Overview
This is a summary of the Resuscitation Council UK guidelines and like all material on this website, must only be used for exams and revision and must not be used for patient care. Always check the Resuscitation Council UK guidelines, NICE, and any other relevant guidelines for updates or changes.
When a foreign body enters a child’s airway, they immediately cough to attempt to remove it. If coughing is ineffective or absent, the object may completely obstruct the airway and asphyxiate the child.
Foreign body airway obstruction (FBAO) presents with sudden coughing, gagging, or stridor and the majority of FBAO events happen during play or while eating in children.
For as long as there is effective coughing, encouraging the child to cough and continuing monitoring is sufficient.
However, if features of ineffective coughing and/or clinical deterioration are present, shout for help and call emergency medical services.
- A single rescuer should perform rescue manoeuvres unless they can call for help simultaneously
Definitions
The Resuscitation Council UK have the following definitions:
- Newborn – an infant just after birth
- Infant – <1 year old
- Child – between 1-18 years old
If the responder believes the person is a child, then they should use the paediatric guidelines. It is important to differentiate between infants and children as their management differs.
Features of Choking
Overview
General signs of choking include:
- Witnessed episode
- Choking or coughing
- Sudden-onset
- Recent history of playing with/eating small objects
Features of effective coughing include:
- Crying or verbal responses to questions
- Loud coughing
- Able to take a breath before coughing
- Fully response
Features of ineffective coughing include:
- Unable to vocalise
- Quiet or silent cough
- Unable to breathe
- Cyanosis
- Decreasing consciousness
Child/Infant Conscious but Ineffective Coughing
Back blows
If the child is conscious but has ineffective coughing, give back blows. The technique varies depending on age.
For infants:
- Place the infant prone and head facing down, usually across the rescuer’s lap and support the infant’s head and neck, avoiding putting pressure under the infant’s jaw
- Give up to 5 sharp back blows with the heel of the hand in the middle of the back between the shoulder blades
- All 5 blows may not be needed as the obstruction may be relieved with each blow
For children <1 year:
- If the child is small enough, place across the lap as with an infant as mentioned above and give up to 5 back blows
- If this is not possible, lean them forwards with support and give up to 5 back blows
- All 5 blows may not be needed as the obstruction may be relieved with each blow
Back blows ineffective and child still conscious
If back blows are ineffective and the child is still conscious give chest thrusts to infants or abdominal thrusts to children.
For infants, perform chest thrusts and do not use abdominal thrusts in infants:
- Lay the infant face up along the lap, place your free arm along the infant’s back and support the infant’s head with your hand encircling the occiput
- Place the tips of the index and middle fingers on the lower sternum (around 1 finger breadth above the xiphisternum) and give 5 chest thrusts
- These are similar to chest compressions but sharper and slower
- All 5 chest thrusts may not be needed as the obstruction may be relieved with each chest thrust
For children <1 year old:
- Stand/kneel behind the child and place your arms under their arms and encircle their torso
- Place one hand in a clenched fist between the umbilicus and xiphisternum and grasp your fist with the other hand
- Pull sharply inwards and upwards up to 5 times
- Avoid applying pressure to the xiphoid process/lower ribcage as this can cause trauma
- All 5 chest thrusts may not be needed as the obstruction may be relieved with each chest thrust
After back blows, reassess the child/infant
If the object has not been expelled and the child/infant is still conscious:
- Repeat back blows and chest thrusts for infants or abdominal thrusts for children
- Call for/send for help
- Do not leave the child at this stage
If the object has successfully been expelled:
- Assess the infant/child
- Some parts of the foreign body may still be present
- If in doubt or abdominal thrusts were necessary for treatment, urgently seek emergency help
Child/Infant is or Becomes Unconscious
Perform paediatric basic life support
