Choking

Choking happens when food or an object blocks the airway so that air cannot pass. It can be mild, where the person is still moving air and coughing, or severe, where nothing is getting through.

The difference matters because it decides what to do. Mild choking usually clears itself with coughing. Severe choking needs immediate help from whoever is there, because the brain begins to suffer within a few minutes without oxygen.

• Mild: the person can cough forcefully, speak, cry or breathe, and may be distressed but is moving air
• Severe: they cannot speak, cry, cough or breathe
• Clutching the throat with one or both hands, and a look of panic
• Silence, or a weak, high-pitched noise instead of a cough
• Lips, face or fingertips turning blue, grey or pale
• In a baby: no strong cry and no forceful cough
• Going floppy, then unconscious

See a doctor within a few days for a cough, wheeze or noisy breathing that continues afterwards, for chest or tummy pain following thrusts, or for repeated coughing at meals, which can be a sign of a swallowing problem.

In adults the usual cause is food: a large piece of meat or roti, a hard sweet, or eating quickly while talking or laughing. Loose dentures and alcohol add to the risk.

In children, whole nuts, grapes, chunks of fruit, popcorn and boiled sweets are common, and so are non-food items put in the mouth: coins, marbles, beads, small toy parts, balloon pieces and button batteries.

• Children under five, who explore with the mouth and cannot chew hard food well
• Eating in a hurry, while walking, running, talking or lying down
• Older age, ill-fitting dentures and dental problems
• Stroke, dementia, Parkinson's disease and other conditions that affect swallowing
• Alcohol
• Small objects, batteries and magnets within reach of a small child

A completely blocked airway starves the brain and heart of oxygen, and within minutes this can cause brain injury or cardiac arrest. This is why the first aid cannot wait for an ambulance.

An object that slips further down can cause a lasting cough, wheeze or chest infection. Back blows and thrusts can bruise or, rarely, injure ribs and organs, and a swallowed button battery can burn the food pipe within hours.

• Cut food for young children into small pieces, and avoid whole nuts, hard sweets and popcorn in the early years
• Keep children seated while eating, and supervise meals and snacks
• Keep coins, beads, marbles, button batteries, magnets and small toy parts out of reach
• Eat slowly, chew well, and avoid talking or laughing with a full mouth
• Have dentures checked so they fit properly
• Ask about a swallowing assessment for anyone who coughs at meals after a stroke
• Learn the steps for babies, children and adults before you need them

Choking itself is recognised at the scene, not in a laboratory, from the sudden inability to speak or breathe while eating or playing.

Afterwards a doctor listens to the chest, checks for injury from the first aid, and arranges imaging or a look inside the airway if a piece of the object may still be there or symptoms carry on.

For an adult or a child over one who cannot speak, cough or breathe, with someone calling for emergency help:

• Stand behind and slightly to one side, support the chest with one hand and lean them well forward
• Give up to five sharp blows between the shoulder blades with the heel of your other hand, checking after each one
• If that fails, put your arms around the waist, make a fist and place it just above the navel, grasp it with the other hand and pull sharply inwards and upwards, up to five times
• Keep repeating five back blows and five thrusts until the airway clears or help arrives
• For a pregnant woman or a very large person, use chest thrusts, with the fist on the middle of the breastbone, instead of abdominal thrusts

For a baby under one year:

• Lay the baby face down along your forearm, supported on your thigh, with the head lower than the body and the jaw supported in your fingers
• Give up to five firm back blows between the shoulder blades with the heel of your hand
• Turn the baby face up, place two fingers on the middle of the breastbone just below the nipple line, and give up to five sharp chest thrusts
• Repeat, checking the mouth each time and removing the object only if you can see it clearly

If the person stops responding, lower them to the floor and start CPR. In hospital, oxygen is given, the airway is examined, anything left behind is removed, and any injury from the choking or the first aid is treated.