Performing Heimlich maneuver on choking children

Donya Betancourt, Pediatrician, drdonya@hotmail.com

After discussing in this column two weeks ago how to help children less than a year old who are choking, we will now talk about what to do with choking children over the age of one.

Remember that if the child can cough freely, has normal skin color and can speak, he or she is not choking. If the cough is more like a gasp and the person is turning blue, he or she is probably choking. If in doubt, ask the choking person if he or she can talk. If the person can speak, then the airway is not completely blocked and oxygen is reaching the lungs.

If the child is conscious, start with the Heimlich maneuver. To perform the Heimlich maneuver:

1. Stand or kneel behind the child and wrap your arms around his or her waist. Bend the child forward slightly.

2. Make a fist with one hand and put the thumb of your fist just above the child's navel, staying well below his or her breastbone.

3. Cover your fist with the other hand and press hard into the abdomen with a quick, upward thrust. Be very gentle with younger or smaller child. Repeat this procedure until the object is expelled from the airway. This should get a child to breathe or cough.

4. If the child still isn't breathing after the Heimlich maneuver, open his or her mouth to check for foreign objects. If you see something, see if it can be moved with a hooking motion to sweep the object out. Do not poke your finger into the mouth if you cannot see anything or cannot hook the object. Repeat the Heimlich maneuver until the object is expelled or the child becomes unconscious.

5. If the child becomes unconscious, use the Heimlich maneuver with the child lying on his back. Kneel at his or her feet, put the heel of one hand above his or her navel, put the other hand over your fist with the fingers of both hands pointing toward his or her head. Press into his or her abdomen with quick upward thrusts. Repeat until the object is expelled.

6. If the child remains unconscious, or if you cannot removed the object, start to give artificial respiration and have someone call for help. With the child on his back, open his air passage by tilting his head back and lifting his chin with your fingers. Pinch his or her nose, cover his or her mouth completely with yours and breathe into it two times. Use just enough breath to make the chest rise. If you cannot make the chest move, reposition the airway and attempt to give him or her two more breaths.

7. If the air doesn't enter the child's lungs, repeat step 5 and

8. Continue to alternate mouth-to-mouth and the Heimlich maneuver until the child resumes breathing or until help arrives.

How to give artificial respiration (mouth-to-mouth) when the child or victim is not breathing: With an adult, breathe at your natural speed. With a child, use slightly quicker, shorter breaths. Never give artificial respiration to a person who is breathing.

1. First open the air passages by positioning the child's head. Do this by tilting the forehead back while lifting up on the chin with your fingers. Maintain this position every time you give a breathe.

2. With a child's small face, you can breathe into the nose and mouth together. With children older than a year old, breathe into the mouth while pinching the nose shut.

3. Breathe into the child's air passages using only minimal force. A small child's lungs cannot contain your entire exhalation. Remove your lips, allowing the child's chest to contract while you take in your next breath. Breathe into the child's air passages again.

The best way to learn how to give mouth-to-mouth is by taking a first aid course. -- This articles is part two of an article on choking that appeared two weeks ago. The column did not appear last week because of delivery problems.