeps can push the object deeper into the airway, especially in young children. Mayo Clinic warns that this is risky and should be avoided.
Do not give abdominal thrusts to a person who is coughing strongly.
Do not hit someone on the back if they are breathing normally and clearing the object themselves.
Do not practice hard abdominal thrusts on a person who is not choking.
First aid is powerful because it is fast, simple, and correctly timed.
Choking Prevention at Home
Prevention is especially important for children, older adults, and people with swallowing difficulties.
High-risk foods for young children include whole grapes, hot dog pieces, nuts, hard candy, popcorn, and chunks of raw vegetables.
Cut food into safe sizes. Encourage children to sit while eating. Keep small toys, coins, batteries, and magnets away from babies and toddlers.
Adults can reduce choking risk by eating slowly, chewing thoroughly, avoiding excessive alcohol during meals, and being careful with tough meat or large bites.
Expert Perspective
The American Heart Association’s 2025 resuscitation guideline update is especially important because it refreshed choking guidance for adults, children, and infants. It recommends back blows as the starting step for conscious adults with foreign-body airway obstruction, followed by abdominal thrusts when needed.
The FDA has also encouraged the public to follow established choking rescue protocols from organizations such as the American Red Cross and the American Heart Association during complete airway block emergencies.
The expert message is clear: learn the technique before you need it, act quickly during a real emergency, and rely on established first-aid protocols rather than improvisation.
Interesting Facts
- The Heimlich maneuver is named after Dr. Henry Heimlich, who promoted abdominal thrusts as a choking rescue technique.
- Choking is more common in young children because they explore objects with their mouths and have smaller airways.
- A person who can cough forcefully usually still has some airflow.
- Universal choking signs often include clutching the throat with one or both hands.
- Back blows are now emphasized as an important first step in major updated choking guidance.
- Infants need a different response than adults and older children.
- Taking a certified first-aid and CPR course can make emergency response faster and more confident.
Glossary
- Heimlich Maneuver — A choking rescue technique using abdominal thrusts to help remove an airway blockage.
- Abdominal Thrusts — Quick inward and upward thrusts applied above the navel and below the breastbone.
- Back Blows — Firm blows delivered between the shoulder blades to help dislodge an object from the airway.
- Chest Thrusts — Thrusts applied to the chest, used in specific choking situations, especially for infants or when abdominal thrusts are not possible.
- Airway Obstruction — A blockage that prevents normal airflow through the mouth, throat, or airway.
- Foreign Body Airway Obstruction — Choking caused by an object such as food, a toy, or another item blocking the airway.
- CPR — Cardiopulmonary resuscitation, an emergency technique used when a person is unresponsive and not breathing normally.
- Unresponsive — A state in which a person does not respond to voice, touch, or stimulation.
- Emergency Services — Local medical emergency responders, reached through numbers such as 911, 112, or the relevant emergency number in your country.
