What is choking?

Choking is when something gets stuck in your windpipe, blocking the flow of air to your lungs.

In adults, choking can happen when a piece of food enters the trachea (windpipe) instead of the oesophagus (food pipe). Babies and young children put all sorts of things in their mouths and can choke on anything smaller than a 20 cent coin.

Sometimes the windpipe is only partly blocked. If you can still breathe, you may be able to push out the object by coughing forcefully.

If the object blocks your windpipe completely and you cannot breathe, it's a medical emergency. Your brain can only survive for a few minutes without oxygen.

What are the symptoms of choking?

Someone may be choking if they:

• clutch their throat
• cough, wheeze or gag
• have difficulty breathing, speaking or swallowing
• make a whistling or 'crowing' noise — or can't make any sound at all
• have a blue face, lips, earlobes or fingernails
• are very agitated
• lose consciousness

Choking first aid — What should I do if someone is choking?

Adults and children over 1 year

Perform choking first aid:

1. Try to keep the person calm. Ask them to cough to try to remove the object.
2. If coughing doesn't work, call triple zero (000) and ask for an ambulance.
3. Bend the person forward and give them up to 5 sharp blows on the back between the shoulder blades with the heel of one hand.
   After each blow, check if the blockage has been cleared.
4. If the blockage still hasn't cleared after 5 blows, give up to 5 chest thrusts. Place one hand in the middle of the person's back for support. Place the heel of the other hand on the lower half of the person's breastbone. Press hard into the chest with a quick thrust.
   After each thrust, check if the blockage has been cleared.
5. If the blockage has not cleared after 5 thrusts, continue alternating 5 back blows with 5 chest thrusts, until medical help arrives.
6. If the person becomes blue, limp or unconscious, start CPR immediately. Start with compressions, not breaths.

Babies under 1 year

After calling for an ambulance, perform choking first aid:

1. Lay the baby face down on your forearm with their head lower than their body, supporting their head and shoulders on your hand.
2. Hold their mouth open with your fingers.
3. Give up to 5 sharp blows to the back between the shoulders with the heel of one hand.
   After each blow, check if the blockage has been cleared.
4. Use your little finger to remove the object from their mouth if it has cleared from their airway.
5. If the blockage has not cleared after 5 back blows, place the baby on their back on a firm surface. Place 2 fingers on the lower half of the breastbone and give up to 5 chest thrusts.
   After each thrust, check if the blockage has been cleared.
6. If the blockage has not cleared after 5 thrusts, continue alternating 5 back blows with 5 chest thrusts until medical help arrives.
7. If the baby becomes unconscious, start CPR immediately. Start with compressions, not breaths.

What not to do

• Don't ask the person if they're okay. Instead, ask them if they are choking. They could have difficulty breathing from something else, such as asthma.
• Don't try to perform the Heimlich manoeuvre (where a big thrust is given to the abdominal area). This can break ribs and damage internal organs.
• Don't put your fingers in the person's mouth — they may bite you accidentally and it could push the object further into the windpipe.
• Don't pick up a child who is choking and turn them upside down.
• Don't bang on the person's back while they are upright.

Choking first aid — What should I do if I am choking?

If you are choking while you're alone, keep calm and try to get someone to help you. Try to clear the blockage with a forceful cough.

Treatment and recovery from choking

In the emergency department, the hospital team can try a few different techniques to unblock your windpipe.

Sometimes the choking episode seems to have passed, but the object may be stuck further down in your airways. You may need to have a bronchoscopy to check your airways are clear. If something is stuck there, it can cause an infection.

You may need to stay in hospital for observation to check there is no damage to your lungs.

You may need medical help if you have:

• a cough or wheeze that doesn't go away
• blood coming up when you cough
• a fever
• difficulty breathing

Who is at risk of choking?

Anyone can choke, but babies and young children are at especially high risk. Their airways are soft and narrow, they are still learning how to eat safely, and they often put objects in their mouths.

People over age 65 years and people with a disability, such as cerebral palsy, intellectual disability or dementia, are at greater risk of choking. People with epilepsy are at risk of choking during a seizure.

Can choking be prevented?

It's important to keep all small objects out of the reach of babies and children. Take care to keep your child away from common choking hazards, such as:

• household items such as coins, safety pins, magnets, buttons and beads
• batteries — keep toy battery compartments firmly closed and avoid buying toys with button batteries
• toys with small parts such as marbles, bouncy balls or small blocks
• polystyrene beads inside bean bags and stuffed toys
• water-absorbing beads used in some toys
• balloons — especially broken, popped or deflated

Make sure your child's toys meet Australian safety standards, and are not broken or damaged. Find out more about choosing safe toys.

Product Safety Australia's Choke Check tool can help you identify toys and other objects that are a choking hazard.

Here are some things you can do to reduce your child's risk of choking while eating:

• Make sure your child sits down to eat and drink, rather than lying down or running around. Watch your child when they are eating.
• Cut up food into small pieces and encourage your child to chew well.
• Avoid giving your child high risk foods such as lollies, raw apple, raw carrot, whole grapes, nuts and popcorn until they are old enough.
• Cook, grate or mash hard foods to a level that is right for your child's age and developmental stage.
• Cut grapes lengthways in half and in half again. Take the bones out of meat and fish. Cut up sausages and take off the skin.
• Don't force your child to eat.

Read more on food textures and how to introduce your baby to solid foods.

It's important for everyone to:

• eat and drink slowly and chew food well
• take small mouthfuls, especially of high-risk foods such as popcorn or nuts
• avoid eating while talking, laughing or lying down
• cut food into small pieces (especially people with a dry mouth or difficulty with chewing or swallowing)

Choking games

The 'choking game' is a very dangerous behaviour where someone chokes themselves or someone else to produce a feeling of a 'high'. This is also sometimes called a pass-out or blackout challenge.

People who engage in choking games plan to let go and start breathing normally before the person loses consciousness. If they don't let go in time, it can cause brain damage or death. The risks are higher if someone does this alone.

There have been media reports about children and young people engaging in choking games. They might do this because of peer pressure or to feel a thrill. Most of the time, parents are not aware.

Signs that your child is taking part in choking games may include:

• showing interest in choking
• bruises on their neck, or wearing clothes that cover their neck
• tiny red spots on or around their eyes or eyelids
• headaches
• irritable behaviour
• spending a lot of time alone and seeming confused afterwards
• ropes, scarves or cords in their bedroom

Talk to your child about the risks of choking games. If they are know the dangers, they may be less likely to participate.

If you are concerned that your child may be engaging in choking games, call Kids Helpline on 1800 55 1800.

Resources and support

The best thing you can do to help with choking is to learn first aid, especially if you are caring for a young child. You can find first aid courses at St John Ambulance Australia, the Royal Life Saving Society Australia, and the Australian Red Cross.

Download and become familiar with St John's fact sheets about choking first aid, both in adults and in infants.

Product Safety Australia's Choke Check tool can help you identify toys and other objects that pose a choking hazard.