Choking in babies: what to do in the first seconds

I went through a choking episode with my six-month-old son and, in the moment, I froze. Afterwards I studied, took a first aid course and understood that the first seconds make all the difference. This text is what I wish I had read before I needed it. But I will say it up front: read it, read it again and take a hands-on course, because reading does not replace training with your hands.

First of all: call for help

If the baby is really choking, ask someone to call SAMU on 192 (Brazil’s public emergency medical service) while you act, or put the phone on speaker. The phone assistance guides the rescue step by step. If you are alone, start the maneuvers first and call as soon as you can, without wasting time if the baby is not breathing.

How to recognize severe choking

Not every choking episode is severe, and telling them apart is the first step.

• Mild choking: the baby coughs strongly, cries, breathes and makes sound. The cough is the natural cleaning mechanism.
• Severe choking: the baby makes no sound, may turn blue, opens the mouth without being able to cry, goes limp or brings the hands to the throat.

If it is mild, stay calm, let the baby cough and observe. Do not stick your finger in the mouth to try to remove the object, because you can push it further in.

Pay attention to the context too. A baby who starts coughing right after feeding, or who always chokes at mealtime, needs an assessment of the latch and the texture of the foods. Repeated choking is not a coincidence and deserves a conversation with the pediatrician.

What to do in the first seconds

The maneuvers below are the ones taught in first aid courses for babies under 1 year old. They do not replace hands-on training, but they help you recognize the movement so you can act with less panic.

1. Confirm that it is severe choking: no sound, no breathing and no coughing.
2. Sit down and support the baby face-down along your forearm, with the head lower than the body, holding the jaw firmly without squeezing the throat.
3. Give five firm blows with the heel of your hand between the shoulder blades, in the middle of the back.
4. Turn the baby face-up, still with the head low, and give five compressions in the center of the chest, with two fingers, on the line between the nipples.
5. Alternate five back blows and five chest compressions, looking inside the mouth between sets. If the object appears, remove it carefully.
6. Repeat until the object comes out or help arrives. If the baby faints, follow SAMU’s guidance on the phone and continue until the team arrives.

If you have your phone nearby, put it on speaker and let the SAMU operator keep time with you. Hearing a voice guiding you helps maintain the rhythm of the blows and compressions, and keeps despair from making you stop before the object comes out.

Meanwhile, watch the signs. If the baby starts breathing and crying again, he still needs a medical assessment, because there may be residue left in the airway or some injury.

What not to do

• Do not stick your finger blindly into the mouth to try to grab the object.
• Do not shake the baby.
• Do not offer water to push down what caused the choking.
• Do not turn the baby upside down by the legs.
• Do not skip the emergency room just because the baby cried and seemed to get better.

Another thing I learned: a baby who nurses needs attention during the feeding. If you have doubts about the latch and position, it is worth reading about breastfeeding in the first days, because the wrong position also increases the risk of choking on milk.

After the choking, go to the emergency room

Even if the baby seems fine, seek care. The doctor will assess whether anything is left in the airway and whether the baby breathes without effort. This care prevents a complication hours later. If the choking happened with food, the pediatrician can advise on the texture appropriate for the age, a care that starts back in introducing solids to the baby.

Write down what happened: what the baby choked on, how long ago, whether he stopped breathing and for how long. This information helps the medical team a lot in deciding which tests to run.

And if your baby has frequent reflux or cries with legs pulled up after feeding, the problem may have another cause. It is worth checking how to tell if your baby has colic, because the two are easy to confuse.

Frequently asked questions

What is the difference between choking and reflux?

In reflux, the milk comes back and the baby coughs or spits up, but keeps breathing and crying. In severe choking, he stops breathing and making sound. When in doubt, call SAMU on 192.

Can I pat the baby face-down on my lap?

The face-down position along the forearm, with the head lower, is the basis of choking rescue. The ideal is to take a hands-on course to train the right force and position, because these are details that get done wrong in a hurry.

Is choking on milk the same?

Choking on milk is usually milder, with coughing and milk coming back out of the mouth. If the baby makes no sound and is not breathing, follow the severe choking maneuvers and call SAMU on 192.

Seeing a baby choke is one of the biggest fears of any mother, and going through it changes the way we see every meal. The right information gives you action in the moment of the scare, but it is the first aid course that turns knowledge into reflex. It is worth the investment.