whooping If the child is an infant: Lay the baby face down on your forearm, with your hand supporting his head. The baby's head should be lower than his chest. Using the heel of your hand, give four quick blows to the baby's back between the shoulder blades. Then place your free hand on the back of the baby's head and. holding him between your forearms, turn him face up, with his head still lower than his body. Put two fingertips on the baby's chest between the nipples. Press quickly and fairly hard four times. (You are trying to squeeze the upper abdomen and lower chest, which will force up the diaphragm so that air is pushed out of the lungs. The rush of air out of the lungs may pop the object out of the airway.) Repeat the cycle of four blows and four presses for as long as the baby is still choking. Don't give up. If the child is a toddler or an older child: Stand behind the child. Reach around the child, lock your hands together, and place them just below his breastbone. Use a quick upward motion while pulling his stomach in. (You are trying to squeeze the upper abdomen and lower chest, which will force up the diaphragm so that air is pushed out of the lungs. The rush of air out of the lungs may pop the object out of the airway.) Repeat if necessary. Only if these efforts are unsuccessful should you attempt to get the object out with your fingers or tweezers (there is a danger of pushing the object farther into the airway). If breathing stops, begin resuscitation once the airway is clear. Continue until trained help arrives. PRECAUTIONS • When an object completely blocks the air passage, the child seldom reaches a doctor in time. However, the object may be only partially blocking the airway, even though you may not think so. Do not abandon your efforts to help a choking child until medical help arrives. • Never give mouthtomouth resuscitation until the obstructing object has been removed. To do so may force the object farther down the throat. • A baby who has been vomiting should be placed on his stomach to lessen the chance of choking on the vomit. • Prevention of choking is most important. Examine all toys for loose eyes or other small parts. Keep tablets under lock and key. Do not give peanuts, popcorn, or hard candies to toddlers, and be sure to clean up after adult parties before children can wander unattended into a room and find such hazardous treats. MEDICAL TREATMENT The doctor may need to perform a tracheotomy (make an opening through the neck into the windpipe) on the spot. Then oxygen, artificial respiration, and intravenous fluids will be administered. RELATED TOPICS: Convulsions with fever; Convulsions without fever; Croup; Swallowed objects Quick Reference Circumcision INDICATIONS FOR PERFORMING CIRCUMCISION • No opening in the foreskin • Opening too small to allow urine through • Pulledback foreskin cannot be drawn forward HOME CARE • Cover a circumcision with gauze coated with petroleum jelly and a nonstick bandage until it has healed. cough