What to Do When Someone Is Choking
Back blows, abdominal thrusts and when to start CPR, following Resuscitation Council UK guidance — plus an honest answer on anti-choking devices.
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Quick answer
If someone is choking, encourage them to cough first. If coughing becomes ineffective, give up to five back blows between the shoulder blades, then up to five abdominal thrusts (chest thrusts for infants under one), alternating until the obstruction clears. If they become unconscious, call 999 and start CPR without delay. On anti-choking suction devices such as LifeVac and Dechoker, Resuscitation Council UK makes no recommendation for or against them while awaiting an updated evidence review — established choking treatment comes first.
This page previously promoted an anti-choking device we no longer sell, and repeated the manufacturer’s claim that it was “100% effective”. We have replaced it with the actual Resuscitation Council UK guidance, because that claim was not one we could stand behind.
Choking is one of the few emergencies where a bystander who knows what to do makes the difference between a frightening few minutes and a death. It is also one of the easiest to get wrong under pressure, and one of the few where the wrong instinct — reaching into the mouth — actively makes things worse.
Mild or severe? The first judgement
Everything follows from this distinction, and getting it wrong in either direction causes harm: intervening on a mild obstruction can turn it into a severe one, and waiting on a severe one wastes the time you have.
| Mild obstruction | Severe obstruction | |
|---|---|---|
| Can they speak? | Yes — can answer “are you choking?” | No, or only a whisper |
| Cough | Loud, forceful, effective | Silent or ineffective |
| Breathing | Able to breathe between coughs | Struggling or unable |
| Appearance | Distressed but coping | Clutching throat, red then blue, panicking, may go quiet |
| What to do | Encourage coughing. Stay with them. Do nothing else | Back blows, then abdominal thrusts |
The counter-intuitive part: silence is the danger sign, not noise. A person coughing loudly is moving air. A person who has gone quiet may have stopped being able to.
What to do — adults and children over one
- Ask “are you choking?” and encourage them to cough if they can.
- If coughing becomes ineffective, give up to five back blows. Lean them forwards, support their chest with one hand, and strike firmly between the shoulder blades with the heel of your other hand. Check after each blow — you are not required to give all five.
- If back blows fail, give up to five abdominal thrusts. Stand behind them, put both arms round the upper abdomen, place a clenched fist between the navel and the bottom of the breastbone, grasp it with your other hand and pull sharply inwards and upwards. Check after each one.
- Keep alternating five back blows and five abdominal thrusts until the obstruction clears or they become unconscious.
- If they become unconscious, call 999 and start CPR immediately — chest compressions can dislodge an obstruction that thrusts could not.
Two things people get wrong in practice. Back blows have to be firm — most people’s first attempt on a training manikin is far too gentle to move anything. And you must actually lean them forward, so that anything dislodged comes out rather than travelling further down.
Age makes a real difference
| Infant (under 1) | Child (1 to puberty) | Adult | |
|---|---|---|---|
| Position | Face down along your forearm, head lower than chest | Leaning forward, supported | Leaning forward, supported |
| Back blows | Up to 5, heel of hand, between shoulder blades | Up to 5, between shoulder blades | Up to 5, between shoulder blades |
| Then | Chest thrusts — 2 fingers, lower half of breastbone | Abdominal thrusts | Abdominal thrusts |
| Abdominal thrusts? | Never | Yes, adjusted for size | Yes |
| If unconscious | 999 and CPR | 999 and CPR | 999 and CPR |
Never give abdominal thrusts to an infant — they can cause serious internal injury. Paediatric first aid training covers this properly, with a manikin. Reading it is not the same as having done it.
Special cases worth knowing
- Pregnancy, or someone very large. Where you cannot get your arms around the abdomen, or abdominal thrusts are inappropriate, chest thrusts are used instead — same principle, hands on the lower half of the breastbone.
- A wheelchair user. You can deliver back blows and thrusts from behind the chair. Do not waste time moving them first.
- Someone alone. Self-administered abdominal thrusts against a firm edge — the back of a chair, a worktop — are the recognised option. Call 999 first if you can; a phone on speaker keeps your hands free.
- After it clears. Some material can remain in the airway. Anyone who has had a severe choking episode, and everyone who has received abdominal thrusts, should be assessed by a doctor.
What about anti-choking devices?
Suction-based airway clearance devices — LifeVac, Dechoker and similar — are marketed to care homes, nurseries and restaurants, often with dramatic effectiveness claims. Here is the honest position.
Resuscitation Council UK makes “no recommendation for or against the use of suction-based airway clearance devices whilst awaiting the findings of an updated ILCOR systematic review”. RCUK “continues to emphasise that established choking treatments for adults and children should be prioritised, as these can be delivered immediately and form the basis of current resuscitation practice.”
| Claim you may hear | What the evidence position actually is |
|---|---|
| “100% effective” | Not a claim any UK resuscitation body supports. RCUK makes no recommendation either way pending an evidence review |
| “Better than back blows and thrusts” | RCUK says established treatments should be prioritised, because they can be delivered immediately |
| “Replaces the need for CPR” | No. If the person becomes unconscious, call 999 and start CPR |
| “Recommended for care settings” | Not recommended, and not condemned. It is a decision for the organisation, on top of trained staff |
So: not condemned, not endorsed, and definitely not a replacement for back blows, abdominal thrusts and CPR. If your organisation has bought one, it belongs after the standard sequence has been tried, used by someone trained in both.
One further warning worth knowing: in 2024 the MHRA issued an alert about counterfeit and unbranded copies of LifeVac devices sold through online marketplaces, which may fail or make a choking incident worse. If you are buying one, buy from the manufacturer’s own distribution channel.
Who is most at risk
Choking risk is concentrated at the two ends of life — young children, and older adults, particularly anyone with a swallowing difficulty (dysphagia), dementia, Parkinson’s or a condition affecting swallow or gag reflex. That is why care homes, nurseries and schools take this more seriously than most workplaces need to.
If that describes your setting, the useful investment is trained staff on every shift, not a device in a cupboard. Practical prevention measures matter too:
- Follow the texture-modified diet or thickened fluids prescribed for anyone with a known swallowing difficulty — and make sure agency staff know
- Supervise meals where risk has been identified, and do not rush people
- People should be sitting upright to eat, not reclined
- For young children, the usual high-risk foods — whole grapes, cherry tomatoes, whole nuts, hard sweets — should be cut lengthways or avoided
- Keep small objects, button batteries and small toy parts away from under-threes
Learn it properly
Choking is covered on every first aid course we run, including the one-day Emergency First Aid at Work. Practising on a manikin is what makes the difference: almost everyone hits too gently the first time, and finding that out in a training room is considerably better than finding it out in a dining room.
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Frequently asked questions
Encourage them to cough. An effective cough generates more pressure than anything a bystander can apply. Only move on to back blows when coughing becomes ineffective — when they cannot speak, cough properly or breathe.What is the first thing to do if someone is choking?
Up to five back blows, checking after each one, then up to five abdominal thrusts, again checking after each. Keep alternating the two until the obstruction clears or the person becomes unconscious.How many back blows and abdominal thrusts should I give?
Call 999 and start CPR without delay. Chest compressions generate pressure that can dislodge an obstruction, and the person now needs resuscitation regardless.What do I do if a choking person becomes unconscious?
No. A blind finger sweep can push the obstruction further down and cause injury. Only remove an object you can clearly see and easily grasp.Should I put my fingers in their mouth to remove the object?
Resuscitation Council UK makes no recommendation for or against them while an updated international evidence review is awaited, and emphasises that established choking treatments should be prioritised because they can be delivered immediately. They are not a substitute for back blows, abdominal thrusts and CPR.Are anti-choking devices like LifeVac recommended?
For an infant under one, give back blows followed by chest thrusts using two fingers on the lower half of the breastbone. Never give abdominal thrusts to an infant — they can cause serious internal injury.What is different about helping a choking baby?
Yes. Abdominal thrusts can cause internal injury even when they successfully clear the airway, so anyone who has received them should be assessed by a doctor.Does someone need to see a doctor after abdominal thrusts?
Call 999 if you can, and put the phone on speaker to keep your hands free. Self-administered abdominal thrusts against a firm edge — the back of a chair or a worktop — are the recognised option when nobody else is present.What if I am choking and alone?
Where abdominal thrusts are not appropriate or you cannot get your arms around the abdomen, use chest thrusts instead — hands on the lower half of the breastbone. Back blows are unchanged.How do you help someone choking who is pregnant?
Whole grapes, cherry tomatoes, whole nuts and hard sweets are the commonly cited ones. Cutting round foods lengthways rather than into discs removes much of the risk, and children should be seated and supervised while eating.Which foods are the biggest choking risk for young children?
Train your team
If your staff work with young children or older adults, this is the single most likely emergency they will face. Call 0845 838 4643 or use the enquiry form on this page and we will arrange training at your premises.
Choking is covered on every one of our first aid at work courses, and the current resuscitation guidance behind it is summarised in CPR and resuscitation guidelines.
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