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Paediatric choking and airway emergencies
What is paediatric choking?
Paediatric choking happens when food, toys or other objects block the airway and stop air moving into the lungs; complete obstruction is immediately life-threatening, whereas partial obstruction may still allow some air movement. The priority is to recognise the difference quickly and use age-appropriate techniques to clear the airway without causing further harm.
Choking in children most often happens during eating or play with small pieces of food or loose objects, and because their airways are narrower and reserves smaller, mild obstruction can deteriorate to complete blockage very quickly. Recognising the signs early and using age-appropriate sequences of back blows and thrusts is essential to prevent collapse and cardiac arrest while you wait for advanced help.
Analysis of Office for National Statistics data shows that a small number of UK children die from choking each year, with most deaths in 1-4 year-olds, highlighting why close supervision at mealtimes and rapid first aid are strongly promoted in official advice.
Who needs this skill?
Health & Social Care
In health and social care, especially paediatrics, learning disability services and residential settings, staff must be familiar with paediatric choking risks (such as texture-modified diets and aspiration risk) and be able to distinguish mild from severe obstruction. Training should cover the practical choking sequence, documentation and escalation, including when to suspect underlying swallowing or neurological problems.Licensed venues & nightlife
Licensed venues that host family events, children's parties or daytime sessions still carry paediatric choking risk, especially where food, sweets or small toys are provided. Door and bar staff do not need to be paediatric specialists, but core first aiders should know how to apply the child and infant choking sequence until ambulance crews arrive.Schools
Schools and early years settings are directly exposed to choking risk every day at lunch, snack and play times; EYFS and education guidance expect enough paediatric first aiders on site, clear supervision arrangements during meals and prompt, competent care if a child chokes.Workplaces
In workplaces serving food to children - nurseries, cafés, leisure centres, family attractions and holiday parks - managers should consider choking risk in their first aid needs assessment and menu design. Staff should know the choking routine, how to summon help and what to do after a choking episode, including recording the incident and advising parents.How to manage paediatric choking
- 1Spot the signs of chokingWatch for sudden coughing, difficulty breathing, noisy or silent attempts to breathe, clutching at the throat or a panicked look while eating or after handling small objects. Check quickly whether air is still moving - can the child cough effectively, speak or cry, or are they unable to make any sound?Distinguishing between mild and severe obstruction is critical: effective coughing can be encouraged and observed, while an inability to cough, speak or breathe normally demands immediate intervention.
- 2Treat mild chokingIf the child is coughing forcefully and able to speak or cry, encourage them to cough and stay with them, keeping them upright. Do not hit their back or put your fingers in their mouth; continue to watch for any change, and be ready to act if the cough becomes weak or they stop making noise.With mild obstruction, the body often clears the object itself; your role is to reassure, monitor and be ready to escalate if the situation deteriorates.
- 3Treat severe choking in a childIf a child cannot cough effectively, speak or breathe, stand or kneel behind them, supporting their chest and leaning them forwards. Give up to 5 sharp back blows between the shoulder blades with the heel of your hand, checking after each blow to see if the obstruction has cleared; if not, stand behind and give up to 5 abdominal thrusts, pulling inwards and upwards above the navel. Alternate back blows and abdominal thrusts until the airway clears or they become unresponsive.Using the correct sequence of back blows and abdominal thrusts for severe choking can dislodge the obstruction; someone should call 999 as soon as you recognise a severe obstruction.
- 4Treat severe choking in an infantFor an infant, support their head and neck and lay them face-down along your forearm, with the head lower than the body; give up to 5 firm back blows between the shoulder blades. If the airway remains blocked, turn the infant onto their back, still head-down, and give up to 5 chest thrusts on the lower half of the breastbone, compressing sharply. Alternate back blows and chest thrusts while someone calls 999, and be ready to start CPR if the infant becomes unresponsive.Infants are more fragile, so abdominal thrusts are not used; controlled back blows and chest thrusts in the correct position are safer and more effective.
- 5If the child becomes unresponsiveIf at any point the infant or child becomes unresponsive, lower them to a firm surface, call 999 if not already done and begin CPR, starting with chest compressions. When you open the airway to give breaths, quickly look for any visible obstruction in the mouth and remove it only if you can see it clearly; never perform blind finger sweeps.Once a choking child collapses, you follow the paediatric CPR sequence; the priority is to maintain circulation and ventilation while emergency services are on the way.
This guide is a learning reference only. It does not replace attended, assessed first aid training.
Qualifying courses
Qualsafe Level 3 Award in Paediatric First Aid (RQF)
2 days
3 years
Qualsafe Level 3 Award in Emergency First Aid at Work (RQF) & Qualsafe Level 3 Award in Emergency Paediatric First Aid (RQF) - Combined
1 day
3 years
Qualsafe Level 3 Award in First Aid at Work (RQF) & Qualsafe Level 3 Award in Paediatric First Aid (RQF) - Combined
3 days
3 years
Common questions
Practical answers for employers, venue managers, and healthcare teams about paediatric choking training.
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Mild choking means the casualty can speak, cough and breathe and may clear the obstruction themselves if you encourage effective coughing and stay with them. Severe choking means they cannot cough effectively, cannot speak or are silent and obviously struggling to breathe, which requires immediate back blows and abdominal or chest thrusts and early 999 activation.