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| Ethan, Henry & Grayson 8/28/12 at Children's Musuem |
12 Months and Younger:
Choking
Step 1: Assess the situation quickly.If a baby is suddenly unable to cry or cough, something is probably blocking her airway, and you'll need to help her get it out. She may make odd noises or no sound at all while opening her mouth. Her skin may turn bright red or blue.
If she's coughing or gagging, it means her airway is only partially blocked. If that's the case, let her continue to cough. Coughing is the most effective way to dislodge a blockage.
If the baby isn't able to cough up the object, ask someone to call 911 or the local emergency number while you begin back blows and chest thrusts (see step 2, below).
If you're alone with the baby, give two minutes of care, then call 911.
On the other hand, if you suspect that the baby's airway is closed because her throat has swollen shut, call 911 immediately. She may be having an allergic reaction – to food or to an insect bite, for example – or she may have an illness, such as croup.
Also call 911 right away if the baby is at high risk for heart problems.
Step 2: Try to dislodge the object with back blows and chest thrusts.
First do back blows
If a baby is conscious but can't cough, cry, or breathe and you believe something is trapped in his airway, carefully position him faceup on one forearm, cradling the back of his head with that hand.
Place the other hand and forearm on his front. He is now sandwiched between your forearms.
Use your thumb and fingers to hold his jaw and turn him over so that he's facedown along the other forearm. Lower your arm onto your thigh so that the baby's head is lower than his chest.
Using the heel of your hand, deliver five firm and distinct back blows between the baby's shoulder blades to try to dislodge the object. Maintain support of his head and neck by firmly holding his jaw between your thumb and forefinger.
Next, place your free hand (the one that had been delivering the back blows) on the back of the baby's head with your arm along his spine. Carefully turn him over while keeping your other hand and forearm on his front.
Then do chest thrusts
Use your thumb and fingers to hold his jaw while sandwiching him between your forearms to support his head and neck. Lower your arm that is supporting his back onto your opposite thigh, still keeping the baby's head lower than the rest of his body.
Place the pads of two or three fingers in the center of the baby's chest, just below an imaginary line running between his nipples. To do a chest thrust, push straight down on the chest about 1 1/2 inches. Then allow the chest to come back to its normal position.Do five chest thrusts. Keep your fingers in contact with the baby's breastbone. The chest thrusts should be smooth, not jerky.
Repeat back blows and chest thrusts
Continue alternating five back blows and five chest thrusts until the object is forced out or the baby starts to cough forcefully, cry, or breathe on his own. If he's coughing, let him try to cough up the object.
If the baby becomes unconscious
If a baby who is choking on something becomes unconscious, you'll need to do what's called modified CPR. Here's how to do modified CPR on a baby:
Open his mouth and look for an object. If you can see an object, remove it with your little finger.
Give him two rescue breaths. If the air doesn't go in (you don't see his chest rise), tilt his head and try two rescue breaths again.
If his chest still doesn't rise, do 30 chest compressions.
Look in his mouth and remove the object if you see it. Give him two more rescue breaths.
Repeat the chest compressions and so on, until help arrives.
How to perform CPR
Step 1: Check the baby's condition.
Is the baby conscious? Flick her foot or gently tap on her shoulder and call out. If she doesn't respond, have someone call 911 or the local emergency number. (If you're alone with the baby, give two minutes of care as described below, then call 911 yourself.)
Swiftly but gently place the baby on her back on a firm, flat surface.
Make sure she isn't bleeding severely. If she is, take measures to stop the bleeding by applying pressure to the area. Don't administer CPR until the bleeding is under control.
Step 2: Open the baby's airway.
Tilt the baby's head back with one hand and lift his chin slightly with the other. (You don't have to tilt a baby's head back very far to open the airway.)
Check for signs of breathing for no more than ten seconds.
To check for breathing in a baby, put your head down next to his mouth, looking toward his feet. Look to see whether his chest is rising, and listen for breathing sounds. If he's breathing, you should be able to feel his breath on your cheek.
Step 3: Give two gentle "rescue" breaths.
If the baby isn't breathing, give her two little breaths, each lasting just one second. Cover the baby's nose and mouth with your mouth and gently exhale into her lungs only until you see her chest rise, pausing between rescue breaths to let the air flow back out.
Remember that a baby's lungs are much smaller than yours, so it takes much less than a full breath to fill them. Breathing too hard or too fast can force air into the baby's stomach.
If her chest doesn't rise, her airway is blocked. Give her first aid for choking, described above.
Step 4: Do 30 chest compressions.
With the baby still lying on his back, place the pads of two or three fingers in the center of his chest, just below an imaginary line running between his nipples.With the pads of your fingers on that spot, compress the chest about 1 1/2 inches. Push straight down. Compressions should be smooth, not jerky.
Do 30 chest compressions at the rate of 100 per minute. When you complete 30 compressions, give two rescue breaths (step 3, above). (Each cycle of chest compressions and rescue breaths should take about 24 seconds.)
Step 5: Repeat compressions and breaths.
Repeat the sequence of 30 compressions and two breaths. If you're alone with the baby, call 911 or the local emergency number after two minutes of care.Continue the sequence of compressions and breaths until help arrives, you find an obvious sign of life, an AED (automated external defibrillator) is ready to use, the scene becomes unsafe, or you are too exhausted to continue.
Even if the baby seems fine by the time help arrives, a doctor will need to check her to make sure that her airway is completely clear and she hasn't sustained any internal injuries.
1-12 Years old
Choking
Step 1: Assess the situation quickly.If a child is suddenly unable to cry, cough, or speak, something is probably blocking her airway, and you'll need to help her get it out. She may make odd noises or no sound at all while opening her mouth. Her skin may turn bright red or blue.
If she's coughing or gagging, it means her airway is only partially blocked. If that's the case, encourage her to cough. Coughing is the most effective way to dislodge a blockage.
If the child isn't able to cough up the object, ask someone to call 911 or the local emergency number as you begin back blows and chest thrusts (see step 2, below).
If you're alone with the child, give two minutes of care, then call 911.
On the other hand, if you suspect that the child's airway is closed because her throat has swollen shut, call 911 immediately. She may be having an allergic reaction – to food or to an insect bite, for example – or she may have an illness, such as croup.
Also call 911 right away if the child is at high risk for heart problems.
Step 2: Try to dislodge the object with back blows and abdominal thrusts.
First do back blows
If a child is conscious but can't cough, talk, or breathe, or is beginning to turn blue, stand or kneel slightly behind him. Provide support by placing one arm diagonally across his chest and lean him forward.
Firmly strike the child between the shoulder blades with the heel of your other hand. Each back blow should be a separate and distinct attempt to dislodge the obstruction.
Give five of these back blows.
Then do abdominal thrusts
Stand or kneel behind the child and wrap your arms around his waist.
Locate his belly button with one or two fingers. Make a fist with the other hand and place the thumb side against the middle of the child's abdomen, just above the navel and well below the lower tip of his breastbone.
Grab your fist with your other hand and give five quick, upward thrusts into the abdomen. Each abdominal thrust should be a separate and distinct attempt to dislodge the obstruction.
Repeat back blows and abdominal thrusts
Continue alternating five back blows and five abdominal thrusts until the object is forced out or the child starts to cough forcefully. If he's coughing, encourage him to cough up the object.
If the child becomes unconscious
If a child who is choking on something becomes unconscious, you'll need to do what's called modified CPR. Here's how to do modified CPR on a child:
Place the child on his back on a firm, flat surface. Kneel beside his upper chest. Place the heel of one hand on his sternum (breastbone), at the center of his chest. Place your other hand directly on top of the first hand. Try to keep your fingers off the chest by interlacing them or holding them upward.
Perform 30 compressions by pushing the child's sternum down about 2 inches. Allow the chest to return to its normal position before starting the next compression.
Open the child's mouth and look for an object. If you see something, remove it with your fingers.Next, give him two rescue breaths. If the breaths don't go in (you don't see his chest rise), repeat the cycle of giving 30 compressions, checking for the object, and trying to give two rescue breaths until the object is removed, the child starts to breathe on his own, or help arrives.
How to Give CPR
CPR isn't hard to do. Follow these steps:
Step 1: Check the child's condition.
Is the child conscious? Tap on the child's shoulder and call out. If she doesn't respond, have someone call 911 or the local emergency number. (If you're alone with the child, give two minutes of care as described below, then call 911 yourself.)
Swiftly but gently place the child on her back on a firm, flat surface.
Make sure she isn't bleeding severely. If she is, take measures to stop the bleeding by applying pressure to the area. Don't administer CPR until the bleeding is under control.
Step 2: Open the child's airway.
Tilt the child's head back with one hand and lift his chin slightly with the other. This will open his airway.
Check for signs of breathing for no more than ten seconds.
To check his breathing, put your head down next to his mouth, looking toward his feet. Look to see whether his chest is rising, and listen for breathing sounds. If he's breathing, you should be able to feel his breath on your cheek.
Step 3: Give two "rescue" breaths.
If the child isn't breathing, give her two breaths, each lasting just one second. Pinch the child's nose shut, place your mouth over hers, and exhale into her lungs until you see her chest rise.If her chest doesn't rise, her airway is blocked. Give her first aid for choking, described above.
If the breaths go in, give the child two rescue breaths in a row, pausing between breaths to let the air flow back out.
Step 4: Do 30 chest compressions.
Kneel beside the child's upper chest. Place the heel of one of your hands on the child's sternum (breastbone) at the center of her chest. Place your other hand directly on top of the first hand. Try to keep your fingers off her chest by interlacing them or holding them upward.
To do a chest compression, push the child's sternum down about 2 inches. Allow the chest to return to its normal position before starting the next compression.Do 30 chest compressions at the rate of 100 per minute. Then give the child two rescue breaths (step 3, above). (Each cycle of chest compressions and recue breaths should take about 24 seconds.)
Step 5: Repeat compressions and breaths.
Repeat the sequence of 30 chest compressions and two breaths. If you're alone with the child, call 911 or the local emergency number after two minutes of care.
Continue the sequence of chest compressions and rescue breaths until help arrives, you find an obvious sign of life, an AED (automated external defibrillator) is ready to use, the scene becomes unsafe, or you are too exhausted to continue.
Even if the child seems fine by the time help arrives, a doctor will need to check her to make sure that her airway is completely clear and she hasn't sustained any internal injuries.
Also, put this number in your cell phone for poison control:
American Association of Poison Control Centers at (800) 222-1222
What should I do if my toddler swallows something that could be poisonous?
First, get the rest of whatever your toddler has swallowed away from him. Then try to make him spit out anything left in his mouth. Keep a sample — unless you have the container — in case it's needed to identify the poison. Call 911 immediately if you notice any of the following symptoms:- Difficulty breathing
- Severe throat pain
- Burns on the lips or mouth
- Convulsions
- Unconsciousness
- Extreme sleepiness
What if my toddler doesn't seem to be seriously ill?
If your child doesn't have any of the serious symptoms listed above, call your local poison control center. If you don't have the number handy, call the American Association of Poison Control Centers at (800) 222-1222 to be automatically redirected to your local poison control center.Experts at the poison center will need to know your toddler's approximate weight, any medical conditions he may have, any medications he's taking, and as much information about the substance he swallowed as you can give. If possible, have the container with you when you make the call. The poison center may need to know the ingredients listed on the label. If your child has swallowed something like part of a plant, describe it as completely as you can.
If your child has swallowed prescription or over-the-counter medication, have the container handy so you can provide all the necessary information. If you can, estimate the maximum number of pills your toddler could have swallowed by subtracting any pills you can account for from the original number in the bottle.
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