Medically reviewed by Carissa Stephens, R.N., CCRN, CPN — Written by Zawn Villines on September 24, 2017
The Heimlich maneuver uses abdominal thrusts to force objects out of the throat. Underneath the lungs is a muscle called the diaphragm. This muscle contracts to move the lungs, helping them exhale air.
In 1972, a doctor from Cincinnati read a story about choking. At the time, choking was the sixth leading cause of accidental death. These statistics inspired the doctor to devise a simple way to prevent these deaths from happening. The procedure became known as the Heimlich maneuver.
The Heimlich maneuver works by creating an artificial cough. By pushing on the diaphragm, the maneuver forces air out of the lungs and up through the throat, forcing a trapped object out.
There are four ways to perform the Heimlich maneuver, depending on the age and needs of the choking person. The underlying action with each approach is the same: using the muscles of the diaphragm to force the object out of the throat.
Conscious adult or child
If the adult or child over the age of 1 is conscious but cannot speak, cough, or breathe, perform the Heimlich maneuver immediately, following these steps:
- Stand behind the person who is choking, arms wrapped around their waist.
- Make one hand into a fist. Position the thumb side of the fist against the person’s stomach, below their ribs and above the belly button. It is possible to feel the diaphragm muscle.
- Put the other hand over the fist and push into this muscle with a rapid, forceful, upward thrust.
- Continue abdominal thrusts until the object comes out.
Unconscious adult or child
If the child or adult is unconscious or cannot sit or stand, perform these steps:
- Position the choking person flat on their back.
- Sit on the person’s thighs, facing toward them
- Place one hand on top of the other, and then position the heel of the hand over their diaphragm, just below their rib cage and above their belly button.
- Lean onto the hands, pushing up and in.
- Continue repeating thrusts until the object is coughed out.
Performing Heimlich on yourself
If you choke while alone, or when there is no one to help, do the following:
- Make a fist, and with thumbs pointing inward, position the fist against the diaphragm – under the rib cage and above the navel.
- Push in and up until the object is expelled.
- If unable to do this or it does not work lean over a solid object, such as a counter or chair. Position the edge at the diaphragm to push in and up. Move slightly forward and backward to produce thrusts.
- Repeat until the object is dislodged.
Infants under 1 year
In infants under 1 year of age, follow these steps:
- Position the baby face down on the forearm, ensuring the baby’s head is lower than their chest.
- With the forearm resting on the thigh, support the baby’s head with the hand.
- Make sure the baby’s mouth and nose are not covered.
- Use the heel of the other hand to smack the baby’s back in between the shoulder blades four times. Repeat until the object comes out.
- If this fails, turn the baby over. Position two fingers in the center of the baby’s chest, between the nipples. Forcefully push down four times to a depth of about 1 inch. Repeat until the object comes out.
Share on PinterestHenry Heimlich.
Image credit: Author unknown, 2014
Henry Heimlich, a thoracic surgeon, read about the epidemic of choking deaths in restaurants.
He discovered that the American Red Cross recommended slapping choking victims on the back. But there was not much evidence to support this strategy.
He began testing various strategies on an anesthetised dog. Heimlich believed that blows to the back did not work because they forced the object further down the airway. He also found that chest presses were of no use either because the ribs prevented the lungs from expelling enough air.
Heimlich discovered that by pressing on the diaphragm in an upward direction, the lungs could push enough air out to expel the object. This simple procedure became the Heimlich maneuver and within a few years, organizations such as the Red Cross began recommending it as the best strategy for saving the lives of people who were choking.
Is the Heimlich maneuver better than other strategies?
Although the Heimlich maneuver has replaced back blows and thrusts to the chests in most situations, some emergency responders still use these strategies when Heimlich fails. It remains unclear whether Heimlich is the better choice, or just the more popular, and perhaps easier, one.
A 1976 study that compared Heimlich-style abdominal thrusts to chest thrusts, for example, found that chest thrusts were more effective. The sample size was very small, however, comprising just six men. With a larger sample size, researchers might have got different results, so the study should not be viewed as conclusive proof that chest thrusts are better.
Share on PinterestThe Heimlich maneuver should not be performed on someone who is not choking.
It is not possible carry out the Heimlich maneuver on someone who is not choking.
However, because the technique involves pushing on the diaphragm, it is possible for a person to familiarize themselves with the procedure by locating their diaphragm and feeling for a thick band of muscle just underneath the rib cage.
Pushing forcefully on this muscle should produce a jarring sensation that pushes air out of the lungs.
This can bolster confidence in the event of an actual choking episode.
If a person can cough, talk, gag, or breathe, they are not choking. Wait for them to cough the item out. Only begin the Heimlich maneuver if the person is unable to dislodge the object and cannot breathe.
The Heimlich maneuver does not save drowning victims, and will not save people from other emergencies, such as cardiac arrest or a seizure.
Sometimes the Heimlich maneuver fails, either because the item is too deeply lodged in the throat or because a person does not do the maneuver correctly. For this reason, always call 911 immediately when someone is choking.
If two people are available, one should call 911 while the other performs the Heimlich maneuver. This maximizes the chance of survival even when Heimlich does not work.
Last medically reviewed on September 24, 2017
- Ear, Nose, and Throat
- Emergency Medicine
- First Aid
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- Brody, J. E. (2015, September 14). What comes after the Heimlich maneuver
//well.blogs.nytimes.com/2015/09/14/what-comes-after-the-heimlich-maneuver/ - Emergencies and first aid – Heimlich maneuver on an infant. (n.d.)
//www.health.harvard.edu/staying-healthy/emergencies-and-first-aid-heimlich-maneuver-on-an-infant - Guildner, C. W., Williams, D., & Subitch, T. (1976, September). Airway obstructed by foreign material: The Heimlich maneuver [Abstract]. Journal of the American College of Emergency Physicians, 5(9), 675-677
//www.ncbi.nlm.nih.gov/pubmed/1018395 - Heimlich, H. (2015, April 15). How Henry Heimlich, and one dog, helped save thousands. New York Post
//nypost.com/2014/02/08/how-henry-heimlich-and-one-dog-helped-save-thousands/ - Heimlich, H. (n.d.). Historical essay: The Heimlich maneuver
//www.abea.net/historical-essay-the-heimlich-maneuver/ - Heimlich maneuver on an infant. (n.d.)
//www.health.harvard.edu/staying-healthy/emergencies-and-first-aid-heimlich-maneuver-on-an-infant - How to perform the Heimlich maneuver. (n.d.)
//henryheimlich.com/how-to-perform-the-heimlich-maneuver/
Key facts
- Choking is a medical emergency. Knowing what to do when someone is choking could save their life.
- A person chokes when the flow of air to their lungs gets blocked, causing breathing difficulties.
- Children and adults with a disability are at greater risk of choking.
- Keep small objects out of the reach of babies and children to help prevent choking accidents.
Choking is what happens when something gets stuck in a person's throat or windpipe, partially or totally blocking the flow of air to their lungs.
In adults, choking usually occurs when a piece of food enters the windpipe instead of the food pipe. Babies and young children can choke on anything smaller than a D-size battery.
Sometimes the windpipe is only partially blocked. If the person can still breathe, they will probably be able to push out the object by coughing forcefully. Be careful not to do anything that will push the blockage further into the windpipe, like banging on the person's back while they are upright.
If the object cuts off the airway completely and the person cannot breathe, it's now a medical emergency. The brain can only survive for a few minutes without oxygen.
What are the symptoms of choking?
Someone may be choking if they:
- clutch their throat (universal sign of choking)
- cough, wheeze or gag
- have difficulty breathing, speaking or swallowing
- make a whistling or ‘crowing' noise
- can't make any sound at all
- have no air coming out of their nose and mouth
- have blue lips, face, earlobes or fingernails
- are very agitated
- lose consciousness
What should I do in an emergency?
Choking — adults and children (over 1 year)
If the person becomes blue, limp or unconscious, call triple zero (000) and ask for an ambulance.
- Try to keep the person calm. Ask them to cough to try to remove the object.
- If coughing doesn’t work, call triple zero (000) for an ambulance.
- Bend the person forward and give them up to 5 sharp blows on the back between the shoulder blades with the heel of one hand.
After each blow, check if the blockage has been cleared. - If the blockage still hasn’t cleared after 5 blows, place one hand in the middle of the person’s back for support. Place the heel of the other hand on the lower half of the breastbone (in the central part of the chest). Press hard into the chest with a quick upward thrust, as if you’re trying to lift the person up.
After each thrust, check if the blockage has been cleared. - If the blockage has not cleared after 5 thrusts, continue alternating 5 back blows with 5 chest thrusts until medical help arrives.
- If the patient becomes blue, limp or unconscious, start CPR immediately.
Choking — Babies under 12 months
If a baby is choking, call triple zero (000) immediately and ask for an ambulance. Stay on the phone.
- Lay the baby face down on your forearm with their head lower than their body, supporting their head and shoulders on your hand.
- Hold their mouth open with your fingers. Make sure you keep supporting their head.
- Give up to 5 sharp blows to the back between the shoulders with the heel of one hand.
After each blow, check if the blockage has been cleared. - Use your little finger to remove the object from their mouth if it has cleared from their airway.
- If the blockage has not cleared after 5 back blows, place the infant on their back on a firm surface. Place 2 fingers on the lower half of the breastbone and give up to 5 chest thrusts — like CPR compressions, but slower and sharper.
After each thrust, check if the blockage has been cleared. - If the blockage has not cleared after 5 thrusts, continue alternating 5 back blows with 5 chest thrusts until medical help arrives.
- If the child becomes unconscious, start CPR immediately.
Choking: What not to do
- Don’t ask them if they’re ok. Instead ask them if they are choking, as they may be suffering from something else (such as asthma).
- Don’t attempt to perform the Heimlich manoeuvre (big thrust to the abdominal area) as it can break ribs and damage internal organs.
- Don’t put your fingers in their mouth – they may bite you accidentally and it could further lodge the object in the trachea.
- Don’t pick up a child who is choking and turn them upside down.
If you are choking yourself
If you are alone and you are choking, call triple zero (000) and ask for an ambulance. Try to get someone to help you if at all possible, and keep calm. Try to clear the obstruction with a forceful cough.
You can do chest thrusts on yourself to try to dislodge the object:
- Place a fist on the lower half of your breastbone (in the central part of the chest).
- Grasp your fist with the other hand and bend over a hard surface, like a countertop or chair.
- Press hard into the chest with a quick upward thrust, as if you’re trying to lift a person up.
After each thrust, check if the blockage has been cleared.
Recovery from choking
After someone has been treated for choking, they may still need medical help if:
- they have a cough that doesn’t go away
- they feel like something is stuck in their throat
Can choking be prevented?
It's important to keep all small objects out of the reach of babies and children, including hard pieces of food like lollies and raw apple, household items like coins and batteries, small parts of toys and pebbles.
To reduce the risk of choking while eating, make sure your child sits to eat rather than lying down or running around. Cut up food into small pieces and encourage them to chew well. Avoid giving your child choking hazards, such as whole nuts, until they are 5.
Check the floor regularly for small objects, and make sure toys aren't broken or damaged. Avoid buying toys with button batteries.
Children and adults with a disability, including cerebral palsy, epilepsy or dementia, are at greater risk of choking. Your doctor can give you extra advice about how to help them avoid choking.
Resources and support
For more information and support, try these resources: