How to Do the Heimlich Maneuver: Step-by-Step Guide for Adults, Children, and Infants

Choking is a life-threatening emergency that requires immediate action. Knowing how to perform the Heimlich maneuver can mean the difference between life and death when someone’s airway becomes blocked. This abdominal thrust technique is the most effective method for dislodging objects stuck in the throat and restoring normal breathing.

Every year, thousands of people experience choking incidents, with food being the most common culprit in adults and small objects posing the greatest risk to young children. This comprehensive guide will teach you exactly how to perform the Heimlich maneuver on adults, children, infants, and even yourself during a choking emergency.

Understanding Choking and When to Use the Heimlich Maneuver

Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of oxygen to the lungs and brain. Without immediate intervention, choking can lead to unconsciousness, brain damage, or death within minutes.

The Heimlich maneuver, also known as abdominal thrusts, works by creating a sudden upward pressure on the diaphragm. This forces air from the lungs upward through the windpipe, effectively pushing the obstruction out of the airway.

When to Perform the Heimlich Maneuver

You should perform the Heimlich maneuver when someone shows signs of severe airway obstruction and cannot:

• Speak or make normal sounds
• Cough forcefully or effectively
• Breathe adequately
• Cry or laugh (in infants and children)

If the person can cough forcefully, encourage them to keep coughing as this may naturally dislodge the object. Only intervene with the Heimlich maneuver when coughing becomes weak or ineffective.

Recognizing the Signs of Choking

Quick recognition of choking is crucial for timely intervention. Watch for these universal signs:

• The universal choking sign: one or both hands clutching the throat
• Facial expressions showing panic, shock, or confusion
• Inability to speak, whisper, or make vocal sounds
• Weak, ineffective coughing or no cough at all
• High-pitched squeaking or wheezing sounds when trying to breathe
• Strained, labored, or noisy breathing
• Skin, lips, and nail beds turning blue or gray (cyanosis)
• Progressive difficulty breathing that worsens rapidly
• Loss of consciousness if the obstruction is not removed

How to Perform the Heimlich Maneuver on Adults and Children Over One Year

The technique for adults and children over one year of age is similar, with adjustments made for the child’s smaller size. Here’s the step-by-step process:

Step 1: Assess the Situation

First, ask the person “Are you choking?” If they cannot speak but nod yes, or if they show other signs of severe airway obstruction, immediately begin the Heimlich maneuver. If another person is present, have them call 911 while you provide first aid.

Step 2: Position Yourself Correctly

• Stand directly behind the choking person
• For a child, kneel down to their level
• Place one foot slightly in front of the other for stability and balance
• Wrap your arms around the person’s waist
• Position the person so they are slightly bent forward at the waist

Step 3: Deliver Five Back Blows (Recommended by American Red Cross)

Before performing abdominal thrusts, the American Red Cross recommends starting with back blows:

• Place one arm across the person’s chest for support
• Bend the person forward at the waist so their upper body is parallel to the ground
• Using the heel of your other hand, deliver five firm blows between the shoulder blades
• Each blow should be separate and distinct, delivered with sufficient force to dislodge the object
• Check if the object has been expelled after each blow

Step 4: Perform Five Abdominal Thrusts

If back blows do not dislodge the object, proceed with abdominal thrusts:

• Stand behind the person and wrap your arms around their waist
• Make a fist with one hand and place it slightly above the person’s navel, well below the breastbone
• Grasp your fist with your other hand
• Press your fist into the abdomen with a quick, inward and upward thrust
• The motion should be firm and deliberate, as if you’re trying to lift the person upward
• Perform five distinct thrusts
• For children, use gentler pressure to avoid damaging internal organs, but maintain enough force to be effective

Step 5: Continue Alternating

Continue alternating between five back blows and five abdominal thrusts until:

• The object is expelled from the airway
• The person begins to cough forcefully, speak, or breathe
• The person becomes unconscious (if this happens, lower them to the ground and begin CPR)

Note: Some organizations teach only the abdominal thrust method without back blows. Both approaches are acceptable and effective for adults and children over one year of age.

How to Perform the Heimlich Maneuver on Infants Under One Year

Infants require a modified technique because their bodies are too small and fragile for traditional abdominal thrusts. Instead, use a combination of back blows and chest thrusts:

Step 1: Position the Infant for Back Blows

• Sit down and hold the infant face-down along your forearm
• Support the infant’s head and jaw with your hand
• Rest your forearm on your thigh for stability
• Position the infant’s head lower than their chest (this allows gravity to assist)
• Ensure the infant’s airway is supported and not compressed

Step 2: Deliver Five Back Blows

• Using the heel of your free hand, give five firm back blows between the infant’s shoulder blades
• The blows should be gentle yet firm—enough to dislodge the object without causing injury
• Keep your fingers pointed upward to avoid hitting the infant’s head
• Check the infant’s mouth after each blow to see if the object is visible

Step 3: Perform Five Chest Thrusts

If back blows don’t work, turn the infant over and perform chest thrusts:

• Carefully turn the infant face-up while supporting the head and neck
• Place the infant on your forearm, resting your arm on your thigh
• Keep the infant’s head lower than their chest
• Place two fingers in the center of the infant’s chest, just below the nipple line
• Push straight down about 1.5 inches (4 centimeters)
• Perform five chest thrusts, allowing the chest to rise completely between each compression
• The motion is similar to CPR chest compressions but at a slower rate

Step 4: Continue and Call for Help

• Continue alternating five back blows and five chest thrusts until the object is dislodged or the infant starts breathing
• Call 911 or have someone else call if the obstruction doesn’t clear quickly
• If the infant becomes unconscious, begin infant CPR immediately
• Never perform abdominal thrusts on an infant under one year old

Important: Never put your finger in an infant’s mouth to remove an object unless you can clearly see it. Blind finger sweeps can push the object deeper into the airway.

How to Perform the Heimlich Maneuver on Yourself

If you’re alone and choking, you can perform the Heimlich maneuver on yourself. Time is critical, so act quickly:

Method 1: Using Your Hands

• Make a fist with one hand and place it slightly above your navel
• Grasp your fist with your other hand
• Bend over a hard, stable surface such as a countertop, table, or chair back
• Thrust your fist inward and upward with a quick motion
• Repeat several times until the object is dislodged

Method 2: Using a Chair or Counter

• Position yourself over the back of a chair, edge of a table, or countertop
• Place the edge just above your navel and below your ribcage
• Thrust yourself against the edge with quick, upward movements
• Continue until the object is expelled

Critical: Even if you successfully dislodge the object yourself, call 911 or seek medical attention immediately. Internal injuries can occur from choking or from the Heimlich maneuver itself.

Special Situations and Modifications

Pregnant Women and Obese Individuals

When you cannot effectively wrap your arms around someone’s abdomen, use chest thrusts instead:

• Stand behind the person
• Wrap your arms around their chest, under their armpits
• Place your fist on the center of the breastbone (sternum)
• Position your fist well away from the bottom tip of the breastbone and the edges of the ribs
• Grasp your fist with your other hand
• Perform quick, backward thrusts
• Continue until the obstruction is removed

Unconscious Choking Victim

If a choking person becomes unconscious:

• Lower the person to the ground carefully, positioning them on their back
• Call 911 immediately if not already done
• Open the mouth and look for the object—if you can see it and easily remove it, do so carefully
• Begin CPR with chest compressions, even if you’re not trained in CPR
• Before giving rescue breaths, look in the mouth for the dislodged object
• If the object is visible and within reach, remove it before continuing
• Continue CPR until emergency responders arrive or the person begins breathing

The chest compressions used in CPR can help dislodge the object by creating similar pressure as abdominal thrusts.

When to Call for Emergency Medical Help

Call 911 or your local emergency number in these situations:

• If you’re alone and choking (call first if possible, then perform self-Heimlich)
• If the Heimlich maneuver doesn’t quickly dislodge the object
• If the person becomes unconscious
• After successfully removing an obstruction, if the person has difficulty breathing, persistent coughing, or feels like something is still stuck
• If the person was unconscious at any point during the choking episode
• If there are any concerns about injury from the choking or the Heimlich maneuver

Optimal approach: If two people are present, one should perform the Heimlich maneuver while the other calls 911 immediately. If you’re alone with a choking victim, provide first aid first, then call for help.

After Care and Medical Evaluation

Even after successfully performing the Heimlich maneuver and clearing the airway, medical evaluation is important:

Why Medical Evaluation is Necessary

• The Heimlich maneuver can cause internal injuries, including rib fractures, internal organ damage, or internal bleeding
• Part of the object may remain in the airway or lungs
• The choking episode may have caused complications such as aspiration pneumonia
• Oxygen deprivation may have affected the brain or other organs

Symptoms Requiring Immediate Medical Attention

Seek immediate medical care if the person experiences:

• Persistent cough or difficulty breathing
• Feeling that something is still stuck in the throat
• Abdominal pain or tenderness
• Chest pain
• Difficulty swallowing
• Coughing up blood
• Confusion or altered mental state

Common Mistakes to Avoid

When performing the Heimlich maneuver, avoid these common errors:

• Don’t perform abdominal thrusts on someone who can cough forcefully – let them continue coughing naturally
• Don’t place your fist on the ribcage or breastbone – this can cause fractures and won’t be as effective
• Don’t use abdominal thrusts on infants under one year – use back blows and chest thrusts instead
• Don’t perform blind finger sweeps – only remove visible objects you can easily grasp
• Don’t give up too quickly – continue efforts until the object is dislodged, help arrives, or the person becomes unconscious
• Don’t forget to call for emergency help – professional medical care is crucial even if you clear the obstruction
• Don’t use excessive force on children – adjust your pressure appropriately for their size

Prevention: Reducing Choking Risks

While knowing how to perform the Heimlich maneuver is crucial, prevention is always better than emergency intervention:

For Adults

• Cut food into small, manageable pieces
• Chew food thoroughly before swallowing
• Avoid talking or laughing with food in your mouth
• Limit alcohol consumption during meals, as it can impair swallowing
• Eat slowly and mindfully
• Be cautious with high-risk foods like large pieces of meat, hard candies, and nuts

For Children

• Keep small objects, coins, and small toys away from young children
• Supervise children during meals
• Cut food into pieces no larger than one-half inch for young children
• Avoid high-risk foods for young children: whole grapes, hot dogs (unless cut lengthwise and into small pieces), hard candies, popcorn, raw carrots, and nuts
• Teach children to sit while eating and not run or play with food in their mouth
• Ensure toys are age-appropriate and don’t contain small parts for children under three

For Infants

• Never give infants hard foods, whole grapes, or anything that could block their small airway
• Keep small objects out of reach
• Inspect toys regularly for loose parts
• Follow age-appropriate feeding guidelines

Getting Proper Training

While this guide provides comprehensive information on how to perform the Heimlich maneuver, hands-on training is invaluable:

• Take a certified first-aid and CPR course from organizations like the American Red Cross or American Heart Association
• Practice on training mannequins to develop muscle memory
• Refresh your training every two years or as recommended
• Ensure babysitters, caregivers, and family members are also trained
• Many courses also cover infant and child-specific techniques

Formal training gives you the confidence and skill to act quickly and effectively during a real emergency.

Conclusion

The Heimlich maneuver is a simple yet powerful technique that can save lives during choking emergencies. By understanding the proper methods for adults, children, and infants, as well as how to perform it on yourself, you’re equipped to respond effectively when seconds count.

Remember the key steps: recognize the signs of choking, call for help, deliver five back blows followed by five abdominal thrusts (or chest thrusts for infants and special cases), and continue until the obstruction is cleared. Always seek medical evaluation after a choking incident, even if the object was successfully removed.

Consider taking a certified first-aid course to practice these techniques hands-on and stay prepared for emergencies. Your knowledge and quick action could make all the difference in saving a life.

Sources:

• Mayo Clinic – Choking First Aid
• American Red Cross – Choking Guidelines
• American Heart Association – Choking Relief
• MedlinePlus – Heimlich Maneuver
• National Safety Council – Choking Prevention