Choking in Babies and Toddlers: the Australian Technique

Choking is the emergency nannies ask about most, and for good reason. Small children put everything in their mouths, their airways are narrow, and a complete blockage can cause unconsciousness in about a minute. The Australian technique is straightforward, but it differs from the abdominal thrusts you may have seen in American films. Abdominal thrusts are not recommended here.

First decide whether the blockage is partial or complete

If the child is coughing forcefully, crying or able to speak, air is still moving and the blockage is partial. Do not hit them on the back. A hard blow at the wrong moment can dislodge the object into a worse position. Stay with them, keep them calm and encourage the coughing.

If the child cannot cough, cry, speak or breathe, if their efforts are silent, or if their lips are turning blue, the blockage is severe. Act immediately and have someone call 000.

Up to five back blows

For a child over one year, lean them well forward so that gravity helps. With the heel of your hand, deliver a firm blow between the shoulder blades. Check after every single blow, because the aim is to clear the airway rather than to complete all five.

Then up to five chest thrusts

If back blows have not worked, place one hand in the centre of the chest, in the same position you would use for compressions, and give a sharp inward thrust. A chest thrust is slower and sharper than a compression. Check between each one, then continue alternating five back blows with five chest thrusts until the object shifts or help arrives.

Babies under one are the same pattern, more gently

Lay the baby face down along your forearm with the head lower than the chest, supporting the jaw, and deliver back blows with the heel of your hand. For chest thrusts, turn the baby face up along your thigh and use two fingers on the centre of the chest. Never hold a choking baby upside down by the ankles, and never sweep your fingers blindly into any child's mouth, because you are likely to push the object further in.

If the child becomes unresponsive

Lower them to the floor, call 000 if nobody has yet, and begin CPR. Chest compressions generate pressure that often shifts the blockage on their own. Look inside the mouth each time you open the airway to give breaths, and remove the object only if you can clearly see it and reach it.

Practise on a manikin before you need it

Back blows on a real baby feel much firmer than people expect, which is exactly why hands on practice matters. Our Childcare First Aid course drills choking response on infant, child and adult manikins. Book a session and get your certificate the same day.