infants 2. Give the child one minute to cough up the object If unsuccessful . . . 3. Stand behind the child. 4. Reach around the child, lock your hands together, and place them just below his breastbone. 5. Use a quick upward motion while pulling his abdomen in. 6. Repeat if necessary. 7. If breathing stops, begin mouthtomouth resuscitation once the airway is clear. PRECAUTIONS • Do not abandon your efforts to help a choking child until medical help arrives. The obstructing object may be only partially blocking the airway, even though you may not think so. • Do not give mouthtomouth resuscitation until the object has been removed. • Do not try to reach into the throat to remove the object unless all other, safer methods have failed. • Prevent choking. Examine all toys for loose eyes, beads, and small parts. Keep tablets under lock and key. Do not give peanuts, popcorn, or hard candies to toddlers, and keep such foods out of their reach. • A baby who has been vomiting should be placed on his stomach to lessen the chance of choking on the vomit Choking is one of the few true emergencies of childhood-minutes may determine life or death. Choking is caused when the airway becomes obstructed, resulting in inability to breathe. A swallowed object is the most common cause of choking. Choking is easily identified by two key signs: the child frantically tries to breathe, and the child is not able to cry out or to speak. If choking continues, the child quickly becomes blue, convulsive, limp, and unconscious. If an object completely blocks the air passage, you have only a few minutes to reestablish an airway before brain damage or death can occur. Objects that present a particular danger of choking if a child puts them in his or her mouth are peanuts, tablets, glass eyes of toy animals, hard or hardcoated candies, beads, popcorn, and tiny toys or small parts from toys. Solid particles of food from the stomach may choke a child who breathes in while vomiting. A baby who has been vomiting is safest from choking when lying on his or her stomach. Choking may also occur in a child who has croup. However, it is easy to tell choking from croup from other choking by one important distinction-a child choking on a foreign object cannot speak or cry out, while a child with croup can do both. Choking caused by croup is treated differently from other choking (see the article on Croup for treatment of that form of choking). SIGNS AND SYMPTOMS Choking on an object is easily identified by two major signs: frantic, unsuccessful efforts to breathe and inability to talk or cry out. HOME CARE Seconds count! Scream for help. A second adult on the scene should phone the police or paramedic squad for help. (Police are usually more quickly available in most communities than an ambulance, the fire department, or a doctor.) Give the child one minute to cough up the object. If the child's efforts are unsuccessful, perform the following maneuvers. foot and mouth