If a baby under 1 year old is choking and can't cry, lay the baby face down and give 5 back blows, turn the baby over and give 5 chest pushes, alternating, and don't press the belly

In a real emergency, call 911 first, then read this.

Cost

Free. Watching the moves once, or taking an infant first-aid class, takes a few minutes to half a day. The hard part is, in a panic, first turning the baby over and getting the baby face down.

What you get

The American Heart Association and the American Academy of Pediatrics published their 2025 pediatric basic life support guidelines. The guidelines say that choking (for example an object blocking the airway) "is one of the leading causes of death in infants and children." What infants most often inhale is liquid. A child who is still coughing and can still make sound has a mild case: let the child cough on their own, and watch for whether it gets worse. A child whose cough is very weak or absent, who can't cry, or whose face has turned purple has a severe case. In a severe case, call for emergency help first, then "repeat 5 back blows followed by 5 chest thrusts until the object comes out or the infant becomes unresponsive." The guidelines do not recommend abdominal thrusts for infants, because they may injure the organs in the belly. For chest thrusts, the heel of one hand is now recommended, because it presses deeper than the earlier two-finger method. If the infant becomes unresponsive, start CPR, beginning with compressions and without feeling for a pulse. An object that can be seen should be removed before giving breaths. The guidelines state plainly "do not blindly sweep with a finger." The 2025 international first aid guidelines of the International Federation of Red Cross and Red Crescent Societies say the same thing. First give up to 5 firm blows between the shoulder blades, and if that doesn't work, turn the baby over and give up to 5 chest pushes, and if that still doesn't work, call for emergency help at once. For the chest, it uses the method of encircling with both hands and pressing with two thumbs. The Fujian Red Cross emergency first-aid training center says that for infants under 1 year, do "5 back blows + 5 chest thrusts." For back blows, lay the infant face down on your forearm with the head lower than the body

Notes

Graded B because the main support for this method is case reports, with no figures on how many deaths following it prevents. The benefit is rated "large" by judgment: a fully blocked airway will stop a child's heart within a few minutes. The beneficiary is almost always your own child. For children aged 1 and over and for adults, press the belly instead; see §13.26 (choking: back blows plus abdominal thrusts). What method to use for chest pushes is written differently by different sources. The American guidelines and the newer Chinese Red Cross edition use the heel of one hand, the international Red Cross uses two thumbs, and old tutorials use two fingers. Because two fingers don't press deep enough, the 2025 American guidelines no longer recommend it. In an emergency, any of these is better than not pressing. Even after the object comes out, take the child to be seen at a hospital, since fragments may be left in the lungs. Keep small things such as coins and small toys out of the child's reach. For what to do after the child stops responding, see §13.44 (CPR for infants).

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. Joyner BL 等 (2025). Part 6: Pediatric Basic Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 152(suppl 2):S424–S447. https://doi.org/10.1161/CIR.0000000000001370，全文见 https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/pediatric-basic-life-support
2. International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025，第 238–240 页. https://www.ifrc.org/sites/default/files/2026-03/IFRC%20International%20First%20Aid,%20Resuscitation%20and%20Education%20Guidelines%202025.pdf
3. 福州市卫生健康委员会 (2026). 海姆立克急救法更新了. https://www.fuzhou.gov.cn/zgfzzt/swjw/fzwj/jkkp/202601/t20260108_5268351.htm

Translated from the Chinese original. Original book, section 13, tip 43. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer